Table 5.

Factors Influencing Couples’ Social Careers in Assisted Living

Factor level	Description
Societal factors
Norms	Norms governing married/unmarried couples and pertaining to gender and age affected couples’ reception. Among married couples, relationship norms, including those governing caregiving, often shaped dedication to care activities and living arrangements (i.e., remaining in the same setting).
Community factors
Size, location, resources, and AL regulations	The size and location of the facility’s surrounding community influenced the availability of nearby health care resources, nursing homes, hospice, rehabilitation facilities, and other AL communities. Availability meant couples could visit one another if separated by illness or having relocation options if discharged. AL regulations provide parameters for facility policies.
Facility factors
Physical environment	Facility size often affected availability of relationship partners. Dementia care unit availability facilitated asynchronous couples being in the same AL setting, but also meant physical separation for certain couples.
Social environment	Degree of tolerance for frailty, availability of support, complaints, and gossiping influenced resident experiences, including of couples.
Policies and resources	Discharge policies (often shaped by facility resources) affected whether couples could remain together with increased impairment and care needs.
Practices and staff intervention	Whether or not staff encouraged residents to spend time in common areas, attend activities and meals, and promoted social relationships affected opportunities for social interaction, particularly among couples. Staff intervention in intimate and social relationships was both proactive and reactive.
Activity programming	The availability of a range of activities allowed couples with different interests and abilities to have some independence from one another and engage with other residents.
Resident characteristics/profile	Resident characteristics, especially levels of impairment, affected levels of tolerance for fellow residents. The number of couples affected opportunities to socialize with other couples. Gender imbalance sometimes led to jealousy and in a few instances, created opportunities for infidelity.
Dyadic/shared factors
Intimate relationship characteristics and history	Married couples in AL all had long-term relationships and past ways of relating that continued in AL and shaped daily life and often the negotiation of illness and decline among spouses. Unmarried couples met and dated in AL and lived in separate apartments.
Pathways to and tenure in AL	Couples’ synchronicity in health and need to relocate to AL affected experiences (see Kemp, 2008) and sometimes led to transitioning at different times. Being asynchronous often involved caregiving, which limited social interaction with others. Longer tenure sometimes meant time to adjust and become open to the idea of socializing with others, but the passage of time could lead to increasing frailty and isolation.
Living arrangements	Arrangements included living in the same or different apartment, floors, or sections of the AL community. These arrangements influenced couples’ interaction patterns with One another and others.
Collective health conditions and functional status	Couples’ health and functional status shaped their daily activities, socialization, and care needs. Those with greater collective limitations often were the most socially and physically isolated from each other and others.
Collective perceptions, behaviors, strategies, and  preferences	The needs of one spouse often defined couples’ overall experiences. Couples’ collective abilities and resources, including for example, resources to pay for assistance such as a private care aide and the couples’ collective perceptions and treatment of other residents, including their interest in and willingness to socialize in AL, affected their overall engagement with others and involvement in AL life. In certain instances, individual spouses’ preferences were at odds, with spouse’s behaviors sometimes dominating a couple’s collective pattern.
Collective social characteristics and identity	Each couple had characteristics that shaped their identity as a couple both in terms of how the related to each other (e.g., loving couple) and others (e.g., social couple). Among unmarried couples identifying as a couple in AL led to being the target of gossip.
Family involvement	Availability of family involvement affected the level of support for one or both, such as facilitating social interaction or intervening in relationship problems.
Individual factors
Health conditions, functional status, and resources	Individuals’ health conditions and functional status affected day-to-day well-being and care needs and abilities and shaped interest in interaction with others, including one’s intimate partner, and willingness and ability to participate in social life, including attending meals and activities.
Perceptions, behaviors, strategies, and preferences	Individuals’ perceptions and treatment of other residents, including their interest in and willingness to socialize in AL affected the couple’s individual and collective engagement with others.
Personal characteristics and identity	Each spouse/partner’s identity affected how they related to the other (e.g., loving spouse) and others (e.g., nice person). Often these identities were shaped by personal characteristics.
Relationships with others	The quality, quantity, and nature of individual spouses/partners’ relationships with others, particularly coresidents, affected their individual and shared social experiences in AL. Friendships were resources for coupled spouses, particularly with caregiving or loss of a spouse. Conversely, relationships with others led to jealousy and infidelity.

Note: AL = assisted living.