Choice,Control, and Adaptation Among Elderly Residents of Sheltered Care Settings1

This study examined how elderly residents' adaptation is affected by naturally occurring levels of choice and control in sheltered care facilities. A representative sample of 244 residential care facilities was assessed with the Multiphasic Environmental Assessment Procedure, which measures the quality of residential settings for older people. Overall, facility policies allowing more choice and control were associated with better rated resident well-being, less use of health, daily living assistance, and social-recreational services, and more integration in the community. Policy clarity and the facility social climate factors of independence, influence, and organization mediated the relationship between choice and control and adaptation, and also independently affected residents' adaptation. In addition, in facilities with functionally able residents, more choice and independence were associated with less use of services; in facilities with residents of poor functional ability, choice and independence were unrelated to use of services. Thus, policies that promote more choice and independence may improve adaptation among functionally able residents of sheltered care facilities, without having a detrimental influence on poorly functioning residents.