When it comes to aging, what do people fear most?

It can vary, but the general themes are pain, disability, loss of independence, death.

We’ve written about all of these things! Yes, even: Managing Your Mortality: When Planning Is A Matter Of Life & Death

Today we’ll be focusing on the topic of loss of independence, a fear that’s especially strong in the US, where feeling or at least seeming independent is more highly valued culturally than in a lot of countries.

Specifically, the question of continuing to live “independently” in one’s own private home, or “communally” in a care home.

A matter of control

The answer seems obvious: one simply has more control over one’s own life in one’s own private home, than one possibly can in a care home.

Right?

Researchers (Dr. Lisa Burrell et al.) interviewed 471 people aged 65+, to compare care-related quality of life (CRQoL) among those living in nursing homes, sheltered housing (care homes), and those receiving home care services.

Surprisingly, the participants receiving home care reported feeling significantly less control over their everyday lives than those living in care homes or sheltered housing, which strongly goes against the common assumption that remaining in one’s own home provides greater independence.

Why this matters: feeling in control is associated with better physical and cognitive health, reduced frailty, lower mortality, better quality of life, and healthier behaviors. However, it really is about the feeling of control, not the control itself—as we become more dependent on assistance, feeling in control becomes less about doing everything independently, and more about being informed, listened to, respected, and involved in decisions.

Further, those living in their own homes also reported fewer meaningful activities than those living in care homes or sheltered housing, and resultantly, more boredom—even though they were on average younger, healthier, and had more contact with family and friends than residents of nursing homes or sheltered housing.

It’s worth remembering at this point that one can still experience age-related alienation even when having contact with family and friends, and this issue is by no means location-bound.

You can read about that, here: When The World Moves Without Us… Can We Side-Step Age-Related Alienation?

As for what factors may have influenced this: participants described long waits, unpredictable visit times, and frequent changes in caregivers*, making it difficult to maintain routines or plan meaningful activities. Plus, in the case of home care compared to care homes, high staff turnover meant many people were regularly cared for by unfamiliar workers, reducing trust, continuity, and feelings of control.

^{*home care providers often make use of a rotating cast of temp workers, compared to residential care homes with their typically longer-term staff}

In short, what’s most important is one’s own situational agency. For example:

• In your own home, you may have the independence to say “I still live in my own private home”
• In a care home, you may have the control of having an entire staff on hand to do your bidding (within reason!)

Now, obviously that doesn’t mean you have to rush to move to care home, especially if you really don’t need care yet. That’s not what this is about; this is not a sales pitch for care homes.

But even so, it’s something to keep in mind, for when eventually the time comes that such decisions become relevant.

To read the paper itself and see all the data in full, here it is: Individual and interpersonal factors associated with care-related quality of life in older adults: a comparison of home-based services, nursing homes and sheltered housing

Want to learn more?

For a practical guide with decision-making flowcharts and helpful checklists, see:

Who Will Take Care of Me When I’m Old? – by Joy Loverde

You should also definitely check out this truly excellent book we reviewed a while back:

This Chair Rocks: A Manifesto Against Ageism – by Ashton Applewhite

…and the equally highly recommendable:

Women Rowing North: Navigating Life’s Currents and Flourishing As We Age – by Dr. Mary Pipher

Take care!