Skip to main content Accessibility help

In home or at home? How collective decision making in a new care facility enhances social interaction and wellbeing amongst older adults



Benevolent, long-term care can threaten older adults' sense of autonomy in a residential home environment. Increasing reliance on a hotel style of living has been seen to erode social identity, life satisfaction and even survival or lifespan. Drawing on evidence from both gerontological and social psychological literature, this paper examines the links between the empowerment of residents and their subsequent quality of life in the context of a move into a new care facility in a medium-sized town in South-West England. A longitudinal experiment was conducted during which 27 residents on one floor of a new facility were involved in decisions surrounding its décor, while those on another floor were not. The residents' attitudes and behaviour were monitored at three points over five months (four weeks pre-move, four weeks post-move, and four months post-move). Consistent with the social identity literature, members of the empowered group reported increased identification with staff and fellow residents in the new home, displayed enhanced citizenship, reported improved wellbeing, and made more use of the communal space. Moreover the staff found the empowered residents to be more engaged with their environment and the people around them, to be generally happier and to have better health. These patterns were observed one month after the move and remained four months later. Some implications for theory and practice are discussed.


Corresponding author

Address for correspondence: Craig Knight, School of Psychology, University of Exeter, Perry Road, Exeter EX4 4QG, UK E-mail:


Hide All
Anastasi, A. 1988. Psychological Testing. Macmillan, New York.
Andersson, I., Pettersson, E. and Sidenvall, B. 2007. Daily life after moving into a care home: experiences from the older people, relatives and contact persons. Journal of Clinical Nursing, 16, 9, 1712–18.
Ashforth, B. E. 2001. Role Transitions in Organisational Life: An Identity-based Perspective. Erlbaum, Mahwah, New Jersey.
Ashforth, B. E. and Mael, F. 1989. Social identity theory and the organisation. Academy of Management Review, 14, 1, 2039.
Bandura, A. 1999. Exercise of personal and collective efficacies in changing societies. In Bandura, A. (ed.), Self-efficacy in Changing Societies. Cambridge University Press, Cambridge, 145.
Barkay, A. and Tabak, N. 2002. Elderly residents' participation and autonomy within a geriatric ward in a public institution. International Journal of Nursing Practice, 8, 4, 198209.
Barnes, L., Evans, D., Mendes, C., de Leon, C. M., Wilson, R. and Bienias, J. 2004. The relation of social networks, social engagement, and cognitive decline in an older bi-racial population. The Gerontologist, 44, 3, 330.
Bartke, A., Bonkowski, M. and Masternak, M. 2008. How diet interacts with longevity genes. Hormones, 7, 1, 1723.
Benaim, C., Froger, J., Compan, B. and Pélissier, J. 2005. The assessment of autonomy in elderly people. Annales de Réadaptation et de Médecine Physique, 48, 6, 336–40.
Bermingham, J. R. 2001. Immigration: not a solution to problems of population decline and aging. Population and Environment, 22, 9, 355–63.
Brink, S. 1993. Elderly empowerment: new rights and research are enhancing nursing-home life. US News World Report Journal, 114, 16, 6970.
Buturusis, B., Straub, M., Treinkman, A. D. and Trella, R. 1986. Assessing health needs: the well elderly. Journal of Gerontological Nursing, 12, 1, 1124.
Calkins, M., Sanford, J. A. and Proffitt, M. A. 2001. Design and dementia: challenges and lessons for universal design. In Preisser, W. F. E. and Ostroff, E. (eds), Universal Design Handbook. McGraw-Hill, New York, 22.122.22.
Campbell, S. L. 2003. Empowering nursing staff and residents in long term care. Geriatric Nursing, 24, 3, 170–5.
Carp, F. A. 1966. A Future for the Aged: Victoria and its Residents. University of Texas Press, Austin, Texas.
Carroll, N. V., Delafuente, J. C., Cox, F. M. and Narayanan, S. 2008. Fall-related hospitalisation and facility costs among residents of institutions providing long-term care. The Gerontologist, 48, 2, 213–22.
Chan, H. M. and Pang, S. 2007. Long term care: autonomy, family integrity and social sustainability: the Hong Kong experience. Journal of Medicine and Philosophy, 32, 4, 401–24.
Chandler, M. J. and Lalonde, C. E. 1998. Cultural continuity as a hedge against suicide in Canada's first nations. Transnational Psychiatry, 35, 2, 191219.
Chapman, N. J. 2002. Assisted living: needs, practices and policies in residential care for the elderly. Ageing & Society, 22, 1, 534–5.
Cheng, S. T. 2009. The social networks of nursing-home residents in Hong Kong. Ageing & Society, 29, 2, 163–78.
Clark, P. and Bowling, A. 1990. Observed study of quality of life in nursing homes. Social Science and Medicine, 30, 3, 1201–10.
Cohen, J. 1992. A power primer. Psychological Bulletin, 112, 1, 155–9.
Collopy, B. J. 1988. Autonomy in long term care: some crucial distinctions. The Gerontologist, 28, 1, 1017.
Csikszentmihalyi, M. 1997. Finding Flow: The Psychology of Engagement with Everyday Life. Basic, New York.
deCharms, R. 1968. Personal Causation. Academic, New York.
Deci, E. L., La Guardia, J. G., Moller, A. C., Scheiner, M. J. and Ryan, R. M. 2006. On the benefits of giving as well as receiving autonomy support: mutuality in close friendships. Personality and Social Psychology Bulletin, 32, 3, 313–27.
Deci, E. L. and Ryan, R. M. 1987. The support of autonomy and the control of behaviour. Journal of Personality and Social Behaviour, 53, 6, 1024–37.
Derks, B., van Laar, C. and Ellemers, N. 2007. Social creativity strikes back: improving motivated performance of low status group members by valuing ingroup dimensions. European Journal of Social Psychology, 37, 5, 470–93.
Desrichard, O. and Köpetz, C. 2005. A threat in the elder: the impact of task-instructions, self-efficacy and performance expectations on memory performance in the elderly. European Journal of Social Psychology, 35, 4, 537–52.
Dixon, S. 1991. Autonomy and Dependence in Residential Care: Evaluation of a Project to Enhance Resident Choice in an Elderly People's Home. Age Concern Institute of Gerontology, King's College, London.
Doosje, B., Ellemers, N. and Spears, R. 1995. Perceived intragroup variability as a function of group status and identification. Journal of Experimental Social Psychology, 31, 3, 410–36.
Drury, J. and Reicher, S. 2005. Explaining enduring empowerment: a comparative study of collective action and psychological outcomes. European Journal of Social Psychology, 35, 1, 3558.
Eggins, R. A., Haslam, S. A. and Reynolds, K. J. 2002. Social identity and negotiation: subgroup representation and superordinate consensus. Personality and Social Psychology Bulletin, 28, 6, 887–99.
Ellemers, N., De Gilder, D. and Haslam, S. A. 2004. Motivating individuals and groups at work: a social identity perspective on leadership and group performance. Academy of Management Review, 29, 4, 459–78.
Ertel, K. A., Glymour, M. M. and Berkman, L. F. 2008. Effects of social integration on preserving memory function in a nationally representative us elderly population. American Journal of Public Health, 98, 3, 1215–20.
Evans, S. 2009. ‘That lot up there and us down here’: social interaction and a sense of community in a mixed tenure UK retirement village. Ageing & Society, 29, 2, 199216.
Fahey, T., Montgomery, A. A., Barnes, J. and Protheroe, J. 2003. Quality of care for elderly residents in nursing homes and elderly people living at home: controlled observational study. British Medical Journal, 326, 580–4.
Feingold, E. and Werby, E. 1990. Supporting the independence of elderly residents through control over their environment. Journal of Housing for the Elderly, 6, 1, 2532.
Fitzpatrick, T. R., Gitelson, R. J., Andereck, K. L. and Mesbur, E. S. 2005. Social support factors and health among a senior center population in Southern Ontario, Canada. Social Work in Health Care, 40, 1537.
Folkman, S. and Lazarus, R. S. 1988. The relationship between coping and emotion: implication for theory and research. Social Science of Medicine, 26, 3, 309–17.
Frazier, R. S. and Baker-Smith, H. T. 1997. Predicting appropriate level of care in an innovative residential program design for people with mental illness. Psychiatric Rehabilitation Journal, 21, 2, 181–3.
Gentleman, A. 2009. A day in the life of an old people's home. The Guardian, 14 July. Available online at [Accessed 13 August 2009].
Gibson, C. H. 1991. A concept analysis of empowerment. Journal of Advanced Nursing, 16, 3, 354–61.
Golander, H. 1995. Chronically ill, old and institutionalized: being a nursing home resident. Family and Community Health, 17, 4, 6379.
Gottesman, L. E. and Bourestom, N. C. 1974. Why nursing homes do what they do. The Gerontologist, 14, 6, 501–6.
Gray, A. 2009. The social capital of older people. Ageing & Society, 29, 1, 531.
Haslam, S. A. 2004. Psychology in Organisations: The Social Identity Approach. Sage, London.
Haslam, S. A., Eggins, R. A. and Reynolds, K. J. 2003. The ASPIRe model: actualizing social and personal identity resources to enhance organisational outcomes. Journal of Occupational and Organisational Psychology, 76, 1, 83113.
Haslam, C., Haslam, S. A., Jetten, J.Hayward, S., Bevins, A. and Tonks, J. 2010. The social treatment: the benefits of group interventions in residential care settings. Psychology and Aging, 25, 1, 157–67.
Haslam, C., Holme, A., Haslam, S. A., Iyer, A., Jetten, J. and Williams, W. H. 2008. Maintaining group memberships: social identity continuity predicts well-being after stroke. Neuropsychological Rehabilitation, 18, 5, 671–91.
Haslam, S. A., Jetten, J., Postmes, T. and Haslam, C. 2009. Social identity, health and well-being: an emerging agenda for applied psychology. Applied Psychology: An International Review, 58, 1, 123.
Haslam, S. A. and McGarty, C. 2004. Experimental design and causality in social psychological research. In Sanson, C., Morf, C. C. and Panter, A. T. (eds), Handbook of Methods in Social Psychology. Sage, Thousand Oaks, California, 235–64.
Haslam, S. A., O'Brien, A., Jetten, J., Vormedal, K. and Penna, S. 2005. Taking the strain: social identity, social support and the experience of stress. British Journal of Social Psychology, 44, 3, 355–70.
Haslam, S. A., Postmes, T. and Ellemers, N. 2003. More than a metaphor: organisational identity makes organisational life possible. British Journal of Management, 14, 4, 357–69.
Hauge, S. and Heggen, K. 2007. The nursing home: a field study of residents' daily life in the common living rooms. Journal of Clinical Nursing, 17, 3, 460–7.
Hjaltadottir, I. and Gustafsdottir, M. 2007. Quality of life in nursing homes: perception of physically frail elderly residents. Scandinavian Journal of Caring Sciences, 21, 1, 4855.
Hodgson, N., Freedman, V. A., Granger, D. A. and Erno, A. 2005. Biobehavioral correlates of relocation in the frail elderly: salivary cortisol, affect, and cognitive function. Journal of the American Geriatrics Society, 52, 5, 1856–62.
Hopkins, N. and Dixon, J. 2006. Space, place, and identity: issues for political psychology. Political Psychology, 27, 2, 173–85.
Jetten, J., Haslam, C., Haslam, S. A. and Branscombe, N. 2009. The social cure. Scientific American Mind, 20, 2633.
Jetten, J., Haslam, C., Pugliese, C., Tonks, J. and Haslam, S. A. 2009. Declining autobiographical memory and the loss of identity: effects on well-being. Journal of Clinical and Experimental Neuropsychology, 32, 4, 408–16.
Jones, G. R. and George, J. M. 1998. The experience and evolution of trust: implications for cooperation and teamwork. Academy of Management Review, 23, 3, 531–46.
Kahana, E., Midlarsky, E. and Kahana, B. 1987. Beyond dependency, autonomy, and exchange: prosocial behavior in late-life adaptation. Social Justice Research, 1, 4, 439–59.
Kane, R. A. and Wilson, K. B. 2001. Assisted Living at the Crossroads: Principles for its Future. Jessie F. Richardson Foundation, Portland, Oregon.
Kasser, V. G. and Ryan, R. M. 1999. The relation of psychological needs for autonomy and relatedness to vitality, well-being, and mortality in a nursing home. Journal of Applied Social Psychology, 29, 8, 935–54.
Klinefelter, D. S. 1984. Aging, autonomy and the value of life. Journal of Applied Gerontology, 3, 1, 719.
Knight, C. P. and Haslam, S. A. 2010 a. Your place or mine? Organizational identification and comfort as mediators of relationships between the managerial control of workspace and employees' motivation and well-being. British Journal of Management, in press.
Knight, C. P. and Haslam, S. A. 2010 b. The relative merits of lean enriched and empowered offices: an experimental examination of the impact of workspace management strategies on well-being and productivity. Journal of Experimental Psychology: Applied, 2, 2, 158–72.
Kontos, A. P. 2004. Developmental sport and exercise psychology: a lifespan perspective. Sports Psychologist, 3, 3, 350–52.
LeCount, J. 2004. Education, empowerment, and elderly adults: enhancing nursing expertise in the long-term care setting. Journal of Gerontological Nursing, 30, 1, 613.
Lidz, C. W., Fischer, L. and Arnold, R. W. 1992. The Erosion of Autonomy in Long-term Care. Oxford University Press, New York.
Marmot, M., Siegrist, J. and Theorell, T. 2005. Health and the psycho-social environment at work. In Marmot, M. and Wilkinson, R. (eds), Social Determinants of Health. Oxford University Press, New York, 105–27.
Matsui, M. 2005. Patient autonomy in clinical decision making and related factors among the elderly. The Gerontologist, 45, 1, 23.
Maugeri, D., Santangelo, A., Abbate, S., Barbagallo, P., Lentini, A., Motta, M., Malaguarnera, M., Speciale, S., Testai, M. and Panebianco, P. 2001. Correlation between the bone mass, psychometric performances, and the levels of autonomy and autosufficiency in an elderly Italian population above 80 years of age. Archives of Gerontology and Geriatrics, 33, 3, 265–71.
McBride, D. L. 1999. Nursing home gardens. In Cooper-Marcus, C. and Hackett, P. (eds), Healing Gardens: Therapeutic Benefits and Design Recommendations. Wiley, New York, 385436.
Mendes de Leon, C. F., Glass, T. A. and Berkman, L. F. 2003. Social engagement and disability in a community population of older adults: the New Haven EPESE. American Journal of Epidemiology, 157, 7, 633–42.
Messer, B. A. E. and White, F. E. 2006. Employees' mood, perceptions of fairness, and organisational citizenship behaviour. Journal of Business and Psychology, 21, 1, 6582.
Moos, R. 1981. Environmental choice and control in community care settings for older people. Journal of Applied Psychology, 11, 1, 2343.
Moreland, R. L. and Levine, J. M. 2002. Socialization and trust in work groups. European Journal of Social Psychology, 5, 2, 185201.
Nolan, M. and Grant, G. 1992. Mid-range theory building and the nursing theory-practice gap: a respite care case study. Journal of Advanced Nursing, 17, 2, 217–23.
Office for National Statistics 2005. UK, Scotland, England Wales and Northern Ireland, Mid-2004 Population Estimates. Online tables, Office for National Statistics, London. Available online at [Accessed 11 June 2008].
Oleson, M., Heading, C., Shadick, J. M. and Bistodeau, J. A. 1994. Quality of life in long stay institutions in England: nurse and resident perceptions. Journal of Advanced Nursing, 20, 1, 2332.
Organ, D. W. 1988. Organizational Citizenship Behavior: The Good Soldier Syndrome. D. C. Heath and Company, Lexington, Massachusetts.
Ozaki, A., Uchiyama, M., Tagaya, H., Ohida, T. and Ogihara, R. 2007. The Japanese centenarian study: autonomy was associated with health practices as well as physical status. Journal of the American Geriatrics Society, 55, 1, 95101.
Park, N. S., Zimmerman, S., Sloane, P. D., Gruber-Baldini, A. L. and Eckert, J. K. 2006. An empirical typology of residential care/assisted living based on a four-state study. The Gerontologist, 46, 2, 238–48.
Peat, G., McCarney, R. and Croft, P. 2001. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Annals of the Rheumatic Diseases, 60, 1, 91–7.
Phillips, C. D., Kimbell, A. M., Hawes, C., Wells, J., Badalamenti, J. and Koren, M. J. 2008. It's a family affair: consumer advocacy for nursing-home residents in the United States. Ageing & Society, 28, 1, 6784.
Platow, M. J., Byrne, L. and Ryan, M. K. 2005. Experimentally manipulated high in-group status can buffer personal self-esteem against discrimination. European Journal of Social Psychology, 35, 5, 599608.
Polit, D. F. and Beck, C. T. 2003. Nursing Research, Principles and Methods. Lippincott, Williams and Wilkins, Philadelphia.
Postmes, T., Haslam, S. A. and Swaab, R. 2005. Social influence in small groups: an interactive model of identity formation. European Review of Social Psychology, 16, 1, 142.
Postmes, T., Tanis, M. and de Wit, B. 2001. Communication and commitment in organizations: a social identity approach. Group Processes and Intergroup Relations, 4, 2, 227–46.
Putnam, R. D. 2000. Bowling Alone: The Collapse and Revival of American Community. Simon and Schuster, New York.
Rappaport, J. 1984. Studies in empowerment. Prevention in Human Services, 3, 17.
Regev, I. 1996. The influence of the elderly's qualities of relations in social networks on their life satisfaction. Gerontology, 25, 1, 6986.
Robichaud, L., Durand, P. J., Bedard, R. and Ouellet, J.-P. 2006. Quality of life indicators in long-term care: opinions of elderly residents and their families. Canadian Journal of Occupational Therapy, 73, 3, 245–51.
Rodin, J. and Langer, E. J. 1976. Long-term effects of a control relevant intervention with the institutionalized aged. Journal of Personality and Social Psychology, 35, 7, 897902.
Sammet, K. 2007. Autonomy or protection from harm? Judgements of German courts on care for the elderly in nursing homes. Journal of Medical Ethics, 33, 9, 534–7.
Sani, F., Bowe, M. and Herrera, M. 2008. Perceived collective continuity and social well-being: exploring the connections. European Journal of Social Psychology, 38, 4, 365–74.
Schrader, S. L. 2008. Centenarians' views on long life and nursing home living. Journal of the American Medical Directors Association, 9, 1, 4550.
Scott, P. A., Valimaki, M., Leino-Kilpi, H., Dassen, T., Gasull, M., Lemonidou, C. and Arndt, M. 2003. Autonomy, privacy and informed consent. 3: Elderly care perspective. British Journal of Nursing, 12, 2, 158–68.
Seligman, M. 1975. Helplessness: On Depression, Development and Death. Freeman, San Francisco.
Shabashova, N. I., Diatchenko, O. T., Bakhtiiarov, P. S. and Merabishvili, V. M. 2001. Demographic, social and medical problems of the aging population. Vopr Onkol, 47, 4, 523–45.
Short, A. E. 1992. Music and imagery with physically disabled elderly residents. Music Therapy, 11, 1, 6598.
Spector, P. E., Allen, T. D., Poelmans, S., Cooper, C. L., Bernin, P., Hart, P., Lu, L., Miller, K., Moraes, L. F. R., Ostrognay, G. M., Pitarlu, H., Salamatov, V., Salgardo, J., Sanchez, J. I., Siu, O. L., Tiechmann, M., Theorell, T., Vlerick, P., Widerszal-Bazyl, M. and Yu, S. 2005. An international comparative study of work–family stress and occupational strain. In Poelman, S. A. Y. (ed.), Work and Family: An International Research Perspective. Psychology Press, Hove, UK, 7186.
Stiggelbout, A. M. 2000. Assessing patients' preferences. In Chapman, C. B. and Sonnenberg, F. A. (eds), Decision Making in Health Care. Cambridge University Press, Cambridge, 289312.
Tajfel, H. and Turner, J. C. 1979. An integrative theory of intergroup conflict. In Austin, W. G. and Worchel, S. (eds), The Social Psychology of Intergroup Relations. Brooks/Cole, Monterey, California, 3347.
Tanis, M. and Postmes, T. 2005. A social identity approach to trust: interpersonal perception, group membership and trusting behaviour. European Journal of Social Psychology, 35, 4, 413–24.
Taylor, F. W. 1911. Principles of Scientific Management. Harper, New York.
Tu, Y. C., Wang, R. H. and Yeh, S. H. 2006. Relationship between perceived empowerment care and quality of life among elderly residents within nursing homes in Taiwan: a questionnaire survey. International Journal of Nursing Studies, 43, 4, 673–80.
Turner, J. C. 1981. Some considerations in generalizing experimental social psychology. In Stephenson, G. M. and Davis, J. H. (eds), Progress in Applied Social Psychology. Wiley, Chichester, UK, 334.
Turner, J. C., Oakes, P. J., Haslam, S. A. and McGarty, C. A. 1994. Self and collective: cognition and social context. Personality and Social Psychology Bulletin, 20, 4, 454–63.
Tyler, T. R. and Blader, S. 2000. Co-operation in Groups: Procedural Justice, Social Identity and Behavioral Engagement. Psychology Press, Philadelphia.
Tyler, T. R. and Blader, S. 2003. The group engagement model: procedural justice, social identity, and cooperative behavior. Personality and Social Psychology Review, 7, 4, 349–61.
Tyson, M. M. 1998. The Healing Landscape: Therapeutic Outdoor Environments. McGraw-Hill, New York.
van Bilsen, P. M. A., Hamers, J. P. H., Groot, W. and Spreeuwenberg, C. 2006. Demand of elderly people for residential care: an exploratory study. BMC Health Services Research, 6, 1, 39.
Vischer, J. C. 2005. Space Meets Status. Routledge, Abingdon, UK.
West, B. T., Welch, K. B. and Galecki, A. T. 2007. Linear Mixed Models: A Practical Guide Using Statistical Software. Chapman and Hall, New York.
Whiteley, S. and Brittain, O. 2006. Assessing the health needs of elderly people. Health Visit, 66, 2, 133–5.
Wilkinson, J. A. 1999. A Family Caregiver's Guide to Planning and Decision Making for the Elderly. Fairview, Minneapolis, Minnesota.
Wilson, C. B., Davies, S. and Nolan, M. 2009. Developing personal relationships in care homes: realising the contributions of staff, residents and family members. Ageing & Society, 29, 7, 1041–63.
Zeisel, J. 2006. Inquiry by Design. Newton, New York.
Zeisel, J., Epp, G. and Demos, S. 1978. Low-rise Housing for Older People: Behavioral Criteria for Design. US Government Printing Office, Washington DC.


Related content

Powered by UNSILO

In home or at home? How collective decision making in a new care facility enhances social interaction and wellbeing amongst older adults



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.