Research Article
In Their Voices: Client and Staff Perceptions of the Physical and
Social Environments of Adult Day Services Centers in Taiwan
Chih-ling Liou
1
and Shannon Jarrott
2
1
Department of Human Development and Family Studies, Kent State University at Stark, North Canton, OH 44721, USA
2
College of Social Work, Ohio State University, Columbus, OH 43210, USA
Correspondence should be addressed to Chih-ling Liou; cliou@kent.edu
Received 14 April 2018; Accepted 19 July 2018; Published 29 July 2018
Academic Editor: Jacek Witkowski
Copyright © 2018 Chih-ling Liou and Shannon Jarrott. Tis is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Studies have examined the impact of environments on long-term care residents’ quality of life; however, environment gets little
attention in adult day services (ADS). Te current study gives voice to clients and staf by capturing their perceptions of the
physical and social environments of their ADS centers. Data were collected from 23 interviews with staf and clients and 270
hours of participant observations at two ADS centers in Taiwan. Te authors triangulated feld notes with interview transcriptions
and analyzed them with the Grounded Teory coding procedure method. Findings reveal clients’ and staf members’ perceptions
of appropriate and inappropriate physical and social environmental features afecting quality of life at the center and refecting
Taiwanese culture. We address how perceived appropriate features can be sustained or replicated and how perceived inappropriate
infuences can be remedied. Results can be translated into action research by implementing supportive environments for both staf
and clients at ADS centers.
1. Introduction
Adult day service (ADS) is a popular community-based
service designed to provide respite to family caregivers by
ofering long-term care (LTC) services during the day to
adults with physical and/or cognitive impairment who need
supervised care [1]. ADS programs have rapidly grown in the
United States as families and researchers fnd them benefcial,
cost-efective alternatives to nursing homes [1, 2]. ADS pro-
grams in Taiwan are largely informed by American models
and have also grown drastically because of the government’s
promotion and planning to develop more centers for the
rapid growth of people aged 65 and over: from 10.9% in 2010
to 41.6% by 2060 [3].
ADS researchers have focused primarily on caregiver
outcomes of ADS use [4]; attention should now turn to ADS
clients and staf who spend most of their day in the care
environment. Te environment in which L TC is provided
consists of a physical and a social environment. Te physical
environment encompasses the setting, d´ ecor, and private
spaces, while facility regulations, activities, culture, and inter-
personal interactions comprise the social environment [5].
Both the physical and social environments have been closely
associated with client well-being [6]. As a “partial institution”
where clients do not live together but receive care services
similar to those provided at LTC, researchers, practitioners,
and families should be concerned with the impact of the ADS
environment as well.
ADS clients are particularly susceptible to environmental
infuences given associated decline in physical and cognitive
functioning [7]. Te environment can be a therapeutic
resource to reduce need-driven behaviors and promote the
well-being of persons with dementia [8]. However, it can also
contribute to ill-being [5, 9]. Among the limited research
on the ADS environment, Lyman [10] discovered that ADS
staf responded to increased caregiving demands by exerting
increasing control over clients within a physical environment
characterized by architectural barriers (e.g., no wheelchair
accessibility) and space limitations (e.g., no separate activity
rooms). Salari and Rich [9] found that a classroom-like
Hindawi
Current Gerontology and Geriatrics Research
Volume 2018, Article ID 5130472, 9 pages
https://doi.org/10.1155/2018/5130472