Housing Arrangements in Later Life PS277- Lecture 17 – Chapter 5

Thoughts from a 94-Year-Old Moved to Nursing Home  “I’m just a bump on a log. I’m absolutely useless. I’m just sitting here a menace, just you might say, worthless. Just sitting here and I have to be cared for. I’m not able to contribute to anything. I hope I don’t live the rest of the year out because there’s no point in it. There would just be more worry and more trouble for my son and his wife. They never miss visiting. They’re just as faithful… they come every week no matter how busy they are…But things like that are a burden to other people. They have to look after me. Life don’t mean anything now. There’s nothing to look forward to. All you’ve got is your memories to look back on.” (Gubrium, 1993)

Older Canadian Adult Living Arrangements (Census, 2001)

Cross-Cultural and Historical Context of Living Arrangements  Older adults in developing countries live in multi- generational households more commonly, less than 10% live alone in Asia or South America  In past, elderly parents lived with children and grandchildren, but this has become uncommon in Canadian society – less parent control over adult kids, more mobility, longer life expectancies for parents, etc. - my grandmother  As older adults become less able to care for selves, living alone is a less possible option, however

My grandmother and her living arrangements

Housing Options on a Three- Dimensional Continuum  Independent – Dependent  Age –Integrated to Age-Segregated  High Quality to Low Quality  My grandmother’s housing transitions

Typology of Housing Options (McPherson, 2004)

Levels of Supportive Housing  Assistive caregiver in own home  Granny flats, adjacent housing with family  Congregate housing – retirement homes  Long-term care institutions/nursing homes

2003 Survey of Assisted Living Facilities in US  Survey of about 6500 facilities in four US states  4 different types of facilities were studied  Small Assisted Living (M = 9 beds)  Traditional AL (M = 46 beds)  New-Model AL (M = 65 beds)  Nursing Home (M = 116 beds)

US Data on Types of Housing (Zimmerman et al., 2003)

Differences in Living Arrangements – NH vs. Assisted Living Facilities (Zimmerman et al., 2003)  Does size matter?  Privacy  Resident controls  Services provided  No diffs in problem behaviors

How to Evaluate Quality?  Standard Quality measures: size, staff ratios, services  Psychosocial Quality:  Person-Environment Fit or Match – Kahana (needs vs. resources)  Types of Needs Addressed – Moos’s work: physical, organizational, supportive, social climate dimensions  Control and Competence: Langer’s work on this

Who Should Have Input about Quality of the Environment?  Residents  Staff  Resident’s Family  Policy Makers

Communication Enhancement with Older Adults (Ryan et al.) – A Positive Cycle