Social Engagement in Assisted Living Communities and Implications for Practice

Background and Purpose

Social engagement plays an important role in the health and psychological well-being of older people. Its role among residents in assisted living (AL) settings has not been well explored, however, and it may be that how it is experienced and affects well-being differs in this setting than for those who live in private residences or nursing homes. Thus, the purpose of this study was to explore the lived experiences of social engagement among residents in AL. The study aimed further to explain the process of social engagement and its relationship to residents' psychological well-being.

Methods

Qualitative data were collected via semi-structured interviews with 29 residents in four AL settings in a Southern state. Interviews included questions concerning social ties to family and friends, relationship building within the AL community, sources of emotional support, and psychological well-being. Salient themes were derived using a grounded theory approach.

Results

Findings revealed the complexity of social engagement and were organized around six key themes.

Meaning of time and loss:

Time appears to work against building solid relationships in AL, where people observe other residents deteriorating rapidly in mental and physical capacities while experiencing their own health declines.

Barriers:

The most frequently mentioned barriers in interacting with other residents involved others' inability to communicate due to cognitive impairment and hearing difficulties. In contrast, participants identified their physical illness and mobility problems as barriers to interaction.

Environment:

AL rules and policies governing residents' everyday lives affected their social interactions with others. Participants mentioned the monotonic life in the facility (e.g., sameness in routines and people) and wanted a wider variety of activities and contact with people from the outside.

Emotional connections:

Making emotional connections with people within the AL community may be difficult to achieve. However, living in AL seems to help resolve social isolation/loneliness to some extent.

Desire for high quality social relations:

Even residents who engaged with other residents in numerous ways admitted they did not have many close friends in the AL setting. Nevertheless, participants were interested in having high quality social experiences with others.

Strategies:

Participants adopted different strategies in an effort to achieve psychological well-being when relationships within the AL community were not satisfactory. For example, participants reported making efforts to build or maintain relationships. Often, they resorted to solitary activities to divert their attention from unpleasant emotions associated with interacting with residents who were unable to communicate. Participants also focused on present-oriented goals and were selective in choosing their social partners.

Conclusions and Implications

Although participants desired high quality social relations, their social world and choices in social partners were bounded by AL policies and features of the social environment. It is not likely that close friendships will be made in this setting, and so to promote social engagement, AL providers might actively provide social opportunities tailored to individuals' physical and mental capacities and preferences. One way to do this is to promote collaborations with other community organizations, such as high schools, colleges, and religious organizations.