Two years after selling his home and relocating to a life care center, an elderly man who participated in this study stated:
I don't exactly know how to describe the feeling of being at home, but there is one thing about home, once you lose the feeling you can never get it back.
The systems of meaning individuals establish regarding home interested the author after conversations with older adults in long-term care settings revealed many of them did not regard their present situations as their homes, despite the fact they probably were never going to be able to leave. They were, in a theoretical sense, homeless. The purpose of this study was to describe the essential structure of the lived experience of feeling at home for older adults who were relocated to alternative care settings which provide some degree of supervision. The study addressed the following research questions:
* What meaning does the experience of being at home have for older adults?
* Is there an essence (i.e., a core of invariant features) to the idea of being at home?
Few individuals are born homeless, but many, at some point in their lives, will face the prospect of being uprooted from familiar surroundings and forced to either move to new homes or become homeless. For older adults in declining health, the move frequently is to settings that provide some degree of supervision and most often is meant to be permanent. Understanding the meaning of such a move to older adults involves seeking an understanding of the meaning of feeling that one has a home. When people say they feel "at home," what emotions are they experiencing? When people say they are "homesick," what is it they are missing?
Nurses participate in the operation of many types of alternative homes for clients. Within these settings, nurses attempt to meet the needs of displaced individuals within a holistic framework emphasizing the uniqueness and worth of each individual. A clearer understanding of the essence of home would enable health care professionals to provide more effectively the miUeu in which this essence is present and can be experienced by the clients.
THEORETICAL FRAMEWORK AND REVIEW OF LITERATURE
Understanding the meaning of a phenomenon from the point of view of the lived life of an individual derives from existential philosophy and is meant to provide a deeper understanding of human behavior than that which can be provided through traditional scientific methodology (Bogdan & Bilken, 1992). Phenomenology emphasizes the search for essences based on the belief that there exists within any phenomenon, an essence or core of invariant characteristics. Essences derive from the experience of being in the world, meaning individuals' perceptions of reality are patterned socially and culturally by their relationships to other worldly objects, and thus, individual reality is constructed (Heidegger, 1962; Schutz, 1967). Despite individual variation and the uniqueness of individuals, it is possible to identify essential constituents of experience helpful in understanding the meaning of the phenomenon of home.
A constant tension between the unsettling forces of change and the reassurance of continuity is theorized to exist among all human beings. Sense of self defines an individual's position in relation to these two dialectic forces (Erickson, Erickson, & Kivnik, 1986; Kaufman, 1980). Because the formation of one's sense of self is a continuous lifespan process, it is subject to the influence of external forces that at times serve to threaten its integrity. The struggle to maintain continuity in older age is concerned partly with the older adults' adaptation to the space they occupy. Maladaptation to the environment at any age impairs development and devitalizes the individual (Erickson & Erickson, 1986).
The congruence model of personenvironment fit (Hooyman & Kiyak, 1993; Kahana, 1982) is based on the idea that behavior is a function of the relationships among individuals and their environment and on the needpress model of human behavior, with individuals seeking environments congruent with their needs. Dissonance between the press and the need necessitates modifying the press or taking leave of the environment. If the choice of leaving the environment is not available, stress and discomfort result.
Research describing home as housing or relating home with the social institution of family (Hareven, 1991; O'Bryant & Nocera, 1985; Rybczynski, 1986; Sopher, 1979) is abundant. From a phenomenological perspective, home involves a sense of place, a lived space that has significance for an individual as an essential aspect of human experience. It means the inhabitants have established a place where they can be themselves most truly (Heidegger, 1962). Humanistic geographers discuss home as place, describing a concept that implies profound psychosocial involvement of the subject residing within it (Benswanger, 1979; Rowles, 1980; Samuels, 1978; Seamon, 1980). Individuals' sense of personal and cultural identity is entwined intimately with their sense of place identity; thus, loss of home or losing one's place is a crisis involving identity (Aiken, 1991; Diamond, 1993; Savishinsky, 1991).
Place involves two reciprocal movements - home and horizons of reach or movement away from home (Buttimer, 1980). These movements are so basic to all life forms they are considered universal. For example, this lived reciprocity can be viewed in terms of security and adventure, territory and range, and privacy and social discourse (Buttimer, 1980). Home is a binary opposition between home and journey, with all of life's experiences involving home and non-home. Sociologists describe home as a physical place and space, and home as a mental and physical condition. Because home involves essentially the people inhabiting the place, it has both moral and esthetic dimensions. The complexity of one's orientation to home depends on the complexity of the ideas about one's self because home is the realization of ideas (Douglas, 1991).
Home should not be confused with house. A home needs no physical structure. It can be as simple as a place where two humans are involved with one another (Hollander, 1991; Rykwert, 1991). Studies of homeless men and women reveal that a feeling of home is a necessary component for maintaining sense of self and continuity, particularly among older adults. Losing one's home, either literally or figuratively, can be a devastating event that threatens one's quality of life and the ability to sustain meaningful existence (Bauman, 1993; Elias & Inui, 1993). In a study of chronically ill homeless men living in either shelters or single occupancy hotels, Elias and Inui (1993) found older adults used their construction of home to negotiate meaning, to preserve independence, and to provide them with a sense of continuity and flexibility that enabled them to respond to changing experiences.
A sense of home served as a platform for coping with potentially threatening future events. Without a sense of home, as occurred frequently in both settings, these older men had difficulty thinking futuristically or planning ahead (Elias & Inui, 1993). Similarly, a study of older women's experiences of feeling strong centered around vivid and powerful stories about home from a variety of perspectives, including having to leave home and losing one's home (Moloney, 1997). The meanings of home that emerged in the study included a desire to have a place in the world that was secure and comfortable. Friends and loved ones were an integral component of home such that, in some situations, loss of a loved one was equated with losing one's emotional home. Leaving home was equated with loss of a place that was safe and familiar and a place in which future events could be contemplated and predicted (Moloney, 1997). A large study of residents of board and care homes employed factor analysis to identify five factors significant in determining whether or not the setting was homelike to residents (Namazi, Eckert, Rosner, & Lyon, 1991). The factors isolated included affinity, ambiance, privacy/refuge, personalized place, and operator's altruism (i.e., whether or not assistance was provided willingly or as an additional paid service) (Namazi et al., 1991).
Home in the present study was postulated to be a significant place where individuals dwell, a human phenomenon constituted of the experiencing individuals within a particular context. It is recognized as existing when "such and such elements" are present (Fischer, 1971, p. 149). The elements present when individuals are able to describe themselves as "at home" in a particular situation form the basis of the questions asked in this study.
The research design used to gather and analyze the data was based on Heideggerian phenomenology and its assumption that all people are situated in the world and each individual's perception of that world is based on the experience of living in it (Heidegger, 1962). Phenomenology is both a philosophic orientation and a research methodology, allowing for an investigation of a particular situation from the perspective of the lived life (Bogdan & Büken, 1992). It is meant to provide rich data about a phenomenon of interest that could not be obtained using another methodology. Phenomenology as a research methodology requires researchers to examine their own assumptions and biases about the phenomenon in question and then bracket them or set them aside. This protects the data so the phenomenon can be studied for what it is, untainted by presuppositions imposed by the researcher. Investigations of lived phenomena become amenable to articulation only in reflection, when one is removed from the situation and able to look back on it (Fischer, 1971; Wagner, 1983).
Three types of alternative residences for older adults were selected for data collection. The homes were characterized by having varying degrees of supervision provided for residents. Two were long-term care facilities, and the third was a life care facility. All were unfamiliar to the researcher.
A purposive sample of 10 men and women, selected in collaboration with personnel from the alternative homes, included individuals requiring minimal physical assistance and without evidence of mental impairment that would limit their ability to understand and communicate clearly. The researcher selected participants believed able to offer the most expert and vivid testimony and, thus, to facilitate the revelation of the phenomenon (Bogdan & Büken 1992). Participants continually were interviewed until there seemed to be exhaustion of emerging themes. The ages of participants spanned 34 years. The youngest subject was age 67, and the oldest participant was age 101. They were not part of a single community. Four lived in the intermediate care section of one long-term care facility, two resided in the intermediate care section of the second long-term care facility, and the remaining four were residents of a life care community in another city. Four participants were married, four were widowed, and two had never married. All participants had been in the alternative home setting from 2 to 7 years. The economic backgrounds of the participants varied, with one fourth of them coming from affluent homes, one fourth coming from very poor homes, and one half coming from homes that could be described as middle class. While all participants could recall and describe the physical characteristics of their homes and the types of activities enjoyed within easily, all had difficulty articulating the meaning of home and what it was like to feel at home. One resident remarked:
SEVEN LIFE THEMES
I've often wondered if we did the right thing coming here, and yet we're comfortable; we have everything we need; we're close to family; they have a busy social calendar here for the residents, and yet we are not at home. I don't exactly know how to describe the feeling of being at home, but there is one thing about home, once you lose the feeling you can never get it back.
Data Collection Methods
The data collection techniques used in this study included extensive interviews focused on broad questions that sought to elicit the meaning of home as experienced by the participants. Of concern was this phenomenon across the individuals' lifespans, including their present homes (Wallace, 1993).
Interviews were conducted on the basis of phenomenological theory. Prior to interviewing, relevant literature was reviewed and analyzed. This knowledge then was set aside or bracketed so it would not influence the interpretation of participants' lived experiences. Open-ended questions encouraged participants to remain focused and to continue. Three lV^-hour interviews were conducted with each participant in the participant's own room within the residence. The first interview was used to explain the study, establish rapport with the participant, and obtain consent. Participants were informed that the researcher was interested in the meanings people ascribe to home and what it meant, from their points of view, to feel at home. The second interview focused on the specific information with which the researcher was concerned, and the third interview allowed for validation of the interviewer's perspective and the addition of any further thoughts participants may have had in the interim between interviews. The interviews were audiotape recorded, transcribed verbatim, and subjected to the data analysis protocol of Giorgi (1985). When the researcher found the data had become repetitive, data collection was concluded.
The analysis of qualitative data began with a search for meaning units or themes, accomplished through a series of transformations of the data. The methodology for data analysis described by Giorgi (1985) was followed, with the researcher first reading each interview to obtain a sense of the whole. Next, the interviews were read with the researcher assuming a psychological attitude directed toward the idea of being at home. The meaning units then were transformed to a higher level of abstraction, more reflective of the language of science. An on-going analysis of the data during collection allowed the researcher to evaluate the procedure and rethink the questions or possible sources of data. The summation of each participant's interview and a summary of the revealed themes of all participants was the final step.
Of the 10 participants, three described feeling at home in thenpresent environments. Six participants stated clearly they did not feel at home, and one participant was ambivalent. One man residing in a long-term care facility stated:
Home is the freedom to do just as you please. Here I cannot do just as I please and that will always distinguish this place from home.
A woman remarked:
I've been here for 4 years and I'm not at home. I miss my home. You are nothing but a prisoner here... y ou can't do anything, you are just here.
The general structural description of the experience of being at home emerged from the situated descriptions and reflects seven recurring themes, described within a framework of a dialectic, with the themes associated with not being at home. (Table). The themes were common across participants and can be said to reflect the essence of the phenomenon.
General Structural Description
The general structural description was developed from the seven recurring themes (Giorgi, 1985). It is a synthesis resulting from participants' specific descriptions.
The phenomenon of home is concerned minimally with physical structure. It concerns the most personal of feelings and is a necessary precursor to a meaningful existence. It transcends time. When one is at home, provision is made for privacy, a space of one's own, where it is possible to retreat and be alone. The boundaries of this space are respected and protected. Individuality is preserved within the space, and it is shared with others only through invitation. At home, one feels comfortable and confident seeking the fulfillment of physical and psychological needs. One feels in control and able to exert responsibility for one's actions. One feels safe and secure. At home, there is a sense of belonging, of being on equal footing with others who occupy or are present in the home. Mutual respect characterizes the relationships existing within the home. One feels affection for those in the home and senses a reciprocity of that affection. Relationships are nurtured with others perceived to share some common bonds (e.g., intellectual, cultural, social).
When one is not at home, the feeling is of being surrounded by individuals not of one's choosing nor of one's liking. The presence of these individuals in the realm of one's space creates feelings of psychic discomfort, depression, and sometimes anger. One feels a pervasive, relentless desire to be elsewhere. One is unsettled and dwells on the idea of moving. Compounding this feeling of unrest is a perception that the situation is out of one's control. Without power, one simply exists, devoid of purpose or significance. One feels no sense of belonging and harbors the suspicion one is not liked. Feelings of insecurity prevail, although not related to physical safety. Rather, insecurity centers on fears related to the future and a perceived powerlessness to influence the direction of one's life. One feels vulnerable, impotent, and at the mercy of others. Being without a home means having no place to be alone with one's thoughts, to resolve issues, to recuperate physically or emotionally, or to renew one's energy.
In the course of identifying the themes of home, it became apparent the participants were revealing themes that described their individual lives. Whether they were able to reaffirm those themes in their current residences influenced their present feelings of being at home or not being at home. Those participants who did not feel at home seemed preoccupied with resolving the situation of perceived homelessness, while participants who reported feeling at home seemed to be conducting their lives in a manner that satisfied them. While there emerged a general structure of the experience of being at home, the reaction of each participant was unique and dependent on the individual's life story. Within the seven identified themes, expressions of widely varying intensity were found. Thus, the same environment meant different things to different participants. One could find privacy or intrusion in the same setting, depending on the importance privacy played in the individuals' or couples' lives. A female resident, satisfied with the degree of privacy presently enjoyed, was fearful of losing her private room status. She stated, "I don't know what I'd do if I didn't have my own room, I can't even think about it." She perceived her privacy to be well maintained and respected, and she described "keeping to myself unless I need them for something, which isn't very often." A male resident occupying a private room in the same setting denounced having to "account for himself and his whereabouts to someone else." Security versus fear was reflected in this resident's statement:
I don't know what will happen to us, when we are no longer able to care for ourselves and have to go over to the other part [referring to the skilled nursing care facility associated with the life care complex], I suppose we will just be there.
The need for commonality versus discordance was exemplified by one resident's desire not to "live close to people who are in wheelchairs and that are so old that they will die soon." He described another facility he had heard about where "the people in wheelchairs are kept in a separate place." Another resident, attending a musical event in the facility, felt the other residents to be widely inattentive and stated:
They made so much noise that I was forced to get up and leave. That's the kind of people that live here, so that was the first and last time that I had anything to do with them.
The theme of affection versus disdain was evident in the expressed desire by many of the residents to form new friendships and was voiced frequently, along with a wish to be "liked." One resident described things she considered important in a home:
And of course, friends. I think that in a new home, friends that you make, it takes a little while. I have a few friends that mean a great deal to me. I see them every day at dinner. They are always available if you feel like talking. So I think friends are very important.
Respect versus disrespect manifested itself in the residents' perceptions of the ways they are treated versus others in the same environment. One woman, who believed she was a victim of class oppression for her entire Ufe, stated:
We would never consider this our home because we are not treated right here. When you are at home in your own home, people coming in respect you and your home because it is yours, but here they treat people differently; some get more respect than others.
As in other aspects of their lives, participants sought a sense of meaning or purpose to their existences, expressed in the theme of significance versus anonymity. To continue to be of significance in their present setting seemed as important to them as it had been previously. One resident assists at religious services conducted daily at his residence. He stated, "the priest could not get along without me. Father depends on me to serve Mass with him every day." Autonomy versus dependence was evidenced in another resident's comments:
Once they get you, you are trapped and you can't get away. Why, I cannot even go out by myself. I would like to go and get my hair done, but I cannot leave unless someone is willing to take me, and I have no one, so I am just a prisoner.
Another resident, who had admitted to being totally dependent on her husband until he died, is comfortable with the degree of dependency she finds in her residence. She has a selfimposed confinement to a wheelchair because of a "fear of falling," which she never experienced when her husband was living because "he always held my arm when we were walking." She described her reasons for relocating to the faculty:
I tried to look at the advantages of coming here. I think that this was safer for me here. After my husband passed away, I didn't want to be alone at night. It isn't the idea of being alone so much, it's the idea that no one would know if you needed help. Also, there is maintenance here. I always had someone to clean once a week.
Another resident described feelings of being at home in the setting as the acceptance of change:
I am very happy and very much at home here. I realize that it is the best place for me to be. I am sensible enough to realize that there are some things that I am no longer capable of doing and that's that. I am no longer able to maintain a home by myself and so I am grateful to have a place such as this.
The identified themes that emerged from this study can be recognized and described as universal. They form a substantial part of accepted theories of personality development and self-concept by many researchers in the fields of sociology and psychology (Birren & Schaie, 1990; Erikson et al., 1986; Kaufman, 1980). The unique finding of this study relates to the need to find a place where these life themes can continue to unfold. The sociologists' descriptions of home as an idea or a state of mind (Douglas, 1991; Hollander, 1991; Rykwert, 1991) is affirmed by the stories of the 10 participants of this study who used terms such as "a refuge to gather my thoughts" or "a feeling I can't get back." Their stories further support the view of humanistic geographers who use the metaphor of the journey to describe the purpose of home (Buttimer, 1980; Rowles, 1980; Seamon, 1980). Those residents who described themselves as not at home were, for the most part, reluctant to engage new friends, participate in social activities within the home, and engage in any type of future planning except that related to moving to a new home.
The findings of this study also can be interpreted using theories concerning the human need for expression of territoriality (Ardrey, 1966; Cooper, 1984; Stokes, 1974). People have a need for privacy to have a place where they can exhibit behavior they do not wish others to observe. The need for security (i.e., security versus fear) is compounded in older age by the threat of loss of power that constitutes the life theme dialectic of autonomy versus dependency or helplessness (Abramson, 1990; Booth, 1986; Laffrey, 1985; Langer & Rodin, 1976; Seligman, 1975). The need to find some common bonds (i.e., commonality versus discordance), to band together in social groups of two or more based on those bonds, and to be liked (i.e., affection versus disdain) are powerful forces that have existed among human beings since the beginning of recorded time and continue into older age (Birren & Schaie, 1990; Butler, Lewis, & Sunderland, 1991; Erikson et al., 1986; Noelker & Poulshock, 1984). Among Kaufman's (1980) findings is the idea that older adults do not conceive of themselves in terms of the developmental stage of life assigned to them within a chronological framework or within traditional models of aging that emphasize declining health, reduced mental and physical acuity, narrowed scope of interest, egocentricity, and disengagement. Their life themes are the vehicles through which they understand and express themselves and experience their present circumstances (Kaufman, 1980, 1986). Kaufman's (1986) ideas are supported by the participants' life stories relating their experiences of adapting to relocation. Feeling at home was dependent on whether they found a fit between the themes in the environment and the themes of their lives. The findings of this study also support Erikson et al.'s (1986) theory that continuity in life does not occur spontaneously. It is achieved through individuals' active search for situations that provide it. This process does not end when one approaches a specific age. Older adults struggle to reconcile their sense of who they have been with a sense of who they may become in older age. They struggle to continue to feel like themselves and establish their existential self (Eliopoulos, 1990; Erikson et al., 1986; Kaufman, 1980).
IMPLICATIONS FOR NURSING
This study revealed a beginning understanding of the phenomenon of home among a small group of older adults residing in alternative home settings. Although the findings of this study are important, the small number of participants may not be representative of the broader population of older adults whose traditional sense of home has been altered. For example, there also may be differences in other age and diverse groups, such as homeless families or displaced children. The meaning of home for these groups needs to be explored. The findings of this study have implications for those interested in quality of life issues for individuals in advancing age. Gubrium (1993) discusses the special matters that confront residents involved in long-term stays in extended care facilities. These matters include family, interpersonal ties, self-worth, life history, and home. These special matters moderate quality of life (as opposed to quality of care) for affected individuals. Quality of life is a concept with multiple viewpoints, but it is becoming recognized increasingly that a subjective sense of well-being has primacy for individuals (Gubrium, 1993; Institute of Medicine, 1986). If it is true, as this study suggests, that an abiding sense of being at home is necessary for person-environmental interactions to take the direction of positive growth, as recognized from the perspectives of the individuals, then a caring imperative in nursing suggests attention to this unique phenomenon (Benner & Wrubel, 1989; Smith, 1981; Watson, 1985). Authentic care (Scudder, 1990; Watson, 1985) implies the empowering of individuals to experience possibilities as well as actualities. Because nursing care historically has focused on possibility (e.g., of recovering from illness, of regaining health, of experiencing a peaceful death), providing for an environment conducive to the realization of possibilities related to holistic health is an appropriate nursing activity (Scudder, 1990; Strumpf & Knibbe, 1990). Attempting to identify life themes when assessing relocated individuals, not only older adults, may help nurses make informed judgments regarding the individuals' ability to be at home in a given environment and the consequences of not being at home (Abramson, 1990; Thomasma, Yeaworth, & McCabe, 1990). It may be a serious mistake to believe all older dependent adults adjust to long-term care facilities in time simply because some do. While assisting individuals to accept their new homes is a frequent goal of nursing care plans of residents of long-term care facilities, specific interventions to address the accomplishment of this goal are lacking. Because this study demonstrated residents within the same care setting did not agree on the characteristics of the setting, the differences in perception must be attributable to the resident rather than the environment and, thus, need to be identified and incorporated into the individual's care.
Although this study revealed seven basic themes participants found important to varying degrees in a home, a method of assessing which of those themes is most important and whose expression offers the best chance of enabling residents to be at home needs to be developed. For example, the need for privacy was voiced early and emphatically in each interview. This theme is one that could be modified more easily in certain settings than, for example, the need to be liked (i.e., affection versus disdain). Although economic factors influence the decision to plan long-term care facilities using a double occupancy model, the findings of this study indicate such a model is a source of extreme distress for most residents.
There is a connectedness in all human events that assists in the process of change and allows for its integration within a life. Participants who described themselves as at home seem to be engaged in an existence that involves possibilities or, in the humanistic geographers' frame of reference, a journey away from home (e.g., making new friends, engaging in social activities, voting in elections, communicating with relatives, visiting sick individuals, shopping, redecorating an apartment, making future plans). Participants who described themselves as not at home seem preoccupied with their loss and are unable to experience their world in a positive way. They make few new friends, are not trusting of others, spend much time immersed in regret, and in some situations have become reclusive and despairing. Much of their psychic energy is devoted to lamenting their loss of home and attempting to formulate solutions to their unhappy situation. In terms of the potential for growth and evolution of their self-identity, they seem to be immobilized or unable to journey outside of their unhappiness. One resident remarked:
I know that if I felt more at home here, I would be doing more than I do here; here I don't feel like doing anything. Every once in a while this feeling crops up in me that I want to go to or be somewhere else. I don't know where, but not here. I don't know why it happens, but I'm used to it now, so I push it to the back of my mind, and I try not to think about it. After a while it goes away. The priest here knows that people are always thinking this way. He talks a lot about it on Sundays and tells us to stop thinking about it and be thankful for what we have. But I don't know. I still think about it.
An appreciation by nurses that the capacity and need for continued development and evolution is characteristic of all living things regardless of age directs nurses to view older adults in terms of growth as well as decline. If an individual's sense of home is conceptualized as an extension of and integral part of the individual's identity, then a sense of home is integral to the preservation of that identity, allowing for the confirmation of self-worth and the continuation of growth and vital involvement in the individual's life. A prelude to enabling individuals to engage in the process of establishing an existential self would be provision of a home base, a haven, or a sanctuary from which to operate. It is within this home that possibilities are envisioned and hope is preserved. The realization by nurses that all humans experience life in the dialectic between actuality and possibility, between home and journeys away from home, reduces the chance older adults will find themselves left homeless and in despair in what may be their last homes.
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