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. Author manuscript; available in PMC: 2020 Jan 10.
Published in final edited form as: Seniors Hous Care J. 2019;27(1):51–61.

Service Availability, Service Use, and Psychological Well-Being of Older Residents of Residential Care Facilities and Nursing Homes

Yeon Jin Choi 1
PMCID: PMC6953900  NIHMSID: NIHMS1065597  PMID: 31929851

Abstract

The Problem:

The availability and use of certain services that can compensate for older adults’ decreased abilities and capabilities may help them maintain their independence and improve their psychological well-being. Therefore, this study investigated whether service availability and service use were associated with the psychological well-being of residents of residential care facilities and nursing homes.

The Resolution:

Residents who used services that provide help with activities of daily living and instrumental activities of daily living were more likely to report a worse mood, poor psychological health, and low self-efficacy compared with those living in facilities where the services were not available. On the other hand, older residents who used social and wellness-related services were more likely to have a better mood, good psychological health, and high self-efficacy.

Tips for Success:

Senior living facilities should consider providing more social and wellness-related services and encourage residents’ use of such services to improve their psychological well-being.

Keywords: Mood, physical activity, psychological health, self-efficacy, social events and activities

INTRODUCTION

According to the press—competence model, individuals’ competence or ability to cope declines as they age because of multiple factors such as social isolation, reduced income, and decreased physical and cognitive functioning (Lawton & Nahemow, 1973). Individuals in residential care facilities and nursing homes may face more barriers to completing their daily tasks or meeting their social needs because they often have multiple chronic conditions and limited physical functioning (Harris-Kojetin et al., 2016; Mitzner, Chen, Kemp, & Rogers, 2011; Rensbergen & Nawrot, 2010). In 2014, approximately 2.2 million older adults resided in residential care facilities and nursing homes, and more than 40% needed assistance with at least one activity of daily living (ADL) (i.e., eating, bathing, dressing, walking, transferring, or toileting) (Harris- Kojetin et al., 2016).

Previous studies have asserted that supportive environments, the use of assistive services or technology, and the adoption of health behaviors can compensate for older adults’ loss of functioning and enhance opportunities to age well, especially for those who have decreased competence (Baltes & Baltes, 1990; Kahana, Lovegreen, Kahana, & Kahana, 2003; Lawton & Nahemow, 1973; Nimrod & Kleiber, 2007; Wahl, Iwarsson, & Oswald, 2012). On the other hand, a poor environment and unmet needs may impose significant constraints on older adults, including psychological distress (Choi & McDougall, 2019; Kahana et al., 2003; van Walsem, Howe, Ruud, Frich, & Andelic, 2017; Wahl et al., 2012). For example, Choi and McDougall (2019) found that a greater number of unmet needs for formal services was associated with more depressive symptoms. Similarly, a study by van Walsem et al. (2017) found that unmet needs for health care and social support services were associated with a lower quality of life.

Based on empirical evidence, providing appropriate services may help older adults maintain their independence and improve their psychological well-being. Therefore, this study aimed to determine which services were positively associated with the psychological well-being (i.e., mood, psychological health, and self-efficacy) of older adults.

METHODS

Data and Sample

The National Health and Aging Trends Study (NHATS) has been surveying a nationally representative sample of more than 8,000 Medicare beneficiaries (aged 65 and older) annually since 2011. The sample person questionnaire collects detailed information about respondents’ demographic characteristics; physical and cognitive health; physical, social, technological, and service environment; use of assistive devices and rehabilitation; help received with daily activities; and well-being. In addition, the NHATS collects data from facility staff for survey participants living in seniors housing facilities (facility staff questionnaire) and from proxy respondents for survey participants who died between the data collection rounds (Last Month of Life [LML] questionnaire). If a survey participant is unable to respond due to physical or mental impairments, the surveys can be completed by a relative or staff member familiar with the participant’s daily routine. The facility staff questionnaire includes information about the facility and the services it provides, while the LML questionnaire focuses on end-of-life care. In 2015, the sample was replenished for the youngest age group (ages 65–69) and for those who died or were lost to follow-up in older age groups (DeMatteis, Freedman, & Kasper, 2016).

For the current study, observations were drawn from the NHATS Round 5 to Round 7, which include information about 13 services. Before Round 5, the NHATS included nine services. The NHATS Round 5, Round 6, and Round 7 covered 8,334 survey participants, approximately 9.44% (n = 787) of whom lived in senior living facilities, including residential care facilities and nursing homes, at least once during the survey period. Of the 787 residents, 565 (71.79%) completed the sample person interview and constituted the subsample for this study. Because the NHATS collects data annually, multiple survey data sets were available for participants who lived in residential care facilities or nursing homes multiple times or for longer periods. For example, participant A lived in a nursing home in 2015 and 2017. Thus, data from the 2015 and 2017 surveys are available for this resident. When two or more data sets were available for a participant, the most recently collected data—2017 data for participant A—were used.

Measures

Dependent variables.

To assess older adults’ psychological well-being, this study included three dependent variables: mood, psychological health, and self-efficacy.

Mood.

Mood was assessed by means of four items. Respondents were asked how often during the last month they felt “cheerful,” “bored,” “full of life,” and “upset.” The response options were 0 (never), 1 (rarely [once a week or less]), 2 (some days [2–4 days a week]), 3 (most days [5–6 days a week]), and 4 (every day [7 days a week]). Two items that asked respondents if they were “bored” and “upset” were reverse coded. The items were then summed to create a score in which higher values indicated a better mood. The summed score ranged from 0 to 16 (Cronbach’s α = .70).

Psychological health.

The NHATS includes four items to assess psychological health: (1) “My life has meaning and purpose,” (2) “I feel confident and good about myself,” (3) “I gave up trying to improve my life a long time ago” (reverse coded), and (4) “I like my living situation very much.” The response options were 0 (not at all), 1 (agree a little), and 2 (agree). The third item was excluded from the psychological health score (ranging from 0 to 6) because of the low internal consistency. Cronbach’s α for the three items was .65, which is slightly lower than the ideal cut point of .70 (Nunnally, 1978). This measure may reflect the small number of items in the scale. In this case, Briggs and Cheek (1986) suggested using the mean interitem correlation as a guide. The recommended mean interitem correlation values ranged from .2 to .4 (Briggs & Cheek, 1986). The mean interitem correlation for the three items was .38. The summed psychological health score was skewed and not appropriate for ordinary least squares (OLS) regression because of the limited range. Thus, it was coded as 0 (poor psychological health [0–4]) or 1 (good psychological health [5–6]).

Self-efficacy.

The NHATS includes three items to assess self-efficacy: (1) “Other people determine most of what I can and cannot do” (reverse coded), (2) “When I really want to do something, I usually find a way to do it,” and (3) “I have an easy time adjusting to change.” The response options were 0 (not at all), 1 (agree a little), and 2 (agree). Answers to the first two items were summed to create a self-efficacy score (ranging from 0 to 4); the third item was excluded from the self-efficacy score due to low internal consistency. The mean interitem correlation for the two items was .26. The summed self-efficacy score was skewed and not appropriate for OLS regression because of the limited range. Thus, it was coded as 0 (low self-efficacy [0–2]) or 1 (high self-efficacy [3–4]).

Independent variables.

The independent variables for this study are service availability and service use. The NHATS collected information about nine services from 2011 (Round 1) to 2014 (Round 4): (1) meals in a common dining area or in the resident’s room, (2) help with medications, (3) help with bathing or dressing, (4) laundry service for linens or clothing, (5) housekeeping, (6) transportation (e.g., a van or shuttle) to doctors or other medical care providers, (7) transportation to stores or events (e.g., concerts), (8) recreational facilities for residents (e.g., swimming pools, game rooms, and tennis courts), and (9) organized social events and activities. In 2015 (Round 5), four more services or features were added: (1) an indoor fitness center, (2) areas in which to walk for pleasure or exercise (e.g., an outdoor walking path), (3) onsite health and wellness programs, and (4) a medical emergency system to call someone for help.

For each service, respondents were asked if the service was available and if they used the service. Using this information, I created a new set of variables with three categories to reflect both service availability and service use: 0 (service not available), 1 (service available, not used), and 2 (service available, used).

Control variables.

The control variables were age (65– 69 [reference group], 70–74, 75–79, 80–84, 85–89, and 90 and older), gender (male [reference group] and female), marital status (married/partnered [reference group], separated/divorced/widowed, and never married), race/ethnicity (non-Hispanic White [reference group] and non-White and/or Hispanic), annual income (Q1 [less than $14,514.30], Q2 [$14,514.30– $26,536.29], Q3 [$26,536.30–$49,999.99], and Q4 [$50,000 or more]), self-reported health (range, 0–4), and depression (range, 0–12). A greater value for self-reported health indicates better health and a greater value for depression indicates more severe depression.

Statistical Approach

Since the sample included cases with missing data, imputation procedures were used to avoid biased results. Multiple imputation is one of the most rigorous and accepted techniques for dealing with missing data because it maximizes the use of available information, takes into account the uncertainty of missing data, and minimizes bias (Allison, 2000; Donders, van der Heijden, Stijnen, & Moons, 2006; Johnson & Young, 2011). According to the early literature (Rubin, 1978; Rubin, 1987), generating a few imputed data sets (e.g., five) for analysis was recommended. However, more recent literature suggests that a larger number of imputations can decrease the likelihood of bias. For example, Graham, Olchowski, and Gilreath (2007) recommend 20 imputations in cases in which 10% to 30% of the data are missing. Thus, to reduce potential bias and obtain more accurate and reliable results, 20 complete data sets without missing values were created using the multiple imputation by chained equations procedure. Cases with imputed values for the dependent variables were excluded from the analyses (Von Hippel, 2007).

Univariate descriptive analyses (i.e., frequencies and means) were conducted to provide an overview of the sample. A series of OLS regression and logistic regression models were then estimated to assess the relationship between the service environment and older residents’ mood, psychological health, and self-efficacy. Regression analysis takes into account the covariance of other variables and attempts to estimate the unique effect of each variable. Analyses were conducted using STATA 15 software (StataCorp). In all analyses, sample weights provided by the NHATS were applied to adjust for differential selection probabilities and nonresponse.

RESULTS

Residents’ Characteristics

Overall, the respondents reported good psychological well-being. As shown in Table 1, the mean (SD) mood score was 11.08 (3.24), which means respondents were in a good mood 5 to 7 days a week. The majority of respondents (71.79%) also reported good psychological health and high self-efficacy (81.58%).

Table 1. Descriptive Information on the Analytic Sample.

Mean (SD)/% Mean (SD)/%
Psychological Well-Being Offered Services & Usage (continued)
Mood (Range: 0–16) 11.08 (3.24) Social Events and Activities
Psychological Health  Service unavailable 13.52%
 Poor psychological health 28.21%  Service available/ Not used 28.42%
 Good psychological health 71.79%  Service available/ Used 58.07%
Self-Efficacy Indoor Fitness Center
 Low self-efficacy 18.42%  Service unavailable 40.74%
 High self-efficacy 81.58%  Service available/ Not used 35.19%
Offered Services & Usage  Service available/ Used 24.07%
Meals Areas to Walk
 Service unavailable 6.05%  Service unavailable 10.62%
 Service available/ Not used 9.82%  Service available/ Not used 28.92%
 Service available/ Used 84.12%  Service available/ Used 60.46%
Help with Medications Health and Wellness Programs
 Service unavailable 25.19%  Service unavailable 25.82%
 Service available/ Not used 30.57%  Service available/ Not used 40.00%
 Service available/ Used 44.25%  Service available/ Used 34.18%
Help with Bathing/Dressing Medical Emergency System
 Service unavailable 31.69%  Service unavailable 12.39%
 Service available/ Not used 36.80%  Service available/ Not used 66.76%
 Service available/ Used 31.51%  Service available/ Used 20.84%
Laundry Control Variables
 Service unavailable 25.83% Age
 Service available/ Not used 23.63%  Age 65–69 2.72%
 Service available/ Used 50.54%  Age 70–74 11.48%
Housekeeping  Age 74–79 12.25%
 Service unavailable 14.85%  Age 80–84 20.31%
 Service available/ Not used 8.86%  Age 85–89 26.60%
 Service available/ Used 76.29%  Age 90+ 26.64%
Transportation to Doctors Gender
 Service unavailable 21.67%  Male 33.81%
 Service available/ Not used 51.29%  Female 66.19%
 Service available/ Used 27.04% Marital Status
Transportation to Stores or Events  Married/Partnered 22.69%
 Service unavailable 22.68%  Separated/Divorced/Widowed 68.56%
 Service available/ Not used 49.72%  Never married 8.75%
 Service available/ Used 27.60% Race/Ethnicity
Recreational Facilities  White, non-Hispanic 86.23%
 Service unavailable 35.37%  Non-White and/or Hispanic 13.77%
 Service available/ Not used 37.44% Income (Range: 0–999999) 41237.6
 Service available/ Used 27.18% (58503.11)
Self-reported health (Range: 0–4) 2.14 (1.00)
Depression (Range: 0–12) 2.28 (2.70)
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Services that provide help with ADLs and instrumental activities of daily living (IADLs), including meals (93.94%), help with medications (74.82%), help with bathing or dressing (68.31%), laundry service (74.17%), housekeeping (85.15%), and a medical emergency system (87.60%), were often available to respondents. The probable reason for this high level of service availability is that respondents were living in residential care facilities and nursing homes in which the primary purpose is to serve older adults with chronic conditions and disabilities. More than three quarters of respondents reported that transportation services, including transportation to doctors or other medical service providers (78.33%) and transportation to stores or events (77.32%), were available. A wide variety of social and wellness-related services, including recreational facilities (64.62%), social events and activities (86.49%), an indoor fitness center (59.26%), areas in which to walk for pleasure or exercise (89.38%), and onsite health and wellness programs (74.18%), also were available. When services were available, respondents reported the highest use for meals (84.12%), followed by housekeeping (76.29%), areas to walk in (60.46%), and social events and activities (58.07%). On the other hand, use was lowest for a medical emergency system to call someone for help (20.84%) and an indoor fitness center (24.07%).

With regard to demographic characteristics, the majority of respondents (53.24%) were older than 85; female (66.19%); separated, divorced, or widowed (68.56%); and non-Hispanic White (86.23%). Respondents’ mean (SD) income was $41,237.60 ($58,503.11). Their mean (SD) self-reported health score was 2.12 (1.00), which is between “good” and “very good,” and the mean (SD) depression score was 2.28 (2.70).

Service Availability, Service Use, and Psychological Well-Being

Table 2 presents the results of the OLS and logistic regression modeling for the relationship between service availability, service use, and psychological well-being of older residents.

Table 2. Availability and Use of Services and Psychological Well-Being of Older Residents.

Mooda Psychological Healthb Self-Efficacyb
b 95% CI b 95% CI b 95% CI
Mealc
 Service available/ Not used −0.14 −1.57 1.30 −0.69 −2.37 0.98 −0.71 −3.06 1.63
 Service available/ Used −0.85† −1.69 −0.002 −1.13 −2.58 0.32 −1.83† −3.75 0.09
Help with Medicationsc
 Service available/ Not used −0.01 −0.66 0.63 0.05 −0.77 0.87 −0.17 −1.10 0.76
 Service available/ Used −0.71* −1.39 −0.03 −0.63† −1.33 0.07 −0.89* −1.65 −0.12
Help with Bathing/Dressingc
 Service available/ Not used −0.11 −0.75 0.53 −0.28 −0.99 0.43 −0.38 −1.20 0.45
 Service available/ Used −0.72† −1.46 0.01 −0.86* −1.55 −0.17 −1.02* −1.81 −0.24
Laundry Servicec
 Service available/ Not used −0.64 −1.43 0.14 −0.64 −1.56 0.28 −1.20* −2.18 −0.21
 Service available/ Used −0.48 −1.11 0.16 −0.60 −1.38 0.18 −1.06* −1.89 −0.23
Housekeepingc
 Service available/ Not used −0.51 −1.78 0.76 −0.33 −1.82 1.15 −1.59† −3.26 0.07
 Service available/ Used −0.86† −1.74 0.02 −1.02† −2.21 0.16 −1.84* −3.31 −0.36
Transportation to Doctorsc
 Service available/ Not used −0.66 −1.45 0.13 −0.31 −1.07 0.45 −0.07 −1.00 0.86
 Service available/ Used −0.46 −1.31 0.38 −0.25 −1.11 0.60 −0.10 −1.09 0.90
Transportation to Stores or Eventsc
 Service available/ Not used 0.07 −0.73 0.87 −0.29 −1.04 0.46 −0.12 −0.92 0.67
 Service available/ Used 0.29 −0.52 1.10 0.21 −0.66 1.08 −0.02 −0.92 0.89
Recreational Facilitiesc
 Service available/ Not used 0.04 −0.70 0.78 0.16 −0.51 0.83 −0.12 −0.91 0.58
 Service available/ Used 0.16 −0.59 0.90 0.81* 0.01 1.61 0.42 −0.50 1.34
Social Events and Activitiesc
 Service available/ Not used 0.26 −0.92 1.44 0.94* 0.05 1.83 1.20* 0.26 2.14
 Service available/ Used 0.48 −0.53 1.49 1.17** 0.29 2.04 1.00* 0.06 1.95
Indoor Fitness Centerc
 Service available/ Not used −0.02 −0.66 0.61 0.19 −0.49 0.87 0.30 −0.49 1.08
 Service available/ Used 0.30 −0.42 1.02 0.77† −0.13 1.67 1.14* 0.003 2.28
Areas to Walkc
 Service available/ Not used 0.69 −0.35 1.73 0.88† −0.15 1.90 0.69 −0.41 1.78
 Service available/ Used 0.79† −0.13 1.71 1.11* 0.18 2.03 1.05* 0.04 2.07
Health and Wellness Programsc
 Service available/ Not used 0.72† −0.06 1.51 0.76† −0.05 1.56 0.81† −0.13 1.75
 Service available/ Used 0.17 −0.65 0.98 0.37 −0.38 1.13 0.37 −0.55 1.28
Medical Emergency Systemc
 Service available/ Not used 0.05 −0.70 0.80 −0.22 −1.20 0.75 −0.74 −1.88 0.40
 Service available/ Used −0.84† −1.70 0.03 −0.50 −1.59 0.59 −0.91 −2.15 0.34
N 477 474 469
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a

Ordinary least squares (OLS) regression model

b

Logistic regression model

c

Reference group: Service not available

Note. All models include control variables to adjust for age, sex, socioeconomic status, and physical and psychological health. Results for the control variables are available upon request.

†

p<0.10;

*

p<0.05;

**

p<0.01.

Mood.

The availability of services—except for onsite health and wellness programs (b = 0.72, p < .10)— was not associated with the residents’ mood. In other words, there was no significant difference in mood between older adults who were living in residential care facilities or nursing homes in which the services were not available and those who did not use the services when they were available. Residents’ use of services that provide help with ADLs and IADLs, including meals (b = −0.85, p < .10), help with medications (b = −0.71, p < .05), help with bathing or dressing (b = −0.72, p < .10), housekeeping (b = −0.86, p < .10), and a medical emergency system (b = −0.84, p < .10), was negatively associated with their mood, when other variables were kept constant. Therefore, residents living in facilities that provide such services and who used the services had a worse mood on average than those living in facilities in which the services were not available. Older adults who lived in facilities with areas in which to walk for pleasure or exercise and who used these areas reported having a better mood compared with those living in facilities without this feature, when controlling for other variables (b = 0.79, p < .05).

Being non-White or Hispanic and better health status were positively associated with mood, while being separated/divorced/widowed and a higher depression score were associated with a worse mood. Age, gender, being never married, and income were not statistically significantly associated with mood.

Psychological health.

Older residents who used services that provide help with ADLs and IADLs, including help with medications (b = −0.63, p < .10), help with bathing or dressing (b = −0.86, p < .05), and housekeeping (b = −1.02, p < .10), were more likely to have poor psychological health than those living in facilities in which such services were not available, when other variables were held constant. On the other hand, residents who used social and wellness-related services, including recreational facilities (b = 0.81, p < .05), social events and activities (b = 1.17, p < .01), an indoor fitness center (b = 0.77, p < .10), and areas to walk in for pleasure or exercise (b = 1.11, p < .05), were more likely to have good psychological health than those living in facilities without such services or features, when other variables were controlled. The availability of social events and activities (b = 0.94, p < .05) and the availability of areas in which to walk (b = 0.88, p < .10) were positively associated with good psychological health even when these features were not used.

Better health status was associated with better psychological health, whereas being separated/ divorced/widowed and a higher depression score were associated with poor psychological health. Age, gender, race/ethnicity, being never married, and income were not statistically significantly associated with psychological health.

Self-efficacy.

Older residents who used the meal service (b = −1.83, p < .10), help with medications (b = −0.89, p < .05), help with bathing or dressing (b = −0.38, p < .05), laundry service (b = −1.20, p < .05), or housekeeping (b = −1.84, p < .05) were more likely to have low self-efficacy compared with those who lived in facilities in which such services were not available, when other variables were kept constant. Regardless of residents’ use of these services, the availability of laundry service (b = −1.20, p < .05) and the availability of housekeeping (b = −1.59, p < .10) were associated with low self-efficacy.

Residents who were using social and wellness-related services, including social events and activities (b = 1.00, p < .05), an indoor fitness center (b = 1.14, p < .05), and areas in which to walk for pleasure or exercise (b = 1.05, p < .05), were more likely to have high self-efficacy than those who were living in facilities in which such services were not available, when other variables were kept constant. The availability of social events and activities (b = 1.20, p < .05) as well as areas to walk in (b = 0.81, p < .10) were positively associated with high self-efficacy even when residents did not use these services.

Being non-White or Hispanic was positively associated with self-efficacy, while being separated/divorced/ widowed, being never married, and a higher depression score were negatively associated with self-efficacy. Age, gender, income, and self-reported health were not statistically significantly associated with residents’ self-efficacy.

DISCUSSION

This is the first study, to my knowledge, to examine whether the availability and use of specific services are associated with the psychological well-being of older adults living in residential care facilities and nursing homes. Overall, the use of services that provide help with ADLs and IADLs was negatively associated with older residents’ psychological well-being. This finding may reflect the need for residents to use such services because of multiple chronic conditions and limited physical functioning, which have been associated with poor psychological well-being (Backe, Patil, New, & Clench-Aas, 2018; Na & Streim, 2017).

The availability and use of social and wellness-related services, which promote social interactions and encourage health behaviors (specifically physical activity), were positively associated with psychological well-being. In particular, social events and activities as well as areas to walk in for pleasure or exercise were consistently associated with psychological health and high self-efficacy. Vozikaki, Linardakis, Micheli, and Philalithis (2017) found that older adults who participated more frequently in social activities (i.e., a sport, an educational or a training course, a social or another kind of club, a religious organization, or a political or community-related organization) had a higher level of well-being, including higher life satisfaction, better quality of life, and fewer depressive symptoms. This may be because social participation or social engagement increases social interaction and strengthens one’s social support network. Previous studies have reported an association between social interaction/social support and better psychological well-being (Krause, 1986; Park, 2009; Portero & Oliva, 2007; Thomas, 2009; Tough, Siefrist, & Fekete, 2017).

The psychological benefits of physical activity are also well documented in the literature (e.g., DiLorenzo et al., 1999; Emery & Gatz, 1990; Hui, Chui, & Woo, 2009; Netz, Becker, & Tenenbaum, 2005; Ross, Bohannon, Davis, & Gurchiek, 1999). For instance, walking is associated with stronger self-efficacy and a better quality of life (Oka et al., 2000; Resnick & Spellbring, 2000). Previous studies have reported that built environments (e.g., gym, golf course, swimming pool, and green spaces) are associated with older adults’ physical activity (Booth, Owen, Bauman, Clavisi, & Leslie, 2000; Brownson, Baker, Housemann, Brennan, & Bacak, 2001; Cunningham & Michael, 2004). Intervention programs to improve psychological well-being through physical activity (e.g., dance, Tai Chi, walking, stretching, and muscle strengthening) also have been successful (Emery & Gatz, 1990; Hui et al., 2009; Ross et al., 1999). Therefore, improving facilities’ built environments and providing interventions to increase physical activity would benefit older residents.

In this study, although the availability of certain services was associated with psychological well-being even when the services were not used, most services were significantly associated with positive outcomes when they were used by respondents. This finding suggests that psychological well-being is not affected significantly by the availability of services but by the use of these services. Thus, residential facilities for older adults should encourage residents to use or participate in the available services. Researchers have reported that older adults’ awareness of and perceptions regarding the health benefits of these services are associated with greater use (McMahon et al., 2018; Snider, 1980). Client outreach using community bulletins, as well as observations and encouragements from family and friends, may be effective as they are the most commonly identified sources for increasing older adults’ awareness and use of services (McMahon et al., 2018).

Transportation services were not associated with psychological well-being in this sample. One possible explanation for this finding is that residential care facility and nursing home residents do not need to travel to obtain essential services, including meals, medical services, and social/recreational opportunities, because they often are available at the facilities (Ewen, Washington, Emerson, Carswell, & Smith, 2017). The situation may be different for older residents living in retirement communities or independent living facilities. Reduced mobility due to residents’ poor health and functional limitations could be another explanation. Further research is needed to confirm these findings.

Study Limitations

Several limitations need to be considered. This study used a cross-sectional design, which limits the ability to assess causality of the examined relationships. For example, it is possible that those who have better psychological well-being tend to use social and wellness-related services, rather than the other way around (i.e., those who use social and wellness-related services have better psychological well-being).

Generalizability is another limitation of this study. The study sample is composed of older adults who were living in residential care facilities or nursing homes during the survey period. Service availability and service use may have different effects in other facilities such as retirement communities or independent living facilities, where residents have intact physical functioning and greater social needs (Harris-Kojetin et al., 2016; Van Dijk, Cramm, Ban Exel, & Nieboer, 2015). Therefore, additional research should be conducted on a broader population.

CONCLUSION

This study highlighted the importance of the service environment in promoting older residents’ psychological well-being. The findings suggest that senior living facilities should consider providing social and wellness-related services and encourage residents to participate in or use such services to improve their psychological well-being. Providing social activities and events and promoting walkability may be the most effective ways to improve older residents’ psychological well-being.

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