Assessing the Effect of Relocation Control on the Psychological Well-Being of Assisted Living Residents

Background and Purpose:As the number of older adults who experience Assisted Living Facility (ALF) relocation continues to rise, it is important that researchers and practitioners increase their understanding of the challenges encountered by the ALF relocates. Although past study has revealed the psychological well-being of long-term care relocates, especially those experiencing involuntary relocation (Chen et al., 2007; Chentiz, 1983; Johnson, 1996; Thomasma et al., 1990), few studies have investigated the mediating role of social support, self-reported health, and functional impairment as they may influence the psychological well-being of ALF residents. The purpose of this study was to examine how relocation control prior to admission is associated with the psychological well-being(e.g., depression, anxiety, and life satisfaction) of ALF residents and to explore the extent to which the social support, self-reported health, and functional impairment plays a role in improving psychological well-being in ALF residents.

 Methods: The sample included 336 assisted living residents from 19 ALFs across eastern Tennessee. The average age of participating residents was 86.32 years (SD = 6.97 years). Annual personal income fell predominantly in the $10,000 to $49,999 range (73.4%). Approximately one third (31.3%) were high school graduates. Structural equation modeling (SEM) was used for testing the hypothesized relationships among the variables. This study used eight measures to assess independent variables (the Perceived Control Measure), control variable (demographic questionnaire), dependent variables (the Center for Epidemiological Study Depression-20; the Brief Symptom Inventory-6; the Life Satisfaction Index-Z 13), and mediating variables (the Katz Index of Independence in Activities of Daily Living; the Instrumental Activities of Daily Living Scale; The perceived Social Support Scale; Self-reported Health Scale).

 Results: SEM revealed that greater resident involvement over relocation was associated with lower levels of depression and higher levels of life satisfaction, whereas resident control over relocation was not associated with anxiety before or after relocation, controlling for demographic factors. The second critical finding from this study was the statistically significant mediation results of a trend for social support to be a mechanism through which relocation control affected psychological well-being (e.g., depression and life satisfaction). However, an indirect linkage of relocation control and anxiety via social support was not statistically significant. Surprisingly, the hypothesis that the mediation relationship from relocation control to self-reported health to psychological well-being was not demonstrated. Furthermore, functional impairment mediated the association between relocation control and life satisfaction. Functional impairment did not act as a mediator between relocation control and psychological well-being (e.g., anxiety and depression).    

Conclusions and Implications: The study suggests that involuntary ALF relocates are at risk of depression and low life satisfaction when they are socially isolated after admission. Currently, relocation support and mental health services are not federally mandated at ALFs. It may be useful for ALF staff members to provide individual counseling, group sessions and on-site mental health service teams so that residents can understand stressors and explore how these concerns may be associated with their psychological well-being.