Home and Community Care Digest

Home and Community Care Digest February 2004 : 0-0

Assisted living: A hotel or a home?

Abstract

With assisted living becoming a prevalent form of community-based care, the study highlights the deterioration of well-being and health risks associated with adjustment to any form of institutionalized care. The importance of 'aging-in-place' is well documented, as is the need to integrate individuals into new institutional settings such that they consider their new surroundings to be 'home'. This study uses ecological theory and place integration theory to study the processes by which individuals 'make themselves at home', in assisted living environments.
Background: The study explores the roles of place attachment, non-family social involvement, place evaluation, and individual characteristics in the process of becoming at home in assisted living residences. Place attachment often focuses on homes and sacred places, with particular emphasis on the unique emotional experiences and bonds individuals have to places. With assisted living becoming a prevalent form of community-based care, the study highlights the deterioration of well-being and health risks associated with adjustment to any form of institutionalized care. The importance of 'aging-in-place' is well documented, as is the need to integrate individuals into new institutional settings such that they consider their new surroundings to be 'home'. This study uses ecological theory and place integration theory to study the processes by which individuals 'make themselves at home', in assisted living environments.

Methods: Qualitative investigations of two assisted living residences in New England revealed numerous issues for further exploration. On the basis of these investigations, a theoretical model of place integration was developed, as well as a questionnaire for a second phase of research. In this second phase, a sample of 35 residences in four states was drawn, representing between 400 and 500 residents in each state. The questionnaire was delivered by residence administrators and was completed by 297 assisted living residents. The results were used to analyze the sense of feeling at home. The outcome variable used in the study- whether the resident had become at home in his or her residence- was based on the question "Do you consider your assisted living residence home?"

Findings: The authors reported a relationship between the social and physical attributes of assisted living and resident satisfaction/quality of life. The study stresses that place attachment to town and community is a necessary, but insufficient condition, to facilitate older adults' processes of feeling at home. The greater the attachment to town or community, the less likely the individual is to become 'at home' in assisted living. A move to an assisted living residence in a town or community where one has important place attachments assists the transition and processes of becoming at home when social involvement and valuation of place are also at work. Attachment to one's town or community was found to be insignificant when considering an individual's ability to successfully age in place in an assisted living residence. The longer the length of stay in the community, the less likely the individual would feel at home in the residence. These individuals were also more likely to consider their assisted living residence as temporary accommodation, similar to a hotel.

Conclusions: The idea of aging in place promotes the notion of remaining in one's community even if a caregiving environment such as assisted living is necessary. Nonetheless, the study does not necessarily support this view. As individuals move from the community to assisted living, they need to reintegrate themselves with the new residence and setting. The theory of place integration suggests that the process of integration is ongoing and that aging in place should be viewed as an active, ongoing process to create new meanings as circumstances change.

Reference: Cutchin, Malcolm P, Owen, Steven V, and Chang, Pei-Fen J."Becoming "at Home" in Assisted Living Residences: Exploring Place Integration Processes". Journal of Gerontology: Social Sciences, 2003; 58B (4), S234-S243

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