Influence of individual and contextual characteristics on the provision of individualized care in long-term care facilities

Sienna Caspar, Heather A. Cooke, Norm O'rourke, Stuart W.S. MacDonald

Research output: Contribution to journalArticlepeer-review


Purpose: Previous research examining improved provision of individualized care (I-Care) in long-term care (LTC) facilities has primarily considered contextual influences. Using Kanter's theory of structural empowerment, this study explored the relationship among contextual-level characteristics, individuallevel characteristics, and access to empowerment structures on LTC staffs' perceived ability to provide I-Care. Methods: Multilevel models were used to examine 567 staffs' (registered nurse [RN], licensed practical nurses [LPN], care aides) reported ability to provide I-Care, nested within 41 LTC facilities. I-Care was first modeled as a function of withinperson (e.g., age, job classification, experience) and between-context (e.g., facility ownership status, culture change models) variables. Independent of these predictors, we then assessed the influence of staffs' access to empowerment structures (information, support, opportunities, resources, informal power, and formal power) on reported ability to provide I-Care. Results: The intraclass correlation coefficient indicated that 91.7% of the total variance in perceived ability to provide I-Care reflected within- versus between-person differences, with the 6 empowerment variables accounting for 31% of this within-person variance independent of the other context- And person-level covariates. In the final model, only informal power (i.e., quality of interprofessional relationships) and resources (i.e., adequate time and supplies) uniquely predicted I-Care. Notably, access to resources also attenuated the significant effect of support, suggesting a possible mediating effect. Implications: These findings suggest that both contextual- And individual-level factors exert considerably less influence on I-Care than factors associated to staffs' perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs' access to structural empowerment.

Original languageAmerican English
Pages (from-to)790-800
Number of pages11
JournalThe Gerontologist
Issue number5
StatePublished - 1 Oct 2013
Externally publishedYes


  • Nursing home
  • Organizational and institutional issues
  • Quality of care

All Science Journal Classification (ASJC) codes

  • Gerontology
  • Geriatrics and Gerontology


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