Perspectives on the living environment and care arrangements

Background: The ageing population and increasing life expectancy present both challenges and opportunities to transform living environments and care arrangements for older adults. Innovative residential care concepts for older adults are increasingly emphasizing the importance of immediate social networks and broader community connections. To ensure these developments align with the needs and preferences of residents, it is essential to understand how these changes resonate with the perspectives of older adults with intensive care needs regarding their current and future living environments, including the role of the community. This study, therefore, seeks to answer the question: What are the perspectives of older adults with intensive care needs, outside of nursing homes, on their living and care environments? Approach: This study aimed to capture the underrepresented perspectives of older adults with intensive care needs living outside traditional nursing homes. A multiple case study was conducted through interviews across five initiatives which focused on creating collective, independent, home-like settings designed to foster community-oriented care environments. An initial interview guide, developed from pilot study interviews with residents (n=10) from a care organisation, explored views on both current and future living environments and care arrangements. Following refinement with input from care professionals, semi-structured interviews were conducted with participants (n=30) who were either on a waiting list or already residing in an innovative residential care concept. These interviews explored not only individual experiences but also the role of community (support) and social connections within living environments. In some cases, partners or family members participated, offering additional insights. Data was analysed by the primary researcher using phenomenological thematic analysis, uncovering key themes that provided a deeper understanding of residents’ experiences. Results: Through the interviews, five key themes emerged, highlighting what residents with intensive care needs value in their living environments and care arrangements. Many residents voiced concerns about whether their homes would meet future care needs, emphasising a desire for security and assured support as they age. Independence and control were also crucial; residents wished to stay in their homes and retain decision-making power, underscoring the value of care that supports autonomy in familiar settings. Accessibility of living spaces emerged as a priority, with many noting the necessity of physical adaptations to maintain independence and support daily living. Beyond physical features, feeling “at home” involved personal touches, familiar furniture, and connections with nearby family and neighbours, creating a comforting and genuine sense of belonging. Social connectedness varied, with some residents favouring regular activities and others valuing quieter interactions. This range suggests that connection doesn’t require intense engagement but can come from small, meaningful moments, allowing each resident to choose their preferred level of social involvement. Implications: These findings highlight the importance of flexible, person-centred approaches that prioritise community engagement while addressing both the physical and social needs of older adults. By continuing to pilot these innovative residential care concepts and incorporating feedback from residents’ ongoing experiences, care providers can develop living environments and care arrangements that genuinely reflect holistic, resident-focused principles

Activities of daily living · Assisted living · Independent living · Intensive care · Life expectancy · Long-term care · Population · Population ageing · Qualitative research · Family and Patient Care in Intensive Care Units · Geriatric Care and Nursing Homes · Interprofessional Education and Collaboration