Moving to congregate housing: the last chosen home.

The recent growth of congregate housing reflects the increased needs of aging and disabled populations who benefit from sheltered care environments yet wish to retain independence and freedom of choice. With demographic forecasts and rising health care costs, it is in the interest of both policy makers and consumers to develop and utilize a wide range of housing options. Moving to congregate housing is an increasingly common transition in late life and is the focus of this study.

Relocation by older adults to nursing homes and to congregate housing settings has received considerable research attention. Pioneering work explored the characteristics of environments (Moos and Lemke 1980; Lemke and Moos 1980, 1981, 1987; Bergman and Cibulski 1981; Lieberman and Tobin 1983), characteristics of relocated individuals (Dooghe, Vanderleyden, and Van Loon 1980; Amenta, Weiner, and Amenta 1984; Smallegan 1985; Dimond, McCance, and King 1987), and of relocation outcomes (Aldrich and Mendkoff 1963; Lawton and Cohen 1974; Pablo 1977; Schulz and Brenner 1977; Borup 1981). Mental and physical health are promoted when people are well-matched by need to the environment (Carp 1974; Lawton 1976; Ryff and Essex 1992). Compared to tenants relocating to traditional housing, those moving into congregate facilities show greater increases in morale, housing satisfaction, and social network (Lawton and Cohen 1974; Lawton 1976).

Beyond environmental factors, personal characteristics play a role in successful adaptation to relocation. In a study of elderly relocated to congregate housing (Carp 1985), the trait of congeniality was related to positive adaptation. Rutman (1988) documented the diversity of coping strategies used by relocated individuals, with problem-focused coping strategies being associated with greater psychological well-being, morale, cognitive function, and physical health. A longitudinal study in a group of community-relocated elders elucidated changes in adaptation over time (Dimond, McCance, and King 1987), with the most negative changes in health and mood occurring around 6 months and overall positive adaptation occurring at 1 year.

While research on relocation in the elderly has focused primarily on characteristics of the move and individual responses to relocation, minimal attention focused on the process and meaning of moving. Moving as a stimulus for psychosocial development was described by Mercer, Nichols, and Doyle (1989) in their study of 80 women over the age of 60. Seventy-five percent of their participants reported that relocation at some time in their lives had been an important psychosocial transition that led to significant personal change. These authors identified a uniform process comprising 7 phases: predecision, decision to move, physical and mental preparation, packing and leave-taking, traveling, unpacking and relocating, and the settling-in phase. The complexity of life changes associated with moving were described by McCollum (1990) in a qualitative study of younger women who moved to a new community. She outlined the myriad losses associated with a move--of home, of social and physical identity, and of friends. Adjusting to a move involved creative efforts over a period of time to create a new home, make new friends and find a niche in the new community, reinforcing the developmental and psychological aspects of moving. These studies examined moves made earlier in life and provide support for studying moving as a process.

An appreciation of the process of moving to congregate housing promises to enhance understanding of adaptation to relocation among older adults. The purpose of this study was to describe the experience of moving to congregate housing, from the point of view of those who relocated. The planned expansion of an existing retirement complex was a natural opportunity to examine this transition among relocatees to a new wing of the community.

DESIGN AND METHODS

Grounded theory was used to capture the meaning of moving in the context of the individuals' total life experiences (Strauss 1987; Glaser 1978). This approach was amenable to the study of complex, contextual, and highly interactive phenomena and is a method used to discover new theories about social situations. (Strauss 1987; Lincoln and Guba 1985). Purposive sampling and concurrent data analysis facilitated exploration of a wide range of experiences and perspectives, culminating in a description of the process of moving that explained the data generated in the course of this study.

The Setting

The study site was a rental congregate housing community in an urban setting. Founded as a home for retired public school teachers over 50 years ago, the facility was under renovation by a private developer during the research period. The original building included 46 apartments without kitchen facilities and limited common space. With the expansion and new ownership, the community was opened to the public. The improvements enlarged the dining and activity areas and added another wing with 58 apartments, each with 1 or 2 bedrooms, full kitchens, and living rooms (approximately 550-800 square feet each). The interior design of the community created a comfortable and accessible environment. Communal areas of varying sizes were scattered throughout the building, fostering social interaction. Apartments in the new wing featured bathrooms using universal design principles, promoting independence with personal hygiene. Services included three meals per day, an activity program, group transportation, and 24 hour staffing.

Two distinct cohorts of residents lived in this community: The retired educators, many of whom had known each other for many decades and the newcomers (some of whom were also teachers) who moved in when the building expanded. There were several important differences between the cohorts, with a lower socio-economic status and poorer functional and physical health among the original residents, many of whom received housing subsidy through their professional association. This community was geared towards residents independent in basic activities of daily living, yet aging in place and increased needs were apparent among the resident population.

Sampling

The sample was recruited from the cohort of new residents to the community. Participants were interviewed 3-9 months following moving into their new homes. Sampling consisted of a combined convenience and purposive approach. Initially, volunteers were sought from the general population. As participant observation and interview data from the convenience sample (n = 11) were analyzed, theoretically relevant participants (e.g., reclusive, having problems with health, function, or alcohol) were recruited with the assistance of follow resident and staff contacts. Purposive recruitment yielded a sample that approximated the demographic mix and health status of the total population of new residents. Sample size was determined by saturation of categories, and sampling was not intended to be representative of a population, but rather serial and contingent upon previous data gathered (Lincoln and Guba 1985). A total of twenty one new residents were interviewed formally over a period of five months, accommodating concurrent data analysis.

Procedures

Data collection included in-depth semi-structured interviews, participant observation, and informal interviews with " members of the social setting. The in-depth interview explored the personal historical experience of moving and the experience and patterns of responses to moving into congregate housing. These interviews were tape recorded and then transcribed verbatim. Participants were asked about their previous experiences with moving and how they usually managed relocation. Subsequent questions focused on the most recent move to congregate housing, and covered details of the move, how this move was managed, how life changed, and what helped in adjustment. Field notes were recorded as a supplementary data source at the conclusion of each interview, and included impressions of the environment, the interview itself, and the general adjustment of the …