Impact of a Single Condition on Elders’ Feeling of Home

Based on the premises of QCA and our research findings, we noted that the sole presence or absence of any individual condition cannot inhibit or induce the outcome. However, an

individual condition could bring about different levels of significance to the outcome when they were configured with other conditions. For example, among the three attributes of institutional conditions, care was present as a necessary condition in three pathways, including the two most promising ones (Pathways I & II). The pattern of its presence suggested that the absence of care

may have a strong impact that hampers elderly residents from constructing a sense of home while its presence alone was insufficient to provoke the outcome. It must work with other attributes to induce a sense of home, as shown by Pathway I. Chinese older adults and their family members often choose institutional care over traditional family-based care based on their expectation for professional staff with the necessary skills, abilities, and time devoted to the provision of professional elder care (Chung et al., 2008). For this reason, Chinese elderly residents often place heavy emphasis on instrumental assistance and attention to their physical

and medical needs in residential care environments, particularly for those who live in hospital- like facilities (Hwang, Hsieh, & Wang, 2012). In this study, participants mentioned that living in an elder care home made them feel safe because they knew that they were being taken care of. The frequent presence of care as a necessary condition in pathways also revealed that a high quality of care services served as the foundational attribute to foster elderly participants’ sense of home.

Among the three attributes of institutional conditions, management and formal activities

were not as important as care because they presented as substitutive conditions, and they were substitutive to each other, as shown in Pathway II. The presence of formal activities seemed to be

more important than management in eliciting the outcome when it was configured with other

social and personal conditions (i.e., Pathway IV). This finding is in line with what Cutchin et al. (2003) discussed in their analyses of the process of becoming “at home”; they reported that involvement in nonfamily activities in place is a significant predictor of place attachment and at homeness. Social involvement in meaningful activities promotes a sense of belonging and collective group identity (Shippee, 2012). More important, providing shared social activities in elder care homes is linked to enhanced opportunities for residents to form social relationships and to enrich their lives.

Furthermore, our analyses reveal that the two social factors (i.e., friendship, filial) were equally important to the outcome. In Pathway I, the presence of either one of the social factors was indispensable among the four routes. And in Pathway II, when institutional conditions were relatively weak (in comparison to Pathway I) and when personal hobbies were absent, the two social factors appeared as necessary conditions for the outcome. Under the influence of

wives, the feasibility of providing family care for the elderly has weakened while the utilization of elder care services has dramatically increased in contemporary Chinese society (Sheng & Settles, 2006). However, supporting elders’ utilization of residential care services does not imply the erosion of the traditional value of filial piety. After moving into an elder care home, adult children continue their filial roles by providing care to their parents in varied ways, such as frequent visits, providing emotional and instrumental support, helping elders to deal with

medication issues and administrative problems, paying the fees, etc. (Zhan et al., 2011). In our study, except for those who have serious conflicts with children, most elderly participants valued their intergenerational interactions, and expressed appreciation or acknowledgement for their children’s various kinds of supports.

Similarly, friendship within the facility was also meaningful. Friendship allows elderly residents to mutually exchange assistance and be reciprocal to one another’s emotional needs. This, in turn, strengthens their resilience toward hardships in challenging living environments (Kontos, 1998; Shippee, 2012; Wreder, 2008). Previous literature generally suggested a similar finding, that older adults are active in developing new social relationships, and their relationships within the place/facility contribute to their morale (Sherer, 2001), and overall well-being (Street et al., 2007). Taken together, friendship within the institution and supports from children were forms of social capital, which enabled the elders to seek help and pull them through problems and hardships.

Moreover, when institutional conditions were weak (i.e., Pathways III &IV), personal conditions (i.e., hobby, optimism, freedom) were significant for the construction of home. Among the three personal attributes, the presence of optimism was most important. As shown in Pathway I, among four sets of substitutive conditions, optimism can only be substituted when hobby and

freedom were both present, suggesting that the sole effect of optimism equals the combined effects of hobby and freedom. The significance of optimism was even more overt when certain conditions were absent, such as in Pathway II and Pathway IV. If the presence of social

conditions served as elderly participants’ social capital, then optimism is a form of psychological capital. Specifically, this notion focuses on elders’ positive awareness of their life situations rather than incompetence, weakness, or hopelessness. With better psychological strength, older adults would be more resilient to adversity and loss (Perkins et al., 2012), and capable of coping with environmental changes and challenges along with their aging process (Komatsu, Hamahata, & Magilvy, 2007).

Moreover, optimism is associated with what Brandtstadter and Greve (1994) called the

accommodation form of coping or the “secondary control strategies” (Heckhausen, 1997). These terms refer to mental strategies that elderly persons may adopt as they face negative life

situations, such as to “reformulate goals and aspirations, mollify emotional irritations, reappraise problems as being unimportant, look to religious or spiritual beliefs to palliate losses” (Glotanta, 2011, p 201). In this cross-sectional study, many elderly participants have resided in elder care facilities for many years. In interviews, some of them shared their psychological journey of living in such environments. Most of them agreed that cognitive appraisal and self-preservation, looking for positive aspects of life, were important to their feeling of settling down, but this process takes time.

Freedom was the least important personal factor affecting the outcome. Although

freedom was present in Pathway III as a necessary condition, it was irrelevant in Pathway II, and it could be substituted by other attributes in the first and second pathways. Contrasted to the literature of Western societies where personal freedom and autonomy are highly valued (Haak et

al., 2007; Perkins et al., 2012), Chinese elders seem to care less about the notion of freedom, especially in a collective living environment. Our participants showed a great understanding of rules and regulations, and considered regulations to be mechanism to protect their safety and maintain collective harmony in the facility. This observation may be explained by the nature of social relationships in t Confucian culture. People in Chinese society are sensitive to others’ opinions, appraisal, or criticism; they pay close attention to social rules and standards, and honor reputation in groups (Yang, 2008). Because most elderly residents grew up in a socio-cultural environment where conformity was highly valued, following rules and regulations as well as communal living did not seem to be a challenging task. This finding does not suggest that freedom is not important at all to elders in institutions. Rather, it means that Chinese elders have a high tolerance for rules and regulations. While freedom may foster the outcome of a sense of home when it is configured with other attributes, its sole presence or absence does not have a direct or strong impact on the feeling of home.