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RESEARCH ARTICLE |
1 School of Allied Health Sciences
2 School of Nursing
3 Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston.
Address correspondence to Malcolm P. Cutchin, School of Allied Health Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77551-1142. E-mail: mpcutchi{at}utmb.edu
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Abstract |
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Methods. Purposive sampling and cross-sectional data by means of a questionnaire completed by current assisted living residents in four states (
) were used to estimate a structural equation model to explain becoming at home.
Results. Place attachment to town and community is a necessary but not sufficient explainer of older adults' process of becoming at home. Nonfamily social involvement plays a pivotal role through which place attachment works to explain becoming at home. Both place valuation and nonfamily social involvement exhibit direct positive effects on the outcome.
Discussion. Findings support a transactional interpretation of assisted living as home. The relationship between place attachment to one's community and full integration into assisted living is more complex than currently acknowledged.
The rapid growth in the number of assisted living residences during the past decade has created an intensification of research interest in these residential contexts for older persons. Because assisted living attempts to offer a middle ground between independent living arrangements and nursing homes, it includes aspects of both, namely the provision of housing and the availability of basic nursing care if and when it is needed. Adjustment to an assisted living residence can be a difficult process, one that may entail risks to health and well-being for the older adult that are not dissimilar to the health risks of adjustment to other types of facilities (Carp, 1974
; Hays, 2002). In particular, the perception that a new place—in this case an assisted living residence—is one's home can be considered a good marker of a successful transition. This article is primarily concerned with the processes that create a type of place integration for older persons who transition into assisted living residences in such a way that they consider that environment their home. It provides an exploratory empirical and theoretical analysis of the process of becoming at home in an increasingly popular type of congregate housing in the United States.
Assisted living residences have become a dominant form of community-based care for older persons in the United States (Chapin & Dobbs-Kepper, 2001; Fonda, Clipp, & Maddox, 2002). As of 2000, there were approximately 33,000 residences serving almost 800,000 residents in the United States, which constitutes a 30% increase since 1998 (Mollica, 2000). Although definition and implementation differs among states, assisted living residences generally combine housing (private apartments) with social and nursing staff care for elders who do not need higher levels of care such as that provided in a nursing home.
The development of assisted living is a trend that is changing long-term care and holds potential for improving the quality of life for frail elders (Kane, 2001). Emerging research on assisted living residences shows that they are associated with improved health and well-being (Fonda et al., 2002; Frytak, Kane, Finch, Kane, & Maude-Griffin, 2001), although one study found no difference in health outcomes between assisted living residents and nursing home residents (Pruchno & Rose, 2000). Other research has identified various social and environmental components of assisted living residences associated with improvement in resident satisfaction and self-reported quality of life (Ball et al., 2000; Mitchell & Kemp, 2000; Sikorska, 1999). Moreover, Maddox (2001, p. 427) has suggested that assisted living contexts are important and "distinctive site[s] for research and theory building in gerontology."
Ecological theories of aging (e.g., Lawton, 1982) provide the fundamental basis for the idea that assisted living creates an environment to enhance the well-being of frail older persons. The concept of place, although not traditionally a central construct in ecological perspectives on aging, adds an important dimension to gerontological theory of person–environment relationships. The literature on place that pertains to social gerontology and residential experience in particular is broad and owes its development largely to geographers, environmental psychologists, sociologists, anthropologists, and architects. Although place theory varies in philosophical orientation, conceptual pillars of place include the following: sense of place (e.g., Tuan, 1975), place identity (e.g., Cuba & Hummon, 1991; Proshansky, Fabian, & Kaminoff, 1983), place attachment (e.g., Altman & Low, 1992), and place integration (Cutchin, 2001). These place concepts are close cousins, exhibiting overlap to a certain extent in their use and meaning in the literature. The impact of their use is to describe and explain dimensions of the complex human relationship with meaningful environments. Moreover, perspectives based on place concepts are somewhat congruent with ecological perspectives on aging, yet they align better with constructivist views that emphasize sociality, meanings, and context (Gubrium & Holstein, 1999). In the context of this article, assisted living residences are viewed as unique and complex types of places with which older adults transact to create important life meaning.
Place is at once both a powerful and ambiguous concept, however. Place may refer to areas of different scale and meaning (e.g., region, town, neighborhood, or home) for older inhabitants. It becomes important in any assessment of person–place relationships to recognize the nested nature of place and how relationships at one scale of place may affect the relationship to others. Furthermore, place as a general concept and its corollaries extend beyond the concept of "environment" because they imply intrinsic or developed meanings of human experience. Assisted living residences may be considered unique places that are both nested within larger places (e.g., towns) and contain more intimate places (e.g., rooms) within them. In addition, an assisted living resident can become a meaningful place for a resident who becomes at home there. Developing "at homeness" in a particular setting, "the usually unnoticed, taken-for-granted situation of being comfortable in and familiar with the everyday world" (Seamon, 1979, p. 70), is a fundamental part of the successful transition to an assisted living residence. A couple of studies have examined the characteristics of being at home in a congregate housing community (Young, 1998) and life care and long-term care facilities (Hammer, 1999). These two studies suggest some universal aspects of the experience of at homeness in senior housing, such as autonomy, self-identity, close social relationships, mutual respect, comfort, involvement, and security. The process through which older persons reach at homeness in assisted living has yet to be sufficiently investigated, however.
Through the life course, transitions into and out of places create challenges. From the ecological perspective on aging, those challenges become more difficult as the environmental competence of an individual wanes. Adaptation to the demands of an environment, therefore, becomes primarily a function of one's physical and cognitive status. More constructivist-oriented perspectives suggest that the transition to such congregate housing situations are chiefly influenced by social environments and social interactions (Hochschild, 1973; Kontos, 1998) and the transference of personal belongings and continuity of identity, home, and their meaning for the older person (Rowles & Ravdal, 2002). The theoretical perspective underpinning our approach to the question of becoming at home is based on the concept of place integration, an idea that merges John Dewey's philosophy of human experience (see, e.g., Campbell, 1995; Dewey, 1989) with a geographical understanding of place. A Deweyan perspective focuses on the continuity of persons and situations (physical and social) and the meaning created by activity to reintegrate the person and situation when that continuity is disrupted by change; or as in the case of a new resident of assisted living, the meaning generated by activity to integrate a new person–situation combination. Dewey's central tenets of continuity, contingency, situation, and action present a worldview that focuses on holistic relations being constantly remade by activity (transactions) to address ongoing change.
Place integration is a concept that takes the Deweyan worldview and grounds it in the empirical circumstances of places with which people live and die, enjoy and suffer; the concept denotes the ongoing process whereby people act to directly or indirectly address some qualitative problem in their relationship with place and thereby reintegrate person and place and make new meanings (Cutchin, 2001). This perspective on human experience and action shares some attributes with the ecological perspective on aging, but it is more accurately a type of transactional view that attempts to encompass contextual wholes and emphasizes change in relations among aspects of the whole (Altman & Rogoff, 1987). Therefore, our starting point is more aligned with the broader theme of constructivist approaches than with ecological ones. A primary goal of taking this perspective on the question of assisted living residences is to explore the process of how older adults become integrated into such environments so that they consider that place their home. To evaluate how that process might be understood, we created and assessed an initial model of that process.
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METHODS |
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). As a way to explore the residential experience further, a sample was developed that could be surveyed more systematically. A purposive sample was derived to provide variation by geographic region, urban and rural sites, residence size (capacity), and residence funding status (for profit or not for profit). Through consultation with the Assisted Living Federation of America, four states were selected: Minnesota, New Jersey, Oregon, and Texas. State assisted living associations were contacted for assistance in obtaining lists of possible residences to include in the sample. From the lists provided, a mix of sites was chosen to attain the sampling purposes. The administrators of those residences were contacted to ask if they would be able and willing to participate in a survey of their residents by overseeing distribution of introductory letters, questionnaires, and follow-up reminders to their residents. Thirty-five residences representing between 400 and 500 residents in each state were included in the sample at this stage. The potential sampled population totaled 1,731 persons based on full occupancy and complete cooperation by selected residences.
Because specific names and addresses for residents were not available, all correspondence with potential participants was conducted through the administrator of each residence. Letters of introduction and explanation of the project were sent to each site for distribution to residents. The questionnaires for residents were mailed to each site approximately 1 week after the letters of introduction, and each included a cover letter and a postage-paid envelope to return the questionnaire directly to the research team. Cards thanking participants and reminding those who had not returned their questionnaire were sent approximately 1 week after the questionnaire was mailed. During the data collection process, 10 residences explicitly or implicitly (no returned questionnaires) dropped out of the research process. The reduced potential sample included 25 residences and 1,337 residents. Three hundred three questionnaires were returned. A response rate is difficult to discern from these data, however, because we do not know the exact population census at time of distribution, how well materials were distributed to residents, and how many potential participants were physically or cognitively able to complete the instrument.
Questionnaire
The project scope, theoretical orientation, and qualitative data and analysis led to the development of a questionnaire to be used with the sample. The instrument was designed to capture aspects of several broad dimensions of the place integration process in an assisted living residence so their interrelationships could be explored. Those included place (town or community and assisted living residence) attributes, dimensions of the move and transition into the residence, activities pursued in place, and personal attributes. Seventy-six items and five open-ended questions comprised the questionnaire. Of specific relevance here, 7 items were intended to measure place attachment, 13 others were derived to measure aspects of social involvement inside and outside the residence, and 17 items covered various dimensions of resident perceptions of quality of life and satisfaction. The outcome variable used here—whether the resident has become at home in his or her residence—was based on the question "Do you consider your assisted living residence home?" Residents were allowed to have someone help them complete the questionnaire, and this was recorded as the last item.
Preliminary Analyses
The distributions of included variables were examined through BMDP 7.0 (Dixon, 1992) and SPSS 11.01 (SPSS, 2001) to assess assumptions of multivariate analysis. A number of ordinal and continuous variables were found to be nonnormal and were transformed. After transformations, data were searched for possible multivariate outliers with BMDP-AM. One case showed a significant (
) Mahalanobis D2 from the group centroid and was deleted from further analysis. An examination of the case showed that this woman reported extremely high satisfaction with her residence and considerable involvement in activities inside and outside the residence, but she reported no attachment to the residence and did not perceive it as "home." Another five cases were excluded from the analysis because they represented individuals who were younger than the age of 50. The total number of cases available for the main analyses was thus 297 of the original 303.
Measurement model
For the survey data to be simplified, it was assumed that item groupings could be combined to form composite scores. If the new composites showed satisfactory measurement properties, they would be used in the final structural model explaining perceptions of assisted living residence as home. As a way to validate the unidimensionality of conceptually related survey items, groups of items were subjected to principal factor analyses (using BMDP; Dixon, 1992), with two criteria: each factor should account for at least 70% of the common variance, and each indicator of the factor should have a minimum loading criterion of.40. Five scale scores were thus created, and their properties are shown in Table 1. During this process, four items were deleted because of substandard loadings.
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advice on confirmatory factor analysis (CFA) to estimate the measurement model for each construct separately, before using the constructs in a structural model. With the use of Amos 4.01 (Arbuckle, 1999), the five measurement models were individually submitted to CFA. In each case, the model fit indices were acceptable. Table 1 summarizes two fit statistics from these CFAs. The Comparative Fit Index (Bentler, 1990) is an estimate of how much better the proposed covariance structure is than a null model with no covariances. Values 
.95 are considered to be evidence of good fit (Hu & Bentler, 1999). The residual mean square error of approximation (RMSEA; Steiger & Lind, 1980) is an assessment of how different the data covariance structure may be from the population structure. RMSEA values 
.08 show acceptable fit (MacCallum, Browne, & Sugawara, 1996). As can be seen in Table 1, all five dimensions showed acceptable fit and were thus ready for use in the structural model of assisted living residence as home.
Structural model
A full explanatory model (see Figure 1) was initially developed from an understanding of the process of becoming at home in assisted living residences, which in turn had been created both theoretically from a place integration perspective and empirically through qualitative fieldwork. Several latent variables were central to that model: Place Attachment, Nonfamily Social Involvement, and Place Valuation. Place Attachment refers here to the strength and types of affective bonds between person and place (town or community). Nonfamily Social Involvement denotes the engagement in a range of social transactions with people (nonfamily members) either in the residence or in the community beyond the walls of the residence. Place Valuation is used to refer to a collection of perceptions regarding place qualities and satisfaction with place. We theorized that after the three precursor variables, Place Attachment should hold a primary role in the process. Assuming that many residents of such residences are attempting to age in place, it seemed reasonable to suggest that those persons had some level of place attachment that came before the move into assisted living and that the place attachment had some relationship to that new environment and the activities within it. In addition, we theorized that activities of Nonfamily Social Involvement would, along with Place Attachment, shape the way elders come to perceive the quality of, and their satisfaction with, their new residence and the broader community within which it exists. We expected each to have some relationship to the criterion, assisted living residence as home, but we could not predict the relative magnitudes of those relationships. Notice that the full model gives considerable weight to indirect pathways. For example, in addition to the direct path from Place Attachment to assisted living residence as home, Place Attachment is proposed to have three additional mediated effects on assisted living residence as home. Finally, from a qualitative understanding of older adults' experiences in assisted living residences, we added years in place, education, and level of disability as precursor variables into the model because they appeared to have an effect on the process.
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). Approximately one third of assisted living residents across the United States are cognitively impaired (AARP, 2001; Hawes, Rose, & Phillips, 1999), and we purposely omitted that part of the population from our sample. Because our intent was to sample the cognitively unimpaired assisted living resident population, our results are not generalizable to all assisted living residents. The median size of institution (50 beds) also is close to the median size (48 beds) reported in a recent survey of U.S. assisted living residences (Hawes, Rose, & Phillips, 1999).
Model Estimation
The full model constructed to explain the outcome of residents considering their assisted living residence as their home showed acceptable fit, with CFI =.99 and RMSEA =.07 (.90 CI =.06–.09). Model modifications were then performed to develop a more parsimonious model. Standardized path coefficients less than.10 and with a critical ratio of less than 1.5 were removed. This eliminated seven paths from the full model, and the resulting structural model is shown in Figure 2. The trimmed model was reestimated and demonstrated similar statistical results: CFI =.99 and RMSEA =.07 (.90 CI =.06–.08). Approximately 30% of the variation in assisted living residence as home was explained by the trimmed model.
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Direct effects
Figure 2 displays the trimmed model's standardized path coefficients and indicator loadings. Although both are measures of the relationship between one variable and another, the path coefficients are the values along the paths that connect the three precursor variables and three latent variables to each other and to the outcome variable. The indicator loadings are the values that stand beside the arrows connecting latent variables and their indicator variables in the rectangles. Table 3 displays a matrix of standardized coefficients among variables in the model. Among the individual predictors, years in place was the most powerful. Path coefficients indicated a relatively strong relationship of years in place to both Place Attachment (standardized coefficient =.38) and Nonfamily Social Involvement (standardized coefficient = -.39), but the former relationship is positive and the latter negative. Neither of the individual predictors with a path to assisted living residence as home showed particularly strong relationships relative to others, although it is worth noting that direct effects of years in place (standardized coefficient =.14) and education (standardized coefficient = -.14) exist, albeit in opposition to each other. Place Attachment appears to be a relatively strong explainer of Nonfamily Social Involvement (standardized coefficient =.79), but a much weaker explainer of Place Valuation (standardized coefficient =.19). Place Attachment also has a moderate but inverse relationship to assisted living residence as home (standardized coefficient = -.29). Both Place Valuation and Nonfamily Social Involvement showed moderate effects on assisted living residence as home (standardized coefficients =.37 and.39, respectively).
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; Mitchell & Kemp, 2000; Sikorska, 1999). Confirmation is apparent in the relationship between Nonfamily Social Involvement and Place Valuation as well as the relationship among indicators of Place Valuation, namely assisted living residence environmental quality and assisted living residence quality of life satisfaction. The primary focus of this research was not satisfaction or quality of life, however. Our model uses a combination of variables different from those in other studies of assisted living. With a focus on the outcome of becoming at home in assisted living, our structural equation model included, in addition to individual predictors, latent variables that represent aspects of place attachment, nonfamily social involvement, and place valuation. This is a step beyond satisfaction studies in that we have modeled a process in which satisfaction acts as a mediator between other variables and one important outcome of the transition to a congregate setting—perception of assisted living residence as home. Our measure of Place Attachment is about the town–community scale, and therefore it offers a view about how the connection to place in a broader sense can relate to the development of new place attachments at a smaller scale, such as considering an assisted living residence one's home. The path coefficients in the model suggest that Place Attachment to town–community has a complex relationship to assisted living residence as home. The direct relationship to becoming at home in a residence is negative, signifying that the greater attachment to town or community, the less likely one is to become at home in assisted living. That relationship is countered, however, by the positive relationship between Place Attachment and Nonfamily Social Involvement, and between Place Attachment and Place Valuation. Working through those two mediators, Place Attachment exhibits a fairly strong positive relationship to assisted living residence as home. These results present a case in which the move to such a residence in a town or community where one has important place attachments assists the transition and process of becoming at home when social involvement and place valuation are also at work.
Although the effect coefficients of Place Attachment indicate that it is an important player in the process of becoming at home in assisted living, we believe that the latent variable's relationship to other variables, particularly Nonfamily Social Involvement, is of the utmost importance for understanding place attachment and affiliated processes. Place attachment is typically used to denote bonds to a place created through one's past experiences. The results we obtained suggest that, for our sample, place attachment to one's town or community is not enough to successfully age in place inside an assisted living residence. In other words, attachments for older persons based on experiences well in the past appear to require redirection through ongoing meaningful activity. Such activity, the type measured in Nonfamily Social Involvement, may be viewed as creating place value that in turn has a positive relationship to at homeness. Furthermore, assisted living activities and community activities have a direct and positive relationship to assisted living residence as home.
In perhaps the most complex theoretical treatment of place attachment, Rubinstein and Parmalee (1992) suggested a similar process, although their emphasis on social relationships is somewhat distinct from our activity-based concept of social involvement. We do not deny the role of relationships in such activity, but we emphasize that the activities and interactions themselves may provide the fundamental basis to relationships and meaning. Moreover, Rubinstein and Parmalee (1992) focused on individuals as meaning makers and creators of place attachment. We propose that individual meaning arises in the context of social transactions, and such transactions have to be ongoing for the establishment of at homeness in a new setting such as an assisted living residence. In essence, our modeling results imply that place attachment as a bundle of memories and relationships in one's town or community is insufficient to create a sense of home within an assisted living residence.
In addition to the relatively large association between Nonfamily Social Involvement and assisted living residence as home, Place Valuation is an important predictor of becoming at home in assisted living. Whereas our instrument measured perceptions of older persons, the perceptions that make up Place Valuation comprise various types of valuations of the person's relationship to place. Rather than indicating some internal measure or uncontextualized valuation of self-satisfaction, these indicators offer a glimpse into the value of the person–place relationship for that individual. Effect coefficients indicate that Place Attachment has a large association with Place Valuation, and much of that association is indirect, working through Nonfamily Social Involvement. The relationship of Nonfamily Social Involvement to Place Valuation is also strong, suggesting that involvement in activities inside the residence and to a lesser degree in the community work to shape one's perception of place. As measured, that perception is multifaceted because it includes valuations of town and assisted living residence. It should not be surprising that perceptions of increasing place value are associated with becoming at home in assisted living.
One intriguing finding that is not as easily explained is the role played by years in place. In particular, it appears that the longer an older adult has lived in the community in which the residence is located, the greater the place attachment but the lesser the involvement in social affairs of residence or community. This is a conundrum that in and of itself suggests no advantage for older adults relocating to assisted living in the place where they have lived the longest. One possible explanation for this result is that those with longer tenure in a town or community may be caught between competing worlds—that of the community outside the residence and that within the residence. Those older persons reside primarily in one world (the residence), but they feel more connected to the wider community at large. Metaphorically, those with relatively many years in place would tend to use their assisted living residence more like a hotel than a home. This may be a result of family contacts or other types of associations outside the residence toward which a resident gravitates, but whatever the case, the resident's process of becoming at home in an assisted living residence is apparently not significantly facilitated by how long he or she has lived in the place where the residence is located. In our opinion, the evidence points toward a problem for some residents of integrating their experience of their residence as home with their experience of town or community surrounding the assisted living residence.
Although they remain in the model, the variables of level of disability and education have relatively small relationships with mediator variables and the outcome variable. As far as level of disability is concerned, its small negative association with other variables may be explained best by disability's dampening effect on nonfamily social activities, though that effect is probably lessened to certain extent by staff assistance in the residence. In terms of education, it seems that more educated persons tend to have a more difficult time becoming at home. Our sample was skewed toward less educated older adults and this may mean that by necessity the assisted living environments and activities are more oriented to the desires and interests of that population than those with more education. In contrast, the effect coefficient of education is relatively weak. We hypothesize that there is enough variation in the activities available to residents of assisted living to compensate for the variety of educational levels and interests. The implication is that residents can usually find a personally meaningful type of activity to enhance place attachment and place valuation, regardless of education.
The findings appear to support a transactional theorization of the relationship between older persons and their assisted living residence as their home. The relationships suggest how the assisted living residence as home exists in a broader geographical life-world (Sixsmith & Sixsmith, 1991) of town and community. This layering of geographical experience is put into action as place attachments at a broader scale (town and community) work in concert with social activities and positive perceptions of the residence and town to foster becoming at home. This more holistic, contextual transaction seems to help create a meaningful relationship to the new place (residence), so that it is considered home. From our interpretation of the analysis, the effort put into social involvement is a key to integrating the new combination of places for the older adult. We hasten to note, however, that a structural equation approach limits our ability to understand the recursive relationship between aspects of the transactional whole; for instance, the model does not allow us to say anything about how feeling at home affects nonfamily social involvement or place attachment.
The inferences we draw from the results are limited by purposeful boundary conditions for focusing the study. The sample was not randomly derived, and it was possibly biased by response patterns. For instance, our study sample is a more able subpopulation of assisted living residents. Moreover, such residential contexts are diverse and our 25 sites cannot represent the entire range of assisted living. We therefore hesitate to generalize our findings to the entire assisted living population across the United States.
Measurement of the variables and processes modeled could be improved. Several indicator variables are factor composites, and the set of indicators for each latent variable could have been more cohesive and comprehensive. Because these are new measures, no previous validity evidence was available. Still, the study's results do provide some validity information, in the sense that the proposed direct and indirect linkages among constructs are supported and are nontrivial. We also acknowledge that the connotation of considering a place one's "home" varies across respondents and that the question asking whether an assisted living resident now considers their residence home could be refined. Although this research was exploratory in nature, we propose that a resident's affirmation that their assisted living residence is home suggests an important, if inexact, level of at homeness. At homeness in this instance may be best signified by the development of a meaningful relationship with the assisted living residence. That the relationship exists at all seems more essential than the specific meaning of the relationship for each individual. Moreover, evidence within the data set points to validity of this outcome measure. First, the ability to explain almost a third of the variation in the outcome variable implies that the outcome variable is measuring a nonrandom effect. Second, the outcome measure's moderate covariation with the item "satisfaction with quality of life in your assisted living residence" (
) offers evidence of convergent validity. Third, assisted living residence as home's nonexistent relationship to the responses to "Do you have children" (
) and gender (
) provides some discriminant validity evidence. Thus, despite limitations of the data, these exploratory analyses provide some useful insights into a relatively neglected but important aging process.
Conclusions
Our exploratory study of assisted living was an attempt to enhance the understanding of the transition to, and experience of, those types of community-based care environments. The analysis of becoming at home suggests that, although it is important in the process, place attachment to the broader community is not sufficient to predict the desired outcome. To recast the findings in more theoretical terms, we conclude that they support a place integration perspective. As summarized at the outset, this view theorizes that meaningful activity in place is central to overcoming disruptions in the person–place relationship. In our data, it appears that involvement in activities of place is a significant predictor of at homeness. The idea of aging in place promotes remaining in one's community even if a caregiving environment such as an assisted living residence is needed. Nonetheless, our data do not necessarily support this view. It appears that if an older adult is moving to assisted living, he or she needs to reintegrate the self (expressed here in the concept of place attachment as a form of identity) with a new combination of places (the residence and the community). We add that although our data are cross-sectional, the theory of place integration suggests that those processes of integration will be ongoing—becoming at home does not mean the effort and activity to maintain that relationship with place are over. Indeed, aging in place should be viewed as an active, ongoing process to create new meanings as circumstances change (Rowles & Ravdal, 2002). How this process is affected by personal contexts of residents (e.g., marital status), residence differences (e.g., number of residents), and larger geographic contexts (e.g., urban vs. rural residences) should be explored in future research. A focus on cognitively impaired residents would also be worthwhile because that population is a significant minority in assisted living.
With the explosive growth of assisted living, there is compelling need for more research on this topic. Work on the concept of home continues and research on assisted living is expanding, yet little has been done to merge the two research areas. We conclude by recommending the development of research that forges such a synthesis. More specifically, we take the argument of Moore (2000) that we need more research that examines the instrumental processes of people and home and extend her idea to older persons who make the transition to places such as assisted living residences. Concerning future research on assisted living, we echo another suggestion by Moore (2000, p. 213) that researchers should "empirically engage with this multifaceted complex concept without losing sight of the many layers of home." Through structural equation modeling, we have attempted to incorporate some of the layered processes predicting at homeness in assisted living. However, there is much more complexity involved in how older adults make the difficult transition and become at home, and thus there is much more to understand.
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Acknowledgments |
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Footnotes |
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Received for publication September 13, 2002. Accepted for publication January 10, 2003.
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