Having a voice and being heard: nursing home residents and in-house advocacy.

As part of an ethnographic study exploring what it means for nursing home residents to "do well," we examined patterns of advocacy on which they relied to have an effective voice. The purposive sample included 17 older, long-stay residents from a for-profit chain nursing home and a large public skilled nursing facility. Data collection included in-depth interviews, participant observation, and document review. Depending on personal history, health status, and facility context, participants relied on family and friends, trusted staff, fellow residents, or themselves as advocates. Although residents varied in their abilities and willingness to express concerns, a program matching staff advocates with residents at the chain nursing home fostered participants' sense that they were heard and their needs addressed. Attending to patterns of advocacy and the effect of the nursing home environment on resident communication are essential for individualizing care and promoting systems to ensure residents have a voice and are heard.