Exploring “Home” At An Assisted Living Facility: Looking Through Residents' Lenses with Photovoice

Purpose: An increasing number of older adults are moving into assisted living facilities when living independently becomes difficult. For some residents, the transition to and settlement in these facilities can negatively impact psychological well-being. Successful transition into an assisted living facility occurs when a resident feels “at home” in their new environment (Cutchin, Chang & Owen, 2005). It is important to understand residents' perceptions of the assisted living facility while they reconcile the loss of previous homes. Although a growing body of literature exists in this area, there is limited research on how African American older adults perceive the assisted living facility as home. Photovoice was used in this study was to "give voice" to residents who are often in the position of having decisions about their home environment decided by relatives or facility administrators.

Methods: Ten African American older adult residents, ages 54-94, were engaged in photovoice to describe their dwelling and document environmental images. Participants were introduced to the study and asked to think about aspects of the assisted living facility that made it feel like home. Residents were paired with social work graduate students to take photographs of “home” at the assisted living facility. Residents then shared their photographs and discussed homelike and non-homelike aspects of the assisted living facility. The ORID focus group method was used to facilitate discussion (Valera, Gallin, Schuk, & Davis, 2009). Afterwards, residents repeated the process of photo-taking with a new theme that emerged from the group discussion. Then they shared photographic images, discussed possible solutions, and identified a plan for communicating residential enhancements to facility administrators.

Results: Residents captured 125 images of the assisted living facility. One dominant theme across shared images was the importance of frequent and continued contact with family members, friends, and church members outside of the assisted living facility, as illustrated in photographs of loved ones hung on resident bedroom walls and displayed on furniture. Another major theme was the importance of personalizing bedroom spaces with furniture and personal objects from previous homes. Critical dialogues emerged during the focus groups about aspects of the assisted living facility considered non-homelike. Residents shared a perspective that their assisted living facility lacked adequate opportunities to socially engage in activities in-house or outside in the surrounding community. Further, residents identified poor communication about scheduled activities. To address these concerns, participants formed a resident council to enhance their involvement in organizing resident activities, connecting family members and friends to activities at the facility, and communicating emergent resident concerns to administrators.

Implications: Photovoice can be used with older adults in a focus group format to stimulate discussions about a shared residential setting. This methodology can help participants, particularly those with slightly diminished physical and cognitive ability, visually identify and communicate environmental concerns that interfere with fully feeling at home after transitioning to a care facility. Photovoice can also empower residents to discover and advocate for programmatic enhancements that can be made to help incoming and established residents acclimate to an assisted living facility.