Older adults who move to independent living units: A regional Australian study

Abstract

Objective

The purpose of this study was to ask older adults in a regional area of Australia how they made the decision to move into an independent living unit (ILU) within a three‐tier residential complex that provides varying services and care to older adults.

Method

Focus groups were used to enable the gathering of rich data and to enable the voices of older adults. A deductive qualitative analysis (Gilgun, Qualitative research in social work, 2nd ed., pp. 107–135, 2013) was deployed using the factors for a successful later‐life transition to an aged‐care facility identified in the researchers’ earlier systematic review.

Results

Feelings of autonomy and control over the decision to move were important to all respondents. Any sense of loss of day‐to‐day autonomy, privacy and purpose, was compensated for by increased feelings of safety and security. Selected items brought from the old home to the new were a significant source of comfort.

Conclusions

This study provides the views and experiences of 19 older adults from regional Australia about moving into ILUs in a three‐tier complex. The values and missions of the complex were important in the relocation decision‐making. Further, if the choice is between living near friends or family, participants recommended choosing friends. The strategic choice of an ILU in a three‐tier complex was seen as providing appropriate care into an unknown future. This study highlights the importance for older adults, their families and health‐care professionals of making timely relocation decisions and the importance for older adults to retain autonomy and control over the relocation decision.

Key words:

• autonomy
• belonging
• creating a home
• independent living unit
• freedom of choice
• friendships

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC

• Moving home in later life is an emotional and stressful event.

• A sense of belonging and feeling of being at home is disrupted during relocation.

• Perceived autonomy and ability to exert control over the relocation decision are important determinants of successful relocation.

WHAT THIS TOPIC ADDS

• It provides the views and experiences from older adults from regional Australia.

• It underscores the importance of strategic choice for appropriate care into an unknown future.

• It highlights the role of friends over family in the decision making process.

INTRODUCTION

The decision to move home in later life is acknowledged as an emotional and stressful event for older people (Crisp, Windsor, Butterworth, & Anstey, 2013; Gardner, Browning, & Kendig, 2005; Hu, Xia, Skitmore, Buys, & Zuo, 2017). This project set out to investigate the decisions of older adults to move to an independent living unit (ILU) in a three‐tier complex in regional New South Wales, Australia, and the subsequent and ongoing process of making a new home. This study was prompted by the lack of choice and participation in decision‐making of older adults relocating to a residential aged‐care facility (RACF), more commonly called a nursing home (Brownie, Horstmanshof, & Garbutt, 2014), and the question whether this was also the case for those relocating to an ILU. The research adopted a focus group approach to answer the questions: What do people view as the key factors when deciding to move to an ILU? How do residents moving to ILUs create a sense of belonging in their new home and what hinders them in this ongoing process?

In this study, the term three‐tier complex refers to accommodation built specifically for older people where three forms of housing—ILUs, a hostel and nursing home—offer, respectively, increasing levels of care (Howe, Jones, & Tilse, 2013, p. 559). The term ILU is used to refer to a form of housing with support where older people “are able to live independently without regular nursing or personal care assistance” (Howe et al., 2013, p. 568). The ILUs in this study were part of a three‐tier complex in a suburb in a regional city in northern New South Wales. The units were single‐level one‐ and two‐bedroom duplexes that constitute a medium‐scale village of less than 60 units with barrier‐free internal design and all were within walking distance of shops and public transport. Support in the ILUs focused on amenity services described in promotional materials as providing people aged 55+ years of age with “the freedom from building and gardening maintenance, a sense of security, companionship and access to other useful services and facilities.” Common facilities included a community centre and a community bus for shopping and other outings. There was an emergency call system, access to prepared meals if required, and some respite care was available in higher‐care sections of the complex. The ILUs were in the medium range of cost compared with similar housing in the region.

Howe et al. (2013) noted that unlike the United Kingdom and United States, there has been little research on Australian residents' experiences of moving to ILUs. An exception is Gardner et al. (2005). Their telephone survey of residents from ILUs in a capital city included a quality of life instrument and short‐answer questions, noted improvements in quality of life compared with a cohort that had considered moving but had not done so. Factors contributing to this improvement included suitability of housing design, increased social participation, enhanced feelings of security, and a village lifestyle. More recently, Xia, Zuo, Skitmore, Chen, and Rarasati (2015) conducted a case study of an Australian capital city retirement village. This involved in‐depth interviews with senior management and only short discussions with residents while on a tour of the village. Other research (Crisp et al., 2013; Knight & Buys, 2008) investigated factors influencing the move to ILUs. Similar to Gardner et al. (2005), this study is focused on the experience of residents after moving to an ILU, however, it differs in that its setting is in a regional area of Australia and in‐depth, face‐to‐face focus group discussions were employed rather than telephone interviews. Thus, this study is enriched by the voices of residents. As Jones et al. (2010, p. 135) note, studies such as this are necessary because they enable examination of the impact of “the quality of management practices [and the capacity of…] housing to respond to continuing care needs as the care requirements of residents increase.”

This study focused on home and belonging and drew on a solid body of literature on the meaning of home in later life (Milligan, 2009; Molony, 2010; Petersen & Warburton, 2012) and the impact of residential transition on a person's sense of being at home and belonging (Cloutier‐Fisher & Harvey, 2009). This literature has noted the importance of the physical and social environment to the process of relocation, as well as personal or dispositional factors. Much of this research considered senses of being at home and belonging as states that can be achieved, whereas recent research considered belonging to be always in‐process through everyday practices and never achieved once and for all (Game & Metcalfe, 2011; Probyn, 1996). This focus on practices of belonging is not only useful theoretically, but also enables research that produces practice‐based recommendations for residents and aged‐care professionals.

Closely associated with developing one's sense of belonging is a feeling of being at home (Cloutier‐Fisher & Harvey, 2009). Recent work by Bigonnesse, Beaulieu, and Garon (2014), building on research on the meaning of home in later life, proposed an explorative framework of the positive meaning of home in later life. Their framework included: personal aspects, social aspects and physical aspects. More recently, a systematic review of influences on the sense of home in nursing homes by Rijnaard et al. (2016) proposed a similar framework of psychological factors, social factors, and the built environment.

A sense of belonging and feeling of being at home is disrupted during relocation from one place to another. Relocations have been of particular interest to aged‐care researchers because of the close link between wellbeing and a successful transition, especially from one's residential home to a high‐care RACF. Brownie et al. (2014) examined the impact of this transition and adjustment to long‐term care on residents. Their review focused on research where the experiences and views of RACF residents themselves were considered. The importance of perceived autonomy and ability to exert control over the relocation decision emerged as important determinants of successful relocation.

The definition that Koestner and Losier (1996) provide for autonomy embodies all the important requirements for control over one's own life: the capacity for self‐determination, self‐expression, and freedom of choice that is without constraint. It is an important psychological determinant of motivation throughout life and essential to wellbeing and personal development. In addition to autonomy being a key factor in a successful transition, RACF residents also cited the importance of independence, privacy, purpose and meaningful engagement, and the continuity of former roles and relationships (Brownie et al., 2014).

Rationale, participant recruitment, and data collection

The transition to long‐term aged care is acknowledged as an emotional and stressful event for older people and their families (Ellis, 2010). Much of the distress is directly related to perceived or real lack of participation in the decision‐making process about the transition (Johnson, Popejoy, & Radina, 2010). This project set out to investigate ageing people's choices in the transition from their residential homes to an ILU that is part of a three‐tier complex. The project adopted a focus group approach to understand the relocation decision‐making and the process of re‐establishing a sense of belonging in their everyday lives. These issues were found on the systematic review findings that a successful transition to an RACF began before and during the decision‐making process and had reached a conclusion between 3 months and 18 months after relocation (Brownie et al., 2014).

Riva et al. (2014, p. 10) suggest that the social complexity and interdependence of “active ageing and healthy living” presents a “wicked problem” that needs a multidisciplinary approach. The issue must be approached from an understanding of “what people do and why they do it.’ As the researchers were committed to ensuring that the voices of residents themselves were represented in the outcomes, a qualitative design was adopted. Each researcher brought a different but complementary disciplinary philosophy to the study. One member brought a discipline background in naturopathy with an interest in healthy ageing and aged care; another contributed as a psychologist with an interest in healthy ageing and the issues of relocation, transition, and adjustment; while the third, a lecturer in cultural studies, supplied insight from a research interest in place, identity, and belonging. These viewpoints enriched the analysis phase by bringing into conversation, respectively, a focus on outcomes for older adults and health‐care practitioners, the personal and cognitive issues regarding relocation, and the practices and sociocultural aspects that affect processes of home‐making and belonging.

The recruitment process was coordinated with the President of the village community. An invitation to participate in the study was distributed to all dwellings and residents via a community newsletter. This invitation explained the purpose of the study. Ethics approval was granted by the Southern Cross University Human Research Ethics Committee (HREC)—Approval Number ECN‐12‐241.

Residents shared their perceptions and views about their transition to and life in the ILU by participating in small focus groups or taking part in an in‐depth interview. Recruitment was not limited to recent arrivals because the process of home‐making and developing a sense of belonging is an ongoing process (Game & Metcalfe, 2011; Probyn, 1996), and therefore all residents have valid views at any stage of the process. Focus groups and in‐depth interviews were considered the most appropriate data collection methods to reveal the range of viewpoints. The interaction among participants in focus groups encourages a greater degree of spontaneity in the expression of views than in individual interviews (Krueger & Casey, 2014), and so focus groups were the preferred data collection method. Interviews were offered to those residents unable to attend a focus group so that all who were interested in participating had the opportunity. Two residents chose an in‐depth interview; the remaining residents participated in small focus groups (3–5 residents) at the community centre. The interviews and focus groups were on average 60–90-min in duration. The three researchers took turns to attend the focus group sessions in pairs. None of the researchers had worked with any of the participants before.

The interviews and focus group sessions were guided by the following questions:

• Was moving to the ILU your decision? How was this decision made?

• What did you hope for from this relocation?

• How have you made your new residence feel like home to you?

• What do you wish you had known before you made this move?

• What sort of advice would you give to those considering such a move?

The interviews and focus group discussions were digitally recorded and transcribed in full prior to analysis.

A deductive qualitative analysis (Gilgun, 2013) was deployed using the factors for a successful later‐life transition to an aged‐care facility identified in the researchers' earlier systematic review (Brownie et al., 2014):

• autonomy and control over the decision to move;

• sense of loss of day‐to‐day autonomy, privacy, and purpose;

• the stress and anxiety of learning the ropes of institutional rules and regulations;

• sense of safety and security;

• living space design;

• sociocultural factors;

• benefit of an enriched environment.

Each author followed these steps and results were compared until agreement was reached: (a) familiarisation with the data by repeatedly reading the transcripts; (b) generation of initial codes by highlighting patterns of words, phrases, and expressions; (c) exploration of the meaning within codes to connect the codes with the themes from the framework; and (d) reviewing the data for missing elements. After review of the data in Step d, it was found that no additional elements were required, that is, that the framework derived from studies of older adults' transitions to an RACF was sufficient for analysing the data from the ILU. Member checking was not part of the methodological design.

RESULTS

This section provides the demographics and findings in terms of the seven factors outlined above. As anticipated, the focus group method delivered rich and lively discussion with differing viewpoints.

Participant demographics

A total of 19 residents participated in the study. Residents are identified below as R1 to R19. The participants ranged in age from 69 to 90-years of age (mean = 79). Of these participants, 14 were female and five were male, with 11 living alone and eight with a spouse. The length of time participants had resided in their ILUs ranged from 1 month to 25-years. One participant had never married, eight were married, four were divorced or separated, and six widowed.

Autonomy and control over the decision to move

In contrast to the lack of control over the relocation decision for RACF residents, ILU residents reported that they maintained their autonomy and control over the decision. Fifteen participants explicitly stated they made a deliberate and planned choice. R4 summed this up: “the people have chosen to come here; they want to be here […].” All made the choice to move due to the effects of ageing. For 11 of the 15 respondents moving pre‐empted a later decline in ability. R1 lived alone and “realised there was no one to check on me, so I put my name on the [waiting] list.” R2 noted that “I was starting to go downhill and I thought that if I participate [in moving] now, I won't have to run around and try to sort this out when I'm older.” R14 said, “I knew I was never going to stay in the house forever and I made my eightieth birthday the year that I would move, I moved at the beginning of that year.” Other respondents explicitly commented that their move was prompted because of a diagnosed illness of a spouse. R7's partner was diagnosed with dementia and “we realised we couldn't manage at home, so we moved.” R18 faced the same issue: “I knew that we needed to move nearer to a nursing home complex, so we came into here because of age and my wife's dementia.” R17's “husband's health wasn't good” so they moved in their 60s: now “I have turned 90 and still loving it.”

A common factor in the respondents' motivation to plan ahead was to ensure their children were not put in a position of making a decision to put them into aged care: “it's my responsibility to sort myself out, not my kids” [R2] and “we knew we were never going to have to let our children put us somewhere, we were going to go while we knew what we were doing” [R8]. For some this motivation sprang from their experiences with a parent. For example, R3 stated, “we put my mum into care […] that was a bad move though because she didn't choose, we did and I saw that and I didn't want my daughter to go through that.”

Sense of loss of day‐to‐day autonomy, privacy, and purpose

While most participants were happy with their move, some (six) acknowledged a sense of loss. A common cause of lost autonomy, noted among four of the six, was surrendering control of home maintenance and modification to the village management: “it has been hard to let go of the control over things that you have at home, here we have to wait for jobs to be done for us” [R14]. The other side of this loss was the benefit of having many maintenance tasks taken care of by management as R6 noted: “You don't have to worry about ringing the chap to cut your lawn, or fix things around your house, that gets done for us.” R11 concurred: “before coming up here, [I was] in a housing commission house, but the garden was becoming too much for me, I couldn't manage it.’ There was a range of other concerns related to autonomy. R16 needed to give up her car during the transition to the village—“The decision to move here has never been regretted although my pride took a serious bump when I first travelled in our free bus”—and noted that “[l]osing our individuality hurt a bit at first [because of] the lookalike units.”

Unlike residents in RACFs, independent living residents did not report a loss of privacy or purpose in their lives. Loss of privacy was not discussed by residents who instead referred to the sense of community, and unlike RACF residents, many of whom shared the same room, ILU residents had their own dwellings. A sense of purpose aided residents' mobility and independence and because the three‐tier complex was located in a wider community and, for many, within existing social networks. This enabled R6 to “go to lots of different clubs here [in the village] and in the community and […] I can go bowling” while R5 was “still involved in outside activities, the church, bowls and things. […] We have so much freedom here, we can do what we want, we can have a garden, we can do as much or as little as we like.” For R18, the existing wider community was crucial after the death of his spouse who then “threw [him]self into volunteer work—Botanical gardens and U3A—to help me cope with my grieving.”

The stress and anxiety of learning the ropes of institutional rules and regulations

The loss of autonomy over home modification and maintenance reported above is an example of how “learning the ropes” is a significant aspect of making a successful transition to ILU. Despite not having to “learn the ropes” of an institutionalised RACF routine, ILU residents nevertheless live in a community with its own set of rules and regulations. Some participants were ready to live with this new state of personal affairs: “I knew that […] I would have to live within the constraints of this organisation, good and bad. You have to get used to the idea of living within a bureaucracy.” R13 felt more able to live with the slow pace of home maintenance when “at one of the meetings we were shown how the jobs get prioritised and that helped me understand how things get done.”

Sense of safety and security

A feeling of safety and security facilitated a positive transition to an RACF. Similarly, increased safety and security was a key affordance of the ILUs for five participants. These feelings predominantly related to health. The management of the three‐tier complex provided a personal alert system which was especially welcome for those living alone or with a frail partner. R1 commented that “I do feel safer, we wear an alarm alert, so I wear mine all the time around my neck, even in the shower” [R1].

A more common theme in relation to safety was being part of an attentive community. R13, who lives with her frail spouse spoke of how this sense of community enabled some overseas travel: “I was overseas for a few weeks, without [my husband] and I felt he was secure here while I was away. There's a sense of insurance about being here, it feels safer, neighbours checking up. This doesn't happen in the [outside] community.” R6 confirmed this: “We check up on each other, we worry about people we don't see for a while, that's part of our security too.”

Another factor affecting this sense of health security is the location of the ILU within the three‐tier complex that included a medium‐care hostel and a high‐care nursing home. Independent living residents often referred to this additional level of care as going “up the hill” to where the nursing home and hostel are located. As R5 says, “This is a good place. […] We can move up the hill if we need to. At least it's not much of a move; we came here for the tri‐care.” Care is also available on a short‐term basis: “From here if you go into hospital, you can go into the hostel before coming back home [to the ILU], so you can be looked after. That's a big help here” [R6].

Living space design

In RACFs, residents' private space is typically confined to one room, and in some cases a room shared with others. Thus, a room size that allows for some selected items to be brought from one's home is a significant source of comfort that aids a positive transition from home to RACF. In ILUs similar issues were faced by some residents, though to a lesser extent, as the units in the ILUs generally had separate living, sleeping and bathroom areas, even if of limited size. R1, who was used to a large house and garden, felt this change of scale: “I had to sell my piano, not enough room.” For R7, the reduced accommodation and yard size resulted in mixed feelings: “I felt guilty bringing my husband here, from home, but I knew it was the best thing for us both. […] I have no regret of leaving; too big a four‐bedroom place. I had to get help with lawns and things, but not here. I was happy to move.” Others reported that downsizing was “rather exciting too, to work out what to keep, what to get rid of, as you enter a different phase in your life” [R3]. R2 concurred, “That's right! Your life is in phases and you need to work out what you need for that phase of your life. Once you lose your storage capacity it forces you to get rid of stuff.” R14 was also adamant about making a break: “I didn't want to be hemmed in with old furniture. I tried to keep it simple.” For R19, having space for one's own possessions was important: “Inside my walls, all my stuff makes it comfortable, that's what makes it home. Those things have always been important to me.”

Sociocultural factors

Sociocultural factors, such as community and family attitudes regarding three‐tier complexes and the religious or secular management of the complex, influenced participants relocation choices and subsequent sense of belonging. The responses indicated that some participants felt a need to defend the decision to relocate to an ILU within a three‐tier complex. Several, such as R3, spoke of the reactions of their friends who want to know “why do you want to live in a retirement village with all those old people?” or for R7 whose family doctor exclaimed “you're too active to go […]to a place like that!” This illustrates a degree of stigma attached to living in three‐tier complexes. It also indicates the misconceptions about the opportunities ILUs within a three‐tier complex afford active, independent, older people. R19 mentioned how living within an ILU was itself a sociocultural choice: “I always knew, particularly since becoming single, that I would eventually live in a retirement village. In our family we did that: my mother did it, my sister did it, it's in our plan, in our way of thinking as a family.”

The ILU in this study was within a relatively low‐cost, not‐for‐profit, church‐run complex and some participants saw these aspects as important for the culture of the village. According to R13, “The whole caring attitude here is really special; that's what makes a difference when you live with a church group” and R14 commented on how “my sons were very happy that I moved to a church‐run community; a charity not‐for‐profit organisation, that really appealed to me.” Others noted that the low cost of this particular facility was a factor influencing its culture. For example, R18 noted, “this place was set up before the days of superannuation; villages had to be affordable. Now super[annuation] will mean that people will pay for a flash unit, with more facilities and amenities. They want the lifestyle. This is one of the cheapest places.” R19 reinforced that class may be an aspect of the ILU culture: “Most of the people here would have only have school leaving certificate; you can tell by looking at the sort of magazines they read and their awareness of current issues and opinions. […] So for some people, let's say snobs, they might find it a bit hard to fit in.”

Benefit of an enriched environment including possibilities for new friendships

Enriched living environments positively influence the transition to an RACF. In high‐care facilities this enrichment is often confined to retaining some personal possessions in one's room and meeting others at programmed events and meal‐times. In an ILU there is a wider scope for enrichment because of the village‐like plan of the ILUs, complete with resident‐run, communal spaces. The higher mobility and capabilities of ILU residents allowed them the potential to pursue social stimulation within and beyond the confines of the three‐tier complex, and so more opportunities to cultivate new friendships.

Shared, resident‐run leisure and entertainment facilities provided a focus for social gatherings. As R8 noted: “we own the Community Centre. It's ours. Everything in the kitchen we own—dishwashers, microwaves, etcetera—out of the money that we have raised.” The Community Centre provided opportunities for an active social life: “You can join in lots of things if you want to. You don't have to, but there's always something to do” [R5]. For example, as R2 said, “When I was in [a nearby town] there was nothing to do. [Now] I go dancing once a week and to Singles Club and I'm on the Jazz Committee; that gives me a full life.” There was a calendar of regular events: “morning tea Saturday and Sunday afternoon we have other social activities” [R4] and “a BBQ once a month” [R5]. R8 gave a sense of the scale of some events: “We have about five luncheons a year. Any time we have an opportunity to have one, or a celebration, we get together, not everyone, but lots join in, on average 50 people come to the luncheons.” These organised activities provided opportunities for an enriched life for partners and spouses: “The social club here take my [spouse] out four days a week, otherwise [he] just lies on the bed all day. That's not good. […] He goes on the buses with us when we go out; I just love it here” [R7].

Making new friends has been found to be an important enriching factor for a positive transition for new RACF residents (Bigonnesse et al., 2014) as it was for the ILU residents in this study. Nine participants noted the positive impact of making new friends with others in the ILU village. Only one participant felt challenged by the new community in which she found herself: “It was OK when I first arrived then I realised that there were women who wanted to be the dominant ones, like at school again. […] I wish people could know that this sort of thing happens” [R1]. Most, however, had positive experiences of being in a new community: “If someone cooks extra, you invite friends over to share a meal; it's always nice if you can share and you have a meal with someone to talk to. Like last night we talked until 10 pm” [R6]. R3 noticed this from “the day I was shifting in. I had quite a few people stop and welcome me and say ‘lovely to meet you.’ […] People even came over to help me settle in. It was just lovely.” In some cases residents' previous housing situation was isolating: “I knew that I wouldn't be lonely [here]. Our [previous] house was the only one that had steps. […] I knew that no one would be able to visit me” [R6]. R7 was in a similar situation and “missed having company before mov[ing] here. We had a house with an empty block beside us and on the other side the neighbours left and I didn't have anyone to talk to.”

The enriched environment was found to extend beyond the ILU to the surrounding community. For R8 “it had to be [town name]. I had no idea of living anywhere else and the grandkids are here too. I came to [town name] when I was 11.” Others discussed family and friends as factors affecting their decision‐making process. R2 believed that “you lose your friends, if you follow your kids.” R18's “children did encourage us to retire to where our friends were rather than follow the family; they might leave or move and we've seen that happen. […] My mother retired near family but she later regretted leaving her friends.” For some participants the combination of a new ILU community and outside community makes for a busy life. For example, R4 and spouse are “busier now than before, if that's possible.” R3 agrees: “You don't stop living; you just get busier. You're living the same as you did before, [but] you've got more added to your life, with people of your same age.”

Other participants noted that the grounds of the three‐tier complex played an important part in their lives. R12 commented: “It's lovely where we are. We hear the birds and it's so nice with the wallabies [and] scrub turkeys.” R18 agreed, countering perceptions of outsiders who have said that “‘It's so cramped up here.’ […] It's not; there's 26 acres, this community centre, all of this is our space and place too. My view is about 80 kilometres; we've never had such a view […]!”

DISCUSSION

The seven factors identified in the systematic review by Brownie et al. (2014) autonomy and control over the decision to move; sense of loss of day‐to‐day autonomy, privacy and purpose; the stress and anxiety of learning the ropes of institutional rules and regulations; sense of safety and security; living space design; sociocultural factors; and benefit of an enriched environment aligned strongly with the experience of the ILU residents, though with significant differences from residents in higher‐care settings. The importance of perceived autonomy and ability to exert control over their relocation decisions is evident in the responses of ILU participants compared with those in an RACF. There is also a clear indication of the thought and deliberation that went into their decisions. This included a consideration of what was important not only in terms of location, surroundings, and level of service for both immediate and future needs, but also in terms of quality of life, values, and affordability. The importance of independence was emphasised, not only in terms of not being a burden to their children, but also in ensuring that they were not put in a position where their living arrangements were subject to the events and life choices of their children. Several confirmed that they wished to avoid having relocation decisions made for them. Safety, security, and knowledge that someone would check on them and be able to come to their aid should the occasion arise seemed to militate against any inconveniences or disappointments experienced.

Belonging and home

As outlined above, in this research we were conscious of a sense of belonging and of home as ongoing processes enacted through everyday practices (Game & Metcalfe, 2011; Probyn, 1996). ILU residents spoke of practices that developed into a sense of belonging, especially with regard to the importance of social contact through the community‐run Community Centre. The smaller day‐to‐day practices of sharing a meal or looking out for each other also contributed positively both to a sense of belonging as well as a sense of security. The transition to an ILU was a significant life event marked through downsizing as people evaluated their possessions for life in smaller dwellings. Through the focus groups it became clear that sharing these common experiences fostered connections between ILU residents. By speaking of downsizing as part of a life‐phase some residents demonstrated a process orientation as they made meaning of the transition to an ILU.

Interwoven with ongoing practices of belonging is making a new home. The framework for considering home developed by Bigonnesse et al. (2014) proved useful in this regard, that is: personal aspects, social aspects, and physical aspects. Regarding physical aspects, the ILU provided room for maintaining continuity with residents' previous lives as they were able to accommodate important objects and furnishings. Moreover, the village‐like design fostered community. Socially, the ILU community provided opportunities for new friendships, while connections to the wider community proved important for many for maintaining previous friendships and leisure activities. The sense of purpose in life contributed to maintaining an ongoing sense of belonging. Personal aspects of home included the services offered by ILU management, which were a both cause of loss of autonomy and freed residents from home maintenance tasks that had becoming difficult to manage. The ILU village community, where people looked out for each other, gave rise to feelings of safety, while throughout the focus groups the sense of autonomy that residents expressed regarding their decision to move to a place they chose was paramount.

Aged care and stigma

Recent research in the Australian context indicates that an effect of three‐tier complexes is to isolate ageing people from the community, which in turn sustains stereotypes of residents as dependent and inactive (Petersen & Warburton, 2012). The language of separation is notable in the discussions with the participants in this study; many distinguished between the space and people of the ILU and “the community.” These same participants, however, dispelled the “dependent and inactive” stereotype with their energy and engagement with residents in other ILUs and beyond the three‐tier complex. The participants were well aware of the stereotype of those who live in a three‐tier complex, and defended their decision to relocate to an ILU that provided for a move to higher care when the time came. In this decision they saw agency that is directed towards their future health and wellbeing.

Limitations of the study

Despite the strong confirmation of the findings in the literature (Bigonnesse et al., 2014; Brownie et al., 2014; Rijnaard et al., 2016), it must be acknowledged that these participants volunteered and therefore self‐selected to discuss these issues of decision‐making and relocation. It is likely that there were other residents who may not agree with the views of the participants in this study. Future investigations should take this into consideration and ensure that the research design and methodology is strengthened to mitigate this potential weakness. Further, while the focus groups enabled a rich discussion in which participants prompted and built on each other's reflections on experience of moving to the ILU, there was the potential that dissenting views, or sensitive issues, such as the experience of loneliness, may have been less likely to be expressed in a group than in individual interviews. The opportunity for interviews was available to the participants in this study and it was notable that one participant who took up this option did so because of a desire to express some negative views about ILU life.

RECOMMENDATIONS AND CONCLUSION

Directions for future research

Our research to date has focused on one of the many relocation options for older adults. With the current emphasis on home support and care, comparison between the perceptions and outcomes for those choosing this option with those choosing ILUs would assist older adults with their decision‐making. Further, it would be helpful to understand the influence of dispositional factors on older adults' choices as it is clear from this study that participants were predisposed towards three‐tier complexes and placed importance on anticipating their future needs.

Recommendations for older adults, their families, and health‐care professionals

Although there is social stigma attached to three‐tier complexes, the respondents in this study were clear about their decisions, the criteria upon which they based the decision and the benefits they believed they were enjoying. We acknowledged that these were self‐selecting participants, however, their message was quite clear: make the relocation decisions yourself; choose a place that provides for your current and anticipated needs; consider the values and mission of the facility and the people who are likely to be attracted to those same values; make the move earlier, rather than later, so that you have time to make friends and enjoy the facilities, entertainment and other social engagement on offer. Finally, if the choice is between living near friends or family, choose friends, but also be open to making new friends and joining in so you have a chance to be a part of the community.

Transition to long‐term aged care can be a stressful and emotional event. Often the discussions that should happen in families and between partners are delayed as a way of avoiding difficult conversations and potentially challenging decisions. This study has shared the views and experiences of older adults who have made the move to independent living in a residential facility. They have shared rationales for their decisions, the benefits, and the sacrifices. It is hoped that others faced with similar decisions, for themselves or for their older family members, will be encouraged to make these important choices with confidence and in a timely manner.

CONFLICT OF INTEREST

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. The authors have no competing interests to declare.