Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose. Aging in place has become one of the key philosophies touted and promised by assisted livings nationally. However, the conceptualization and operationalization of this philosophy have been varied among researchers and policymakers. This study documents the various definitions of aging in place, and how they are being translated into state regulations, statutes, and programs for assisted living. Furthermore, we examined the arguments for and against shared by state-level policymakers and stakeholders on defining and implementing their definitions of aging in place in assisted living.

Methods. Open-ended, structured interviews with policymakers and stakeholders were conducted by telephone. At least three interviews were conducted for every state and the District of Columbia. Employing content analysis technique, transcribed interviews were analyzed for the definition of aging in place; the chronological information on the policy process from formulating to implementing the philosophy, and how aging in place was/ will be then translated into regulations, statutes, and programs for assisted living. This information was later supplemented and triangulated by websites, public documents, journal articles, books, and newspaper articles.

Results. In two years, 161 interviews were conducted with state politicians, provider representatives, state officials, advocacy groups, and other key stakeholders. The majority of the states did not have a formal definition for aging in place, however, the philosophy has/ had been the center of discussion when formulating policies for assisted living. Some of the factors identified as enablers for aging in place in assisted living facilities were strong leadership championing the philosophy, the presence of home health care agencies, family members willing to pay out-of-pocket costs for personal attendants, and flexible use of grace periods especially when the physical conditions of the resident are volatile. Simultaneously, despite the pervasive view of aging in place as beneficial to older adults' health and well-being, there were a number of states, which found aging in place an unfavorable philosophy.

Implication. As states face the rapid growth of the assisted living industry, they encounter, for one, the challenge to balance minimizing regulatory oversight and maximizing quality of life for residents. This study's focus on aging in place provides insights to such challenge at the state-level policymaking process, and the various political, economic, and sociocultural challenges and opportunities exist for a long-term care philosophy to be translated into a feasible and adequate policy for all stakeholders involved. Particularly, the findings and analysis will help understand how geriatric social work can be an integral force impacting and shaping long-term care policies to achieve better health and well-being of older adults and their families.