Social cohesion in communities with high residential mobility: The paradox of aging in place

Tetyana Pylypiv Shippee, Purdue University

Abstract

Social cohesion has been of key interest to sociologists for over a century, largely because of its vital importance for the functioning of society. Social cohesion, defined as the unity and solidarity of a group, provides multiple benefits for group members, including greater social participation (Ross 1977; Streib and Metsch 2002) and positive well-being (Kawachi and Berkman 2000). Robust, cohesive communities may confer added benefits for older adults, who often experience declines in health and social networks. Continuing Care Retirement Communities (CCRCs), facilities comprised of multiple levels of care that correspond to residents’ changing health and functional needs, are designed to compensate for some of the losses experienced in later life. One purported advantage of CCRCs is that they allow residents to “age in place,” or remain in a single facility as they grow older, thus minimizing the disruptiveness of moving to more advanced care. Nevertheless, CCRC residents usually transition to more advanced care when their health needs increase, which may threaten the social cohesion and stability of the communities in which they live. This dissertation examines how social cohesion forms in residential living for older adults, how it corresponds to individual, group, and facility characteristics, and how it protects older adults’ personal adjustment in these settings. Data gathering consisted of observation and interviews with residents in two CCRCs. Observations spanned a period of four years for one facility and two years for the other. Interviews were semi-structured and face-to-face, with 60 residents across all three levels of care (independent, assisted, and nursing living). Lasting from 60 to 180 minutes, interviews probed residents’ reasons for moving into the facility, social relations, participation in activities, relocation to other levels of care, and personal adjustment. I conducted qualitative analyses of observation notes and interview transcripts, consisting of multiple readings, coding for recurrent patterns, and thematic categorization of similar codes. I used NVivo 7 (2006) to organize and code the data. This dissertation consists of three studies which explored the formation and maintenance of social cohesion in CCRCs and its effects on residents’ lives. The first study addressed the unique position of independent living residents, who enjoyed relatively active social lives, but who also faced future health problems and transitions to more-advanced levels of care (which were seen as more restrictive and less cohesive). Results indicated that community identity (e.g., with independence as a shared value), aspects of social participation (e.g., active resident “leaders”), and reactions to deviant acts and characteristics (e.g., declining health as a stigma) fostered social cohesion by reaffirming independent living residents’ high status in each facility. The second study extended this analysis by investigating how levels of care in both facilities functioned as boundaries, and what it meant for residents to cross these boundaries. Levels of care entailed physical boundaries—e.g., distance between levels and security measures for nursing living—and social ones—such as the stigma attached to more advanced care. Four types of boundary crossing emerged, with divergent effects on social cohesion: voluntary-temporary (e.g., volunteering) and voluntary-permanent (empowerment through personal choice) crossings supported residents’ sense of togetherness and belonging; however, involuntary-temporary (health recovery) and involuntary-permanent (moves by the facility) disrupted the norms and stability of the communities on either side of the boundary being crossed. The third project examined the relationship between social cohesion and personal adjustment for all levels of care in both CCRCs, with an emphasis on the accumulation of advantages for socially active residents. Findings showed that participation and social support were key arenas through which social cohesion influenced successful adjustment in CCRCs. Participation and social networks were mutually reinforcing (and responded to other resident characteristics, such as marital status). More-active residents (especially in less-intensive levels of care) further benefited from mutual emotional support. Overall, findings illustrate the importance of facility, group, and individual characteristics for social cohesion in CCRCs, and suggest that administrators could work to make boundaries less intrusive (or less stigmatizing) and “involuntary” boundary crossing less disruptive, perhaps through resident education, staff training, or carefully redesigned policy. However, the facilities should be balanced in their efforts to integrate levels of care because residents in better health may not want to associate with those in poorer health (e.g., IL with AL residents). Conversely, AL and NL residents may not always be better served by intensive or frequent interaction with generally more assertive IL residents. Resident volunteers represent a potential source of social cohesion on a facility-wide scale.

Degree

Ph.D.

Advisors

Ferraro, Purdue University.

Subject Area

Gerontology|Sociology

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