One key aspect of nursing homes has been largely overlooked: To what extent do residents consider a nursing home to be home? This gets to the heart of what makes people feel that the place in which they live is more than just a dwelling. On the surface, it appears that nursing homes are full of barriers to this

feeling. After all, they may have regulations about the extent to which residents may bring their own furnishings and other personal effects with them, and residents are in an environment that has plenty of structural reminders that this is not a house in suburbia. Not having one’s own refrigerator, for example, means that one can no longer invite friends over for a home-cooked meal (Shield, 1988).

Can nursing home residents move beyond these barriers and reminders and achieve a sense of home? Apparently so, but with some very important qualifi­cations. Groger (1995) proposed that a nursing home can, indeed, be perceived as a home. She interviewed 20 older African American adults, 10 who lived in nursing homes and 10 who were home care clients. Groger’s analysis of her interviews revealed that nursing home residents can indeed feel at home. The circumstances that foster this feeling include having the time to think about and participate in the place­ment decision, even if only minimally; having prior knowledge of, and positive experience with, a spe­cific facility; defining home predominantly in terms of family and social relationships rather than in terms of place, objects, or total autonomy; and being able to establish some kind of continuity between home and nursing home either through activities or through similarities in living arrangements.

Groger (1995) also reports that getting nursing home residents to reminisce about home may actu­ally facilitate adjustment. Some residents concluded only after long and detailed reflection on their prior home that the nursing home was now home. In addition, it may be easier for nursing home resi­dents to feel at home on some days than others and from one situation to another, depending on the events or stimuli at the time.

Helping nursing home residents feel at home is an important issue that must be explored in more detail. Perhaps having people think about what constitutes a home, before and after placement, may make the transition from community to the facility easier to face. For those who need the care provided in a nursing home, anything that can be done to ease the transition would be a major benefit. Assessing the degree to which residents feel at home is possi­ble (Molony, McDonald, & Palmisano-Mills, 2008).

At a general level, nursing home residents’ sat­isfaction relates to several key variables: facility factors, staff factors, and resident factors, as shown in Figure 5.4 (Chou et al., 2003). Research indicates that staff satisfaction plays a crucial role in nursing home residents’ satisfaction. In contrast, providing more care does not (Chou et al., 2003). In addition, when residents have a voice in determining the

quality of care, their satisfaction improves (Boldy & Grenade, 2001). As we will see next, how people communicate with residents is also key.