Pathways Study Yields Lessons
Krout, John A., Pillemer, Karl, Wethington, Elaine, Aging Today
The notion of home is extraordinarily powerful for many older people. Adult children often commiserate with one another about their parents' reluctance to leave a living situation that has become isolating, hazardous or too difficult to maintain. What appears to be a straight-forward and rational decision-the move to a supportive living arrangement-can be met by fierce resistance from an older parent determined to remain independent and in a familiar setting.
It has now become commonplace to highlight the positive aspects of "successful aging." However, it is also unfortunately true that many people spend the final stages of their lives with a serious burden of chronic illness or disability. In such situations, older people and their families face a number of stressful and difficult decisions, many of which revolve around the following question: "Where will I live when I can no longer meet all of my own needs?"
A MANY-SPLINTERED THING
By changing the living environment and providing a new context for daily activities, housing has the potential to promote autonomy, foster physical and psychological well-being, and relieve pressure on caregiving family members. However, housing for older adults in the United States appears to be a many-splintered thing in which resources are not necessarily matched to the needs of older people, where amenities tend to be distributed according to socioeconomic status, and where older people's planning for residential moves is often limited.
The Pathways to Life Quality study addresses these issues in a multifaceted way. Since 1997, researchers at Ithaca College and Cornell University have conducted an in-depth study of a small region of upstate New York to examine the relationship between where older people live and their quality of life. In addition, the study has been able to provide unique information on how older people make residential decisions. The rich data from this ongoing study has already produced important lessons for housing and service providers and consumers. Detailed findings appear in the new book Residential Choices and Experiences of Older Adults: Pathways for Life Quality, edited by John A. Krout and Elaine Wethington (New York City: Springer Publishing, 2003).
When making concrete recommendations for policy and practice, it is necessary to consider the constraints placed on the range of options-constraints typically caused by a lack of public and private funding for possible programs. However, it is also instructive to speculate on the characteristics of a system of housing options for older people in the United States that better meets the needs of all older adults. That is, what would the optimal configuration and operation of housing arrangements be in a given geographic area? Several features of this system are clearly indicated by the Pathways findings.
Ideally, a continuum of housing options would exist in the community to meet the family situations, functional status and personal preferences of all older people. These options range from the least restrictive setting-such as one's own home, where one might retain the greatest autonomy-to the most restrictive, such as a nursing home for those with the greatest dependency needs. Some environments may have more than one of these options, or-like continuing care retirement communities (CCRCs)-have all of them.
But the suggestion that people follow a continuum or progression of housing options through old age is misleading. Actually, most older adults live at home, with or without assistance, and many suffer acute health problems that move them from living at home directly to assisted living or a nursing home. Sometimes, this move is due to a lack of availability or affordability of the middle options. Thus, perhaps the word menu is more appropriate for describing housing options than continuum.
Resource issues probably mean that not every community can have the full range of options, but every older American should have reasonable access to affordable housing. …