Planning for the Future or Feeling Old - Older People’s Reasons for Moving to Senior Housing in Sweden

Even though most older people want to remain in their current home [1], some want to move because it no longer fit their needs or preferences [2]. This paper describes a study in Sweden, which investigated older persons’ reasons for moving to senior housing, and whether different reasons were related to background characteristics. Twenty percent of the population in Sweden is 65 years or older and the number of people above 80 years is increasing [3]. Most people above 80 years are living in ordinary housing (84%) [4] and very few move in this age [5]. The wish to remain in the current home is in line with elderly care policy in Sweden, which promotes aging in place [6]. Aging In Place (AIP) is a way to sustain socialties and identity [7]. 

Moving is considered a major life event that elicits stress responses [8]. However, older peoples’ worries about moving seem to be more pronounced when moving to special housing than to ordinary housing [9]. Moving in old age can also be a health promotive action. If the current home does not support safety needs or sense of belonging [10] it might be better for older people to move rather than stay. A discussion about aging in which place is therefore a more interesting question, instead of only focusing on AIP as such [11]. AIP can also be considered a risk for older people [12]. Moreover, AIP might be the result of being stuck at home for older people who wish to move but lack the resources to do so [2]. 

What makes older people move? 

People who move accommodation in old age do so due to a variety of reasons. Common reasons are e.g., related to health, home maintenance, loneliness, financial problems, lack of social or instrumental support, loss of spouse [8]. However, older people also make moving decisions to maintain their lifestyle [13]. A systematic literature review on factors influencing housing decisions among frail older adults resulted in seventy-one factors where most of them were about the meaning and experience of the home [14]. Even though previous studies have described older peoples’ motives to move in general [15] and some describe factors related to the choice of senior housing [16], very few have been conducted in the Nordic countries [17-19]. Internationally, housing models in the Nordic countries are somewhat unique because they are situated in a context of general, tax paid welfare that targets all older people regardless of socio-economic background. This makes it interesting to study housing options for and decisions made by older people in Sweden. 

However, recent changes within the welfare system show a decline in assistive living in Sweden [3], while a growing number of housing models designed for older people is emerging on the market. To understand how changes of the welfare system affects older people’s housing opportunities it is important to understand the reasons for moving to the new premises. The current study aims to shed some light on this question. 

Housing models for seniors in Sweden 

In Sweden, older people who need help 24/7 can apply for special housing (assisted living), which is obtained according to an individual needs’ assessment. This type of accommodation is reserved for people with severe physical or mental health problems [20] and the cost for living here is subsidized by the municipality. In-between ordinary housing for all ages and special housing for older people there, are different models. One such model is ‘service housing’ with apartments in a facility with common spaces, which are obtained according to needs’ assessment. On the ordinary market there is ‘senior housing’ (for people 55+ or 65+) and Care Housing’¹ (65+) [21] which can be rentals or condominiums. 

The research project 

This paper is part of a larger project that was focusing on how to create sustainable housing for seniors. It followed the construction of four sites of housing for seniors and included on site observations of the buildings, interviews with construction clients, architects and questionnaires and interviews with the residents. Three of the housing sites were facilities with rental apartments owned by municipal housing companies² in the western part of Sweden. One site was built the year before the research started, while the other two sites were followed before and after the tenants had moved in. Two facilities were senior housing targeting people above 65 or 70 years of age, while one was Extra Care Housing targeting people above 65 years of age [22]. Since all three examples were housing for seniors on the open market, they are all called senior housing in the text. 

Aim 

The aim of this study is to describe reasons/motives to move to newly built senior housing in Sweden. Moreover, it aims to shed light on whether different reasons/motives are related to different background characteristics. The research questions were: 

• What are the reasons/motives to move to senior housing?
• Are there differences in background characteristics between participants who move because of different reasons?

¹ This is called ‘trygghetsboende’ in Swedish. The apartments in Extra Care Housing are available to all seniors above a certain age, normally 65+. This housing should have good accessibility, common spaces for activities and a host working a few hours per day.

² These are not social housing, which is not available in Sweden. People of all socio-economic backgrounds live in rental apartments owned by municipal companies.

Procedure

A questionnaire and semi-structured interviews were used for the data collection. The questionnaire and interviews were carried out between 6 and 24 months after the tenants had moved in³.The questionnaire was sent out by post to all tenants who were not participating in the interview study⁴.

To get a deeper understanding about participants’ reasons to move and their experiences after having moved to the new accommodation, semi-structured interviews were carried out. Interview participants were selected as a strategic sample including both men and women, younger and older pensioners, those living alone or cohabitating. Fifteen households were recruited for the interviews (5 per site) with the help of a rental official. All participants signed an informed consent form prior to the interviews and were guaranteed that their identities would not be revealed in the results. The content and procedure of the study was approved by the Regional Board for Ethical Reviews in Gothenburg in May 2017 (Dnr 310 -17). 

Residents who agreed to participate were contacted by the interviewer to decide a time for the interview. No person declined to participate. All interviews were carried out in the participants’ homes. Nine were individual interviews and 6 were interviews with couples living together. Participants were encouraged to speak freely about their experiences in relation to the themes. All interviews were recorded and transcribed verbatim. 

Measures 

The questionnaire included 53 questions. The following eight questions were included in the current analysis (Table 1).

Table 1: Questions from the questionnaire that were included in the analysis. 

*) The year of birth was transformed into age with the use of SPSS, **) For the statistical analyses, the answers were dichotomized in two categories (single living or cohabiting); ***) For the statistical analyses, the answers were dichotomized in two categories (yes or no). For the interviews, athematic guide was used to ensure that important themes were captured. For the current study, the following themes were used: age, gender, living alone or together, experienced health, receiving help from home care services or someone else, reasons to move.

³On the two sites which were followed from the construction phase, the data collection took place approximately six months after they had moved in. On the site that was already built it took place approximately two years after they had moved in.

⁴The tenants who participated in an interview were excluded from receiving the questionnaire because we did not want to capture data from the same households twice. 

Participants

All tenants living on the three sites were invited to participate in the study either by answering the questionnaire or participating in an interview. 69 out of 118 households chose to participate (58%). The participants who answered the questionnaire (n = 54) were on average 80 years, mostly women and living alone (Table 2).

Table 2: Sample description.

Participants had moved from detached houses (38%) owner occupied apartments (31%), rental housing (26%) or residential care⁵ (5%). The three most common reasons for choosing the new accommodation was that it: had balcony/patio, was housing for seniors, and provided good accessibility [22]. The interviewees (n = 18) represented 15 households. They were on average 73 years old (57 - 88 years). Ten of them were living alone while eight were cohabitating. Eight were men and ten were women.

⁵Special housing for short time stay.

Data analysis

The analysis was based on previous literature which shows that certain background characteristics may be related to different reasons for moving. In this study, the concept ‘reason to move’ is the same as the answer options in the questionnaire. The concept ‘motive to move’ is constructed by the content of the interviews that reflected the underlying needs of the participants. Quantitative analysis: Descriptive analyses were conducted. Relationships between variables were analysed with the use of Pearson’s correlational analysis. SPSS was used for conducting the statistical analyses. The number of answers differed between questions due to selective missing data⁶.

Qualitative analysis: The qualitative analysis aimed to describe underlying thoughts behind the two most frequent reasons to move from the quantitative analysis: (a) ‘Planning for the future’ and (b) ‘Age and lack of energy’. The analysis drew upon content analysis [23]. Each interview was first read through has a whole, to grasp the narrative of it. Then the interviews were coded to look for answers reflecting the two most frequent reasons to move that came up in the quantitative analysis. In the third step, each interview was categorized in one of the reasons according to if the reason to move mainly was (a) or (b)⁷. In the fourth step, words and sentences reflecting the two reasons to move were coded to grasp underlying thoughts behind the move. In the fifth step, these codes were summarized for (a) and (b) respectively.

⁶Missing data was because the participants who answered the questionnaire could choose not to answer every question.

⁷The number of households that had moved because of reason (a) was 9, while 6 had moved because of reason (b). Two of the interviews included both reason a and b, but since ’Age and lack of energy’ was described as more influential on the decision, we put those interviews in that group.

The first part of the results is based on the questionnaire data, while the second part display the results from the interviews. 

Results from the questionnaire 

Reasons to move 

On the question: Why did you want to move from your previous accommodation? The most frequent answers were because of: (a) ‘Planning for the future’ (n = 26) and (b) Age and lack of energy’ (n = 23). Other common reasons to move were the wish for ‘easier maintenance’ (n = 17) or ‘having problems with stairs’ (n =16). The participants could give multiple answers to this question and twelve out of 51 participants had given both answers (a) and (b) (24 %). Thus, the two reasons did not belong to two entirely separate groups of participants. 

Relationships between background characteristics and reason to move

Descriptive analyses of the background characteristics of the participants showed that those who moved because of ‘Planning for the future’ was younger than those who moved because of ‘Age and lack of energy’. Furthermore, to move because of ‘Age and lack of energy’ was associated with more frequent use of home care services, to receive practical help from others, and to need help shopping (Table 3).

Table 3: Background characteristics between participants who moved because of ‘Planning for the future’ vs. ‘Age and lack of energy’.

*) Subjective evaluation: single item, higher scores indicate lower subjective health (1 = Very good, 2 = good, 3 = fairly good, 4 = bad, 5 = very bad).

Table 4 shows that some background variables were correlated with moving because of ‘Age and lack of energy’: age, use of home care services, receiving practical help from next of kin, and to need help shopping, while none of these variables were related to moving because of ‘Planning for the future’.

Table 4: Correlations between background characteristics and reasons to move.

a) Subjective evaluation: single item, higher scores indicate lower subjective health (1 = Very good, 2 = good, 3 = fairly good, 4 = bad, 5 = very bad). *) p < .05; **) p < .01.

Results from the interviews 

Planning for the future 

One theme associated with moving because of ‘Planning for the future’ was the wish to prevent loneliness. My mother, she became so lonely when she got old and then I thought that I didn’t want to be in that situation. 

Those who talked about loneliness had typically chosen a senior housing with common spaces and a social community (ECH⁸). Another theme within this group was the wish to move to a less demanding home environment. The interviewees described that they had to put a lot of time and effort on the maintenance. Even though they were able to do these things today, they thought it was better to move before it became impossible. We thought it was time purely in terms of age and... then it started to get tough with the garden and so, above all. And then we saw for ourselves that if we were to stay for a few more years there was a lot that we wanted to do with the house… different things with drainage and the roof and everything. Planning for the future was also associated with the wish for a silver lining in life by releasing money when selling their previous home and moving to a rental apartment. We said we don’t want to spend all our money to buy an apartment… we want to have money to spend, and … hope that we can stay healthy for many years so that we can travel. 

Age and lack of energy 

Those who moved because of ‘Age and lack of energy’ also wanted to prevent loneliness and wanted a less demanding housing environment, but with the difference that this group had moved because these things were actual problems. The following quote describes an interviewee who wished that they had moved earlier from a home that did not fit their needs. 

We just thought we should have moved a little bit earlier, but then this house was not there. /…/(- Why?) Because it was bad to live in the semi-detached house. It was on two floors… Interviewees described that they had become socially isolated after having lost their spouse. Another theme within this group was the wish to live among other older people. There are not a lot of children living here… (- Do you prefer living among people your age?) Yes, it’s much calmer. I feel much, much safer here. 

Reasons for couples for moving

Within couples, reasons for moving were in some cases related to the needs of only one of them. This could create tension within a relationship. Sometimes the partner who was the reason for the relocation, had passed away closely after the move. The following quote illustrates different needs and preferences within a couple. 

• The man: It [the previous accommodation] was on the third floor without an elevator and since I have osteoarthritis in my knees /…/I had trouble going down the stairs… and… thought ’OK, I will never get well’ and if I were to break a leg I would get isolated. You need to have elevator, huh! And in combination with the financial part…
• The woman: I would rather live in a villa (laughs)

⁸Extra Care Housing with common spaces and staff a couple of hours per day.

Even though ageing in place is the common housing policy in most places of the world, some older people need to move because their current home no longer fits their needs or preferences [12]. Some older people move to senior housing to get a better home and social environment. There is a gap in the literature, however, concerning who moves to senior housing and why. In this study the two most common reasons for moving were because of ‘age and lack of energy’ and ‘planning for the future’. These reasons are in line with previous research showing that decline in health, the wish for diminished home maintenance, and the need of companionship are common motives to move in old age [8]. However, some of the participants who moved because of planning for the future also did so to maintain their lifestyle [13] e.g., they wanted to release money when selling their previous accommodation. 

The unique contribution of this study is that it adds to our understanding of the varying reasons for moving held by different groups of movers. To move because of ‘age and lack of energy’ was related to being older and to the need of help in daily activities, which was not the case if moving because of planning purposes. The analysis of the interviews shed light on the participants’ underlying motives to move, describing similarities and differences between the two most frequent reasons. Some of the underlying motives were similar between the two groups of movers: to avoid loneliness and the wish to live in a home which was easier to maintain, but the timing was different. For those who moved because of ‘planning for the future’ these difficulties were a future issue, while those who moved because of ‘age and lack of energy’ lived with them in the present. 

Older people are at a high risk for loneliness which has a negative impact on health and wellbeing [24]. The participants’ wish to move to housing that increased their possibilities of being part of a social community is an awareness of this need. Moreover, the wish to move to a less demanding home is in line with the ecological theory of ageing which describes the ageing process as a dynamic interaction between the person’s capabilities and the adaptation and alteration of the environment to reduce environmental press [25]. The results of this study also point to two generations of older people who move to senior housing, which might have implications for the residents’ sense of belonging. It is important to discuss ageing in which place [11], since older people also live in housing that does not fit their needs [2,12], or preferences [13]. It might be the case that moving to senior housing, contributes to better conditions for ageing in place after the move, since many of the needs that the participants expressed are more easily met in senior housing. 

The construction of a place as the home is a mental process which takes place in relation to the physical space [26]. As human beings, we also include the social environment in our judgments of the environment. Senior housing is a special environment since providing a place where only people of a certain age span are allowed to live. Thus, a move to senior housing might increase the possibilities of creating social bonds. When the age group is more similar, it increases the possibilities of finding new friends which contribute to the perceived safety in the housing [21]. From the interviews with the group who moved because of ‘age and lack of energy’ a theme was that they had felt insecure in their previous neighborhood. This might be due to that this group was older and felt more vulnerable. If moving to an area which is perceived as safe, outdoor activities are more likely to occur [27] which is an example showing that older persons also may benefit from moving in the old days.

The study has important implications for practices to support older persons’ decisions on whether to move or not and for housing and city planners to understand different reasons to move among older adults. Future research may need to consider including both participants in couples in the study, to include different attitudes to a relocation. An interesting topic to investigate is whether a move to senior housing contributes to ageing in place i.e., if this model of housing postpones the move to special housing.

Strength of this study is that it is based on data from both questionnaires and interviews which together provide a deeper understanding of the underlying motives behind different reasons to move. However, the study is based on a small sample which is not representative for the Swedish population, and the data collection was retrospective. Thus, causality cannot be inferred.

Thanks to all participants in DIABAHS for contributions to the project and FORMAS, Centre for Management of the Built Environment, Mistra Urban Futures, and Gothenburg City for funding this study.

The author declares no conflict of interest.

1. Abramsson M, Elmqvist A, Magnusson TL (2014) Äldres flyttningar och motiv till att flytta eller bo kvar: Skrift inom regeringsuppdraget Bo bra på äldre dar, Hjälpmedelsinstitutet. (Older peoples’ relocations and motives to relocate or to stay put). Nationella institutet för forskning om äldre och åldrande (NISAL), Linköpings Universitet, Sweden.
2. Granbom M, Nkimbeng M, Roberts LC, Gitlin LN, Taylor JL, et al. (2020) “So I am stuck, but it´s OK”: residential reasoning and housing decision-making of low-income older adults with disabilities in Baltimore, Maryland. Housing and Society 48: 43-59.
3. National Board of Building, Building and Planning (2020) The national population forecast. National Board of Building, Building and Planning, Karlskrona, Sweden.
4. National Board of Health and Welfare (2018) Tabell 1a. Antal personer med pågående insats den 31 oktober 2017. Fördelade efter ålder, kön och insatstyp. Riket. Källa: 71 Registret över insatser enligt socialtjänstlagen till äldre och personer med funktionsnedsättning. (Table 1a. Number of persons with ongoing intervention on 31 October 2017. Distributed by age, sex, and type of intervention. Nationwide. Source: 71. The register of interventions according to the Social Services Act for the elderly and people with disabilities). National Board of Health and Welfare, Sweden.
5. Angelini V, Laferrère A (2012) Residential Mobility of the European Elderly. CESifo Economic studies 58: 544-569.
6. Swedish Government Official Reports (2017) Läs mig! Nationell kvalitetsplan för vård och omsorg för äldre personer (Read me! National quality plan for health and care for the elderly, Part 1)). SOU, Sweden.
7. Berglund-Snodgrass L, Nordh C (2019) The Continuation of Dwelling: Safety as a Situated Effect of Multi-Actor Interactions Within Extra-Care Housing in Sweden. Journal of Housing for the Elderly 33: 173-188.
8. Ewen HH, Chahal J (2013) Influence of Late Life Stressors on the Decisions of Older Women to Relocate into Congregate Senior Housing. J Hous Elderly 27: 392-408.
9. Granbom M, Löfqvist C, Horstmann V, Haak M, Iwarsson S (2014) Relocation to ordinary or special housing in very old age: Aspects of housing and health. Eur J Ageing 11: 55-65.
10. Hagerty BM, Lynch-Sauer J, Patusky KL, Bouwsema M, Collier P (1992) Sense of belonging: A vital mental health concept. Arch Psychiatr Nurs 11: 172-177.
11. Thokle MC (2018) Aging in Which Place? Connecting Aging in Place with Individual Responsibility, Housing Markets, and the Welfare State. Journal of Housing for the Elderly 32: 1-11.
12. Oswald F, Jopp D, Rott C, Wahl HW (2010) Is aging in place a resource for or risk to life satisfaction? Gerontologist 51: 238-250.
13. Oswald F, Wahl H-W (2005) Dimensions of the meaning of home. In: Rowles GD, Chaudhury H (eds.). Home and identity in late life: International perspectives. Springer, New York, NY, USA.
14. Roy N, Dubé R, Després C, Freitas A, Légaré F (2018) Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults. PLoS One 13: 0189266.
15. Löfqvist C, Granbom M, Himmelsbach I, Iwarsson S, Oswald F, et al. (2013) Voices on relocation and aging in place in very old age--a complex and ambivalent matter. Gerontologist 53: 919-927.
16. Hansen EB, Gottschalk G (2006) What makes older people consider moving house and what makes them move? Housing Theory and Society 23: 34-54.
17. Motevasel IN (2008) Senior housing in Sweden-A question of class differences and collective aging. Journal of Housing for the Elderly 20: 77-93.
18. Henning C, Ahnby U, Osterstrom S (2009) Senior housing in Sweden: A new concept for aging in place. Soc Work Public Health 24: 235-254.
19. Tyvimaa T, Kemp CL (2011) Finnish Seniors’ Move to a Senior House: Examining the Push and Pull Factors. Journal of Housing for the Elderly 25: 50-71.
20. SFS (2001) Socialtjänstlagen (Social Services Act). Social departementet (Ministry of Social Affairs). Stockholm, Sweden.
21. Lindahl L, Andersson M, Paulsson J (2017) Perceived Safety in Extra-Care Housing for Senior Residents. Journal of Housing for the Elderly 32: 1-15.
22. Lindahl L, Ryd N (2020) Från idé till verklighet - erfarenheter från fyra bostadsprojekt för seniorer: Slutrapport från projekt DIABAHS (From idea to reality - experiences of four housing projects for seniors. Final report from the project DIABAHS). Vetenskaplig rapport ACE 2020: 1, Chalmers tekniskahögskola (Scientific report ACE 2020: 1, Chalmers University of Technology), Gothenburg, Sweden.
23. Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24: 105-112.
24. Paredes AM, Lee EE, Chik L, Gupta S, Palmer BW, et al. (2020) Qualitative study of loneliness in a senior housing community: the importance of wisdom and other coping strategies. Aging Ment Health 25: 559-566.
25. Lawton MP, Nahemow L (1973) Ecology and the aging process. In: Eisdorfer C, Lawton MP (eds.). The psychology of adult development and aging. American Psychological Association, Massachusetts, USA.
26. Easthope H (2004) A place called home. Housing, Theory and Society 21: 128-138.
27. Nicklett EJ, Lohman MC, Smith ML (2017) Neighborhood Environment and Falls among Community-Dwelling Older Adults. Int J Environ Res Public Health 14: 175.