Elders' Decisions to Enter Assisted Living Facilities: A Grounded Theory Study

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Elders' Decisions to Enter Assisted Living
FacilitiesA Grounded Theory Study
Shu-li Chen, PhD, RN1, Janet W. Brown, PhD, RN1,
Linda Mefford, PhD, RN1, Aloycha de La Roche,
MSN, NP2, Deborah J. Persell, MSN, PhD student1,
1The University of Tennessee, Knoxville, USA and
2Covenant Health Senior Services, Knoxville
Acknowledgement Appreciation is faithfully given
to all of the survey participants, without whom
this study could not have been completed. The
authors are grateful to the Faculty Research
Award from the College of Nursing of the
University of Tennessee at Knoxville. Background
There were 36 million American elders in 2000 and
the elderly population will double in 2030. Many
elders will need some types of residential
long-term care at some point in
lives. Currently, 900,000 people are living in
assisted living facilitates in U.S. No
literature examines how American elders decide to
relocate and choose a particular housing
option. Purpose The purpose of this study was to
develop a substantive theory of elders'
decision-making process to relocate to an
assisted living facility by examining and
analyzing experiences and perceptions of elderly
men and women who had relocated to assisted
living facilities. Method Grounded theory
methodology (Strauss Corbin, 1994). Data were
transcribed, analyzed and interpreted by a
grounded theory research team at the College of
Nursing University of Tennessee. Sample A
purposive sample of 22 female and six male elders
was recruited from two assisted living
facilities. All participants were Caucasian
with a mean age of 87 (range69 to 95). Most
participants were widowed with an average of two
to four children (92). Many participants were
high school graduates (36) or had some college
studies (36) while one participant held a
master's degree and one had a doctorate degree.
A majority of participants (80) lived in their
private homes before moving into assisted living
facilities. The participants resided in an
assisted living facility for an average of 29
months at the time of interview (range 1 to 90
months). The primary financial source to pay
for the assisted living facility was retirement
funds (100). Main Finding The story of elders'
decisions to move into an assisted living
facility is a story about weighing and balancing
gains and losses of moving and the motive is to
go where the help is.
Figure 4 Weighing and Balancing Gains and
Losses The decision makers were weighing
and balancing the gains and the losses even after
moving into an assisted living facility.
Weighing Balancing Exemplar - After moving
into an ALF I lived there (the first ALF) a
year and I was content. But, then I got sick and
for some reason they started to dislike me and
they were unkind and I didnt like it. Clinical
Implications The findings demonstrate the
weighing and balancing nature of the entire
decision-maker process. The findings emphasize
elders role of owning the decision to overall
satisfaction with the relocation experience. The
findings highlight the importance of family
proximity in the decision-making process. The
findings provide a foundation for healthcare
professionals to design, develop, and implement
interventions that can promote positive
relocation experiences for the elderly. The
findings expand knowledge about elder
decision-making process with regard to
residential options. Research Limitations Mostly
female sample (76) All Caucasian elders Two
interview sites both located in East
Tennessee More diverse samples Male Young old
(aged 65 to 75) Cultural diversity Social
economic diversity Geographical
diversity Research Implications Several testable
propositional statements have been derived from
this newly developed theory. Possible areas for
intervention have been identified. Come and join
us!!!!!
Figure 1 Elders' Decisions to Enter Assisted
Living Facilities I would tell you its
not easy to move and when you need some help
youve got to go where the help is. And I was
falling down, falling down, my head is full of
bruises, my arms and legs are too. So something
had to be done. It was lonely at first but you
get used to it..And I would tell you its
nice. Figure 2 Before the Move Weighing
Balancing Weighing Balancing
Exemplar - Before moving into an ALF My son
helped me sell my home when I was in the nursing
home for 4 months after my hip replacement. He
said I could not stay at home alone and nobody
could be home with me. I knew I could not stay at
my daughters places. They have their own things
you know. I was not able to live at home. There
was no place back home that I could stay. So I
could not stay there, so I moved here. Figure
3 Owning the Relocation Decision Weig
hing Balancing Exemplar During the decision
making process When I was making the decision
to move it was kind of sad. But Ive got to do
what Ive got to do. Cant sit around and whine
about it.
Summary Moving to assisted living facilities is
about going where the help is Based on
participants relocation stories, the researchers
developed a theory of the decision-making process
for elders to relocate to assisted living
facilities. A pertinent and unique finding of
the study is the continuing weighing and
balancing process even after elders move into an
assisted living facility. Understanding the
process of decision-making in this segment of the
population may lead to the development of
interventions that can promote positive
relocation experiences among elders and increase
the effectiveness of their decision-making
behaviors.