Inside Assisted Living: The Search for Home

9 Aging in Places

167` NINE Aging in Places Aging in place is frequently discussed as a key philosophical goal of assisted living. The concept broadly refers to enabling older adults to remain in their current or preferred environment, with necessary adaptations and supportive services, to the end of their lives (Bernard, Zimmerman, and Eckert 2001). The assisted living sector has adopted and adapted this concept, so, once an older adult moves into assisted living , the assumption is that he or she should be able to remain there with growing support to meet changing needs (Kane and Wilson 2001; Pastalan 1990). The broad support for aging in place is represented in a statement by Barry, the executive director at the Chesapeake: “This is, you know, your last move (as long as you don’t need skilled care), that you can pass away here with hospice just like you do at your house.” A slightly different view of “place” was voiced by another Chesapeake administrator, Clare, who said that the Chesapeake encourages aging in place by having people transition from independent living to the dementia care unit. Clearly, to some residents and family “place” refers to their room or apartment, while others’ views also encompass moves among multiple levels of care in the same location. There has been a broad debate among experts about whether aging in place is a reality for people living in assisted living or whether, in fact, it even should be a goal (Chapin and Dobbs-Kepper 2001). There is also the question of whether aging in place encompasses moving within the same assisted living or continuing care retirement community setting to a different level of care—such as to a floor or building that provides care for persons with dementia, as Clare suggested. This chapter examines 168 INSIDE ASSISTED LIVING stability and change in the lives of older adults as they reside in assisted living facilities. We focus first on what our informants told us about the decision to move to assisted living, including how a setting is selected. We continue by discussing issues and opportunities that arise as the older person moves into an assisted living setting and remains there for some span of time. In the final section of the chapter we focus on the eventual departure from the setting, either through death or through a move to some other housing/care arrangement. Rather than focusing on aging in place as a singular outcome, however , we examine the process of how aging occurs in places, ranging from the community (one’s own home or that of a relative or friend) to assisted living residences (or varied units within the assisted living setting) to hospital /rehabilitation centers and “back home” to assisted living or to nursing homes. We also discuss the continuities and changes during these periods of residence. Relocation was the initial focus of our research project, but as we began our observations in the six settings, we discovered that the concepts of stability, change, and transition are much more complicated and nuanced than simply moving or staying in a particular place. As a result, our discussion in this chapter addresses the many issues related to entering, staying in, and leaving assisted living, which extend far beyond the simple matters of decline and improvement in physical health and cognitive function. First, our research reinforced the wellestablished finding that most of the older adults living in assisted living would have preferred to remain in their own homes. Second, although the move into assisted living is often discussed as if it were a thoughtful consumer decision, our research showed that most decisions to seek housing in an assisted living facility and the selection of a setting are driven by crisis events, with limited time to consider options and with prior efforts at planning sometimes thwarted. Third, the key elements of selecting an assisted living facility focused on cost, fit, and location. A fourth transition -related finding is that many of the changes we found in the lives of older residents were managed without requiring a relocation to another setting or a higher level of care. Finally, our research also suggests that aging in place remains a complicated achievement for assisted living. For aging in place to be the right outcome, the fit between the resident’s needs and preferences and the assisted living setting’s ability to meet them must remain in balance through time, a difficult challenge in this dynamic envi- [18.118.30.253] Project MUSE (2024-04...