Being in Place: Toward a Situational Perspective on Care

Abstract

An optimum focus in any care situation is creating and sustaining environments that facilitate an ongoing sense of “being in place” for all involved. Using this rationale, we propose a Situational Model of Care for exploring dynamic relationships among aging persons receiving care, the convoy of persons offering this care and support, and the place where this occurs, as evolving situations throughout the course of a disease. The model is grounded in extant literature and illustrated through a case study derived from in-home observations and interviews. Emphasizing an underlying goal of fostering a sense of being in place as a desirable outcome facilitates situationally nuanced directions in research and clinical care.

The essence of care for aging persons is an evolving quest to facilitate an optimal experience of “being in place” for both the affected individual and their care partners, indeed, for all involved in the situation (Rowles, 2018). Being in place is defined as the sense of well-being that involves identifying with and being at one with one’s environment. It builds on the idea that people can feel a sense of comfort and belonging in a place as a result of physical familiarity (through activity), social engagement, and autobiographical affinity (Rowles, 1980, 1983). Essential elements of the dynamic multidimensional experience of being in place include processes of knowing, doing, being, and becoming (Rowles, 1991; Wilcock, 1998), as people transform the spaces of their lives (which in and of themselves have no meaning) into places of their lives laden with meaning (Rowles & Watkins, 2003).

Clinical care and intervention have lacked sufficient focus on the importance of being in place in situational context as an optimal outcome. While some care strategies include environmental elements (Gitlin et al., 2010; Jao et al., 2020), there is a paucity of guiding frameworks delineating situational contexts and how they evolve over time. Each situational context is the multidimensional confluence at a moment in time of diverse elements that define a place and circumstance. In addition to environmental characteristics such as physical, social, economic, cultural, political, and historical contexts of the place where care is provided, it involves relationships and interactions among the actors involved in that place. Care, both formal and informal, is made more complex because the diversity of life histories and places where lived experience accumulates challenge the creation of usable care models to facilitate being in place (Chaudhury & Oswald, 2019).

We propose a multidimensional dynamic framework, the Situational Model of Care (SMC), to illustrate how the places where care occurs provide both constraints and opportunities in caregiving situations. We briefly trace the evolution of theory about person–environment relationships from a dominant ecological perspective through the emergence of more complex transactional perspectives to the idea of place integration focused on understanding lived experience as constantly evolving situations. Considering the evolving care situation through the lens of three interwoven elements, the aging person, the care convoy, and place, provides a base model from which it is possible to envisage eventually embracing the full array of nuances and complexities involved in the process of providing care. This model is illustrated through a case study of one possible trajectory for a person with progressive cognitive impairment. We conclude by considering implications and recommendations for using this framework to enhance applied research and facilitate sensitive care practice grounded in the evolving context of care situations with the objective of fostering and reinforcing a sense of being in place for all involved.

Theoretical Context

Since the time of Kurt Lewin’s (1936) seminal contribution, B = f(P·E), where B is defined as behavior, P as person, and E as environment, there have been numerous explorations of the person/environment relationship that can be broadly defined as representing an ecological approach (Bronfenbrenner, 1979; Kahana, 1982; Lawton & Nahemow, 1973). In recent years this has involved increasing emphasis on understanding the environment not merely as a passive backdrop but rather as place, an integral and inextricable expression of intentionality as manifest in behavior (agency) and lived experience (belonging) (Chaudhury & Oswald, 2019; Golant, 2020; Wahl et al., 2012).

While our perspective owes much to these theoretical contributions, we perceive a need to adopt a broader post-ecological approach that transcends and moves beyond merely overcoming the dualism of person and place. “…people’s lives unfold in places that are complex social and cultural ‘fields of action’ that are occupied, acted and deeply felt” (Andrews et al., 2013, p. 1344). Such an approach necessitates embracing the place-specific dialectic complexity of social practices and sociocultural norms and expectations that shape the behavior of the actors involved in any situation (Lawton & Simon, 1968; Wanka, 2019; Wanka & Gallistl, 2018). Specifically, we propose reframing thinking in relation to Cutchin’s idea of place integration and embracing the lens of John Dewey’s pragmatism (Cutchin, 2001, 2018). Cutchin described human/environment relationships not within a stimulus/response or cause and effect rubric, but rather as a co-constitutive, transactional processes evolving within a constantly changing situation. As situations happen—and the emphasis is always on the world as emergent—person and place coevolve, and their relationships are re-coordinated through active experience. Cutchin envisions each person transactionally related to physical and social surroundings and experiencing a greater or lesser degree of belonging and being in place as they constantly adjust to the instabilities of change and negotiability as each situation evolves (Rowles, 2018). Embracing the place component of each situation as a fundamental element of the caregiving process enables us to better understand both the context in which care is provided and the dynamic progression of the care process.

Toward an SMC

The SMC offers a framework to explore three dynamic complementary co-constitutive and transactional components of any evolving care situation: the aging person, their care convoy, and place (Figure 1).

Figure 1.

A Situational Model of Care.

Aging Person

The aging person and his or her well-being, as reflected in a sense of being in place, is the ultimate focus of the model. Each person is defined by their capabilities which change during the course of aging and a disease. Mobility, physical strength and flexibility, visual and auditory acuity, indeed an array of measurable physiological characteristics, shape each person’s capability at any point in time and situation. These characteristics are complemented by each person’s identity—their personality, level of introversion, morale, and a myriad of interwoven psychological traits—each conditioned by life history, personal circumstances, and lived experience.

Care Convoy

The second component of the model is the dynamic social and care networks within which each person is embedded. Here we embrace the concept of a care convoy, building on the multidisciplinary convoy model of social relations (Antonucci et al., 2013; Kahn & Antonucci, 1980; Kemp et al., 2013). Throughout their lives, each person is surrounded by a constellation of people who provide support; parents, partners, children, other family members, friends, acquaintances, and people involved in the activities in which we engage and the services we harness. During each phase of life, the composition of the convoy changes as new people are added and others drop off. In old age, and particularly in circumstances where a person is grappling with a disease or progressive chronic illness, a care convoy may become comprised of a web of both informal and formal caregivers, often involving a primary caregiver and close family members, eventually complemented by formal service providers, and sometimes, finally, by the staff of an institutional care setting.

Place

The third element of the model, and a key aspect of maintaining a sense of being in place as a goal of care, is an expanded view of the environment. More than a backdrop, physical, social, historical, and cultural settings, as they develop identity (through lived experience) as unique places, become an integral component of caregiving as the aging person and their care convoy negotiate an evolving situation. Place matters.

Place shapes the separateness and mutuality of activity and experience for both the aging person and the care convoy (Baum et al., 2015). Over time, a person’s residence becomes their place of centering (a locus of departure and return), refuge, safety and security, control, comfort, self-expression, and, perhaps most important, identity (Rowles & Chaudhury, 2005). As part of the care process in old age, adjustments to facilitate being in place are essential. But such adjustments, in many ways, are not unique. Changes are made when children leave home. Adjustments necessitated by the need for care as part of coping with illness simply represent a continuation of accommodation to an evolving situation, something for which years of residence in a particular place can establish ample precedent. Acknowledging the perspective of being in place, as a goal in framing environmental affinity, provides an opportunity for sensitive ongoing understanding and support, rather than traumatic disruption. Indeed, this perspective may contribute to explaining why some persons who sustain routine activities in familiar and supportive environments are able to cope with declining capacities much better than others (Rowles, 2000; Snowdon, 1997).

The SMC is grounded in an empathic orientation toward lived experience through a quest for contextual understanding of an evolving care situation as an aging person and their care convoy grapple with the challenges of coping with changes in capability as they try to maintain their daily lives. It is based on recognizing the need to view the aging person, the care convoy, and the place they inhabit, not as individual elements but rather through a holistic lens in which the three are inextricably interwoven. This implies the need to understand each situation through the eyes of those involved and in terms of their individual life histories and lived experience. It necessitates interpreting each situation “in the moment” as all negotiate unique circumstances and seek to maximize a continuing sense of being in place.

Care Situations

In elaborating on the model, we illustrate six care situations representing moments in time using the example of a person experiencing progressive cognitive impairment (Table 1). We emphasize that these are not intended to represent an invariant linear trajectory, but rather situations along one possible trajectory. In most circumstances the sequence of situations is nonlinear, complex, and multidirectional, reflecting the unique fluid characteristics of each care situation, as is the case with most ailments to which the model could be applied.

Table 1.

A Trajectory of Care Situations for Aging Persons With Progressive Cognitive Impairment

Aging person	Care convoy	Place
Care situation 1: historical relationship
Functioning independent older adult	Limited involvement of care convoy	Environmental mastery and autonomy, often with a strong sense of being in place
Care situation 2: recognition of cognitive impairment
Memory impairment, executive function instability,  decreased sensory processing capacity	Awareness that the person is decreasing in cognitive capacity by close care partners	Decreasing congruence with environmental demands creates situational vulnerability that creates a threat to autonomy and maintaining a sense of being in place.
Awareness of increasing difficulties   (1) Cognitive deficits   (2) Difficulty with everyday activities (financial management, mobility challenges in the community, making lists, routinization)   (3) Psychological stress: denial, fear, depression, anxiety   (4) Withdrawal: constricted life space	Growing acceptance of impairments in person with cognitive impairment by care partners and other close members of the care convoy who may experience:  (1) Recognition  (2) Concern  (3) Denial  (4) Acceptance	Self- and care partner initiated environmental and behavioral adjustments seek to sustain being in place:  (1) Environmental cueing to support performance of daily activities (designating space for keys, visible lists)  (2) Situational context reinforces the benefits of environmental familiarity and preference for known places
Care situation 3: shared living at home with informal care
Deteriorating self-care and activity participation	Ongoing caregiving support and accommodation through trial and error with informal care partners in the home and other close members of the care convoy	Deliberate modification of environmental context to maximize autonomy
Worsening behavioral and psychiatric symptoms  (apathy, agitation) Increased confusion/disorientation	Care partners and family members provide assistance through restructuring the environment with cueing to reduce burden and emotional stress	Environmental modification and situational cueing become routine
Care situation 4: shared living at home with formal care
Forced acceptance of increased assistance	Adoption of formal care partners into the care convoy including training of new care help and adjustment to their presence	Transformation of home into a place of care
Behavioral dysregulation Increased environmental docility (Lawton & Simon, 1968)	Maximum engagement and commitment of the care convoy including informal and formal caregiving within the home	Progressive shaping and dependence with increasing environmental dominance
Critical event(s) (e.g., incontinence, injurious fall)	Situation becoming very challenging, requiring constant vigilance and considerable attention thereby utilizing all resources of the care convoy within the home environment	Being in place becomes very difficult and demanding in existing environment
Care situation 5: relocation(s)
Adjustment to institutional lifestyle and routines	Altered roles and activities of primary care partners with addition of institutional care supports	New environment shapes accommodation and adaptation with greater or lesser success in nurturing a sense of being in place
Reduced engagement and increased dependency in  activities of daily living	Altered relationship with members of the care convoy (decreased daily contact from primary care partners and increased involvement of formal care providers—progressive surrogacy; High & Rowles, 1995)	Institutional context becomes dominant
Care situation 6: palliative care
Terminal, passive recipient of care, disengagement	Close contact in providing palliative care in anticipation for end of life; anticipatory grief by primary care partners	Total environmental control reinforcing dependence
Death	End of care convoy	Environmental separation

In reality, most care situations evolve gradually over time with occasional major disruptions resulting from tipping point incidents. Each care situation may be relatively brief or prolonged, repeated or sustained, optimal for allowing a sense of being in place or too divergent from the previous situation to allow a sense of being in place to be easily maintained. For example, toward the final stages of the life trajectory there may be multiple relocations, alterations in the care convoy, and altered focus for life-sustaining purposes.

In addition to its grounding in extant literature, this framework has been developed from extensive clinical experience with aging adults by the first author, as well as in-home observations (n = 16), home environment assessments (n = 8), and interviews (n = 8) with persons living with cognitive impairment and their care partners specifically related to this study (Rhodus et al., 2022). We illustrate care situations of the SMC with a composite case example compiled from this material. While the SMC can be applied to most clinical conditions observed in aging adults who require care, we have selected the continuum of progressive cognitive impairment for illustrative purposes. We emphasize that care trajectories are highly nuanced and vary according to circumstances, processes, and challenges that are conditioned by variables including the sex, race, social class, and culture of those involved. Our example illustrates just one possible pathway.

Care situation 1: historical relationships

Consider the journey of Carol (68 years old) and Paul (74 years old). Married for 37 years, they have resided in their one-story residence for 26 years. Both are retired. They have two adult children. Carol and Paul own their home and so can make modifications as needed to enhance safety and livability. They have familial support from both children who live nearby. Paul has experienced depression and takes a prescribed antidepressant. Carol and Paul are healthy, independent well-functioning older adults caring for each other, but Paul has cognitive impairment, although his condition is not yet detectable. For both, their residence facilitates a sense of being in place because it provides familiarity, ease of social engagement, and autonomy. Their home exerts situational challenges well within the range of their physical and cognitive capabilities.

Care situation 2: recognition of declining capacities

Roughly 18 months from the onset of his depression, Carol notices Paul making errors with managing the checkbook, he often loses his keys or cell phone, and sometimes forgets to turn off the gas stove. He becomes easily frustrated with unexpected changes to his daily routines, becomes reluctant to drive beyond his normal routes, and increasingly prefers to stay at home. Following cognitive testing, a neurologist confirms that Paul has mild cognitive impairment. Paul’s care convoy evolves. Their daughter begins making regular evening visits to their home. Their son adds safety bars in the bathroom and rails to the steps. And friends from Paul’s men’s group offer to drive him to their social gatherings. Such modifications to the care situation support Paul’s sense of being in place as his cognitive capacities change.

Care situation 3: living at home with informal care

Paul continues to make mistakes with household tasks including paying bills and cooking. After another physician evaluation, Paul is diagnosed with Alzheimer’s disease. Carol provides Paul with prepared food which he is able to warm in the microwave on days she is away from home volunteering at the church. Environmental cues, such as leaving snacks on the counter rather than in the cabinet and a water cup placed next to his reading chair, invite him to snack regularly and stay hydrated. Despite the lingering benefits of habituation in sustaining a sense of being in place (Rowles, 2000), challenges in Paul’s behavior and his inability to adjust to the demands of their place of residence eventually become taxing on Carol. She becomes depressed and anxious. Recognizing the tensions of the evolving situation, their daughter starts to bring meals and helps Carol with grocery shopping and cleaning. Added supports of care allow Carol to maintain a sense of being in place as her care load is supported. These modifications also continue to support Paul’s sense of being in place by living in his home.

Care situation 4: living at home with formal care

Eventually, the support received by Carol and her daughter becomes insufficient. Paul’s physician makes a referral for home health to provide in-home therapy, social work for supportive services, and nursing for medication management. Carol also hires a home care aide to help with Paul’s bathing 3 days a week. This provides her with respite but adds to Paul’s agitation. His “sundowning” behavior increases and he becomes increasingly disoriented and sometimes belligerent. Carol becomes more stressed and lonelier, even as her home transforms to a care environment with enhanced levels of family and formal support (Williams, 2002). Paul’s wandering behavior increases, and he begins having episodes of incontinence, particularly at night. To make the bathroom more accessible, Carol rearranges the bedroom to facilitate access but Paul is not able to adapt to this change. Indeed, on the night following the change, he falls over a laundry basket and lands in a closet as he attempts to go to the bathroom. The situation becomes untenable. The fall is a tipping point for Carol as she realizes she can no longer keep Paul safe within their home. Maximal efforts to maintain a sense of being in place at home are exhausted for Paul and his care convoy.

Care situation 5: relocation(s)

With the support of the children, they decide to move Paul into a specialty care dementia unit at a local assisted living facility. After the move, Carol feels some relief as the staff now provide physical care, but the emotional burden continues. Lack of physical familiarity, and reduced autonomy causes Paul to develop severe agitation, and the administrator tells Carol he can no longer reside at the facility. Carol and her daughter tour local nursing homes, but there are no available rooms nearby. So, Paul is moved to a facility 75 min from Carol. She experiences grieving, increased stress, and the loneliness of no longer residing with her husband. Carol is able to visit Paul every Saturday with transportation assistance from her children. Disrupted routines, multiple changes of place, and rapid alterations of the care convoy and being “out of place” hasten Paul’s decline.

Care situation 6: palliative care

Paul loses 45 pounds and becomes completely bedridden. He becomes fully dependent on the immediate care convoy of the staff and the attributes of place to ensure his comfort and preserve any semblance of being in place. One day, not long after a visit with Carol, he dies. Several months later, the stresses on Carol have eased, the tensions and anxieties of her caregiving have abated, and she resumes her volunteer work at the church and begins to reengage with her former social network. Carol continues to visit the nursing home where Paul passed away around major holidays to give the staff homemade gifts.

Discussion and Implications

The SMC, illustrated through the changing care situations of Paul and Carol, facilitates holistically framing research, assessment, and intervention for aging persons needing care and their care convoy through the lens of the mutually overlapping places where care occurs. The care situation evolves with continuous adjustment in actions and understanding during the process of maintaining and promoting a sense of being in place. Typically, care entails changes of place (both in situ and involving relocation). Each place is premised on the notion of sustaining, indeed maximizing, well-being and a sense of being in place for the aging person, their primary care partner, and the rest of the care convoy. Our perspective is consonant with a pragmatic emphasis on aging-in-place and the rapidly proliferating literature on the creation of age-friendly environments viewed through the lens of lived experience (Bigonnesse & Chaudhury, 2020; Meeks, 2022).

Key considerations within the model are the circumstances, processes, and triggers that lead to major transitions in the situation. These can be viewed on two levels. First, for most persons with chronic diseases, there is a typical overall progression marked by gradual deterioration. In addition to the aging person, changing capacities of the care partner and other members of the care convoy to provide support, or the place in which care is provided becoming less conducive to the provision of such care, may lead to the need for “doing transitions” (Urbaniak et al., 2021; Wanka, 2019). The overall trajectory is not necessarily linear or unidirectional; there may be temporary fluctuations in the older person’s condition, the capabilities of the care partner and care convoy, or the supportiveness of place: but a sense of being in place can be sought to until the very end of the care journey. Many transitions are gradual, as members of the care convoy, within the context of accepted social practice and values, gradually come to the realization that change is necessary. For example, the decision to relocate may be made over an extended period as it often involves becoming aware of the need to move, a series of consultations with members of the convoy, a search for and selection from among alternative placement options, and the process of facilitating the actual move (Oswald & Rowles, 2006). Under these circumstances, it may be difficult to isolate when a decision occurs as it has so many contingent elements. On a second level, and in contrast, there may be critical tipping points, precise moments in time when the need for change becomes manifest; for example, the situation when Paul experienced a dangerous fall.

Exploring within the SMC model, the intersections of aging persons, care convoy, and place and the way in which each evolves over time, enables us to consider new themes in care. It may enable us to enhance the quality and, where appropriate, extend the longevity of care within familiar places. We suggest the following elements as key components added by this model.

New Directions for Research

The SMC framework provides an opportunity for research to encompass a situational perspective on place as an integral component of lived experience. A key element of research becomes the challenge of measuring the intended state of “being in place,” investigating how this state is achieved, monitoring the kinds of engagement that are occurring, detecting when this engagement is threatened, and probing its relationship to extant (and perhaps newly created) measures of well-being for the aging person and their care convoy. Methodological innovation, including that of qualitative, mixed methods, and participatory research approaches, is needed to simultaneously monitor evolving care situations over time in the components of the care situation; here, the focus becomes developing an understanding of how components of the care situation influence each other at particular moments in the progression of impairment. An initial step in this process involves developing situational snapshots (documentation of specific characteristics of situations at particular moments in time). In addition to monitoring the situation at key points of tension, there is also a value in researching care situations during times of stability in order to identify and anticipate potential future risks to maintaining a state of being in place. We will continue to misunderstand the lived experience of living with cognitive impairment, indeed a wide array of conditions, if we ignore the subtleties of situational context, with the consequence that assessment and interventions remain less effective, and opportunities for enhanced quality and comfort at the end of life are foregone.

Refining Clinical Assessment

Current outcome measures used in clinical assessment have predominantly focused on the capacity limitations for the aging person. Emphasis has also been placed on the interpretive perspective of primary care informants. Finally, a few assessments acknowledge the role of physical features of place. While these are important directions, we propose increasing simultaneous emphasis on the evolving situation among all three elements, including performance of activities and response to cues; measuring capacity and skill to provide environmental support to facilitate being in place (Baum, 1991; Baum et al., 1993; Phinney et al., 2007). Creating assessments that measure the situation, rather than its individual elements, facilitates measuring and interpreting behavior and accommodation to changing circumstances in a manner that provides new and expanded criteria for evaluating well-being, satisfaction, and quality of life.

We can see an example through continuation of our case example of cognitive impairment. Nearly 90% of people diagnosed with neurodegenerative cognitive impairment demonstrate psychological symptoms and behavior including anxiety, depression, and agitation (Gerlach & Kales, 2020; Lyketsos et al., 2002). Situations which enable safe participation and nurture a sense of belonging become increasingly important in sustaining feelings of being in place (Phinney et al., 2007). Approaches to compensate for the reduced cognitive capacity of a person with progressive impairment may involve sensorial modifications of the situational context, such as decreasing the noise level in the home or enhancing ambient lighting. With increased attention to adaptation of the situation, care partners and other members of the care convoy can utilize sensory influences for behavioral regulation of the cognitive impaired person (Scales et al., 2018). Numerous agencies recommend that treatment of psychological and behavioral symptoms employ nonpharmacological and environmental approaches as first-line interventions prior to the use of medication (Odenheimer et al., 2014). Despite this recommendation, few theories guide assessment and intervention using nonpharmacological and environmentally based treatments (Butler et al., 2020). Care scientists, practitioners, and care providers face a challenge: the medical community recommends nonpharmacological and environmental intervention to promote well-being, but there is limited evidence to support implementation of these types of interventions. The lens provided by the SMC with its focus on situationally assessing what makes for an optimal sense of being in place can facilitate movement in this direction. We posit that a person who experiences and sustains a high level of being in place is less likely to be anxious, depressed, or agitated.

Care Interventions to Facilitate Being in Place

Focusing on the situation and the way this shapes being in place provides a new direction for clinical care intervention to ensure that interventions are appropriately tailored to unique circumstances. For example, implementing environmental modification must fully engage the aging person and the care convoy in order to be effective. Adaptation abilities should be considered prior to making substantial changes, acknowledging the progressively increasing reliance on habit and routine activities within the confined space of the aging person (Cutchin, 2007; Rowles, 2000; Snowdon, 1997). Care partners, clinicians, and behavioral scientists have the opportunity, indeed the obligation, to consider the person within the situation to fully embrace the objective of being in place as a focus for effective clinical provision and change. This dynamic provides a portal for change because considering one element at a time has not been sufficient in providing optimal care and clinical intervention.

Conclusion

We suggest a reorientation in framing research, assessment, and nonpharmacological interventions in considering the lived experience of aging persons and those who care for them. Such a philosophy requires a quest for empathy, adopting strategies of inquiry that facilitate interpersonal and situational knowing. Inevitably, this leads to a level of subjectivity in interpretation as we move beyond the bounds of separate entities—researcher and researched or caregiver and care recipient—and toward complex situational interpretation and understanding. We believe such an approach should be embraced because it represents an ethic of care that holds the potential for truly innovative advances in interventions that de facto are inclusive of diverse populations including those that might otherwise be socially excluded (Tronto, 1998; Urbaniak et al., 2021). This reorientation is based on an SMC that employs a situational focus on the way people of all levels of cognitive capability seek, often implicitly, to sustain a sense of being in place as an element of their well-being. As with any new approach, some caveats are necessary.

Moving forward presents methodological challenges. How do we measure situational contexts, monitor activities that result in circumstantial events, and assess being in place and their dynamic qualities? While several measures of this construct are in various stages of development, none have yet reached a level of validation and replicability that guarantees reliable use. For example, the first author is currently validating a new tool, the “Situational Assessment of Activity and Function,” the second author is testing a “Being in Place” scale, and a comparable scale is under development at Simon Fraser University (Chaudhury, personal communication, July 2021). These assessments integrate notions of universal design to promote measurement of being in place applicable to persons with diverse capacities, including those who are nonverbal or have limited cognitive abilities. Operationally, it will be necessary to grapple with the most appropriate way to monitor dimensions of the model that are inherently overlapping.

A final caveat is the question of acceptability. Can the need to fuse what were formerly discretely considered elements of a situation and to define variables in new ways be reconciled with the power of existing policies and the current culture of care?

With limited usable, holistic care models for aging people, new theoretical models are needed to help frame the development of care options. The SMC illustrates relationships among the aging person, the care convoy, and place in situational context. Social scientists and practitioners in the helping professions may use the model to better understand the intertwining roles, dynamics of burden throughout the continuum of declining capacities observed in old age which require care, and areas in which each of the actors in the evolving narrative may need additional support as they try to manage activities that support daily life. Disciplines emphasizing the critical role of context, such as environmental psychology, behavioral science, and gerontology, may use the model to define mechanisms of interaction among the place, person, and care convoy with the goal of more successful care approaches.

Living with a supportive care convoy and place can have a dramatic positive influence on well-being and quality of life as manifest in a sense of being in place. Conversely, an unsupportive care and/or place impedes function, hastens capacity decline, and promotes maladaptive behaviors and a sense of being out of place. Application of the proposed model through the lens of a situational perspective provides opportunities for professionals in many disciplines to develop interventions that will improve the lived experience of aging persons, and potentially persons at any point in the life span, who may experience capacity decline requiring care, by ensuring an optimal sense of being in place, an underlying aspiration for all involved.

Funding

The first author was supported by the National Institutes of Health/National Institute on Aging T32AG057461: “Training in Translational Research in Alzheimer’s and Related Dementias (TRIAD)” during production of this manuscript.

Conflict of Interest

None declared.