1. Adulthood and Aging, 6e
John C. Cavanaugh
Fredda Blanchard-Fields
Chapter five
Where People Live:
Person-Environment Interactions

2. Describing Person—Environment Interactions
Learning Objectives
• What is the competence and environmental press
model?
• What is the congruence model?
• What are the major aspects of stress and coping
theory relating to person—environment
interactions?
• What are the common themes in the theories of
person—environment interactions?

3. Describing Person—Environment Interactions
Person—Environment interactions
conceptualized (Kurt Lewin, 1936)
B = f(P, E)
Where:
B = Behavior
P = Person
E = Environment

4. Describing Person—Environment Interactions
Competence and Environmental Press
• Competence is the theoretical upper limit of
a person’s capacity to function.
• Environments can be classified on the basis
of the varying demands they place on the
person, a notion called environmental
press.
– Adaption Level: Where behavior and affect are
normal, slight increases in press improve
performance, slight decreases create a Zone of
Maximum Comfort.

6. Describing Person—Environment Interactions
The Congruence Model
• According to Kahana’s (1982) congruence
model, people with particular needs search
for the environments that meet them best.
• Can you offer examples?
1. A person without personal transportation seeks a
house near a bus route.
2. A handicapped person needs a home adapted to
a wheelchair (no steps).
3. An elderly person may need to relocate to an
assisted-living facility.

7. Describing Person—Environment Interactions
Stress and Coping Framework
• Interaction with the environment can
produce stress (Lazarus, 1984).
• Evaluating one’s situation and surroundings
for potential threat value
– Harmful
– Beneficial
– Irrelevant
• If harmful, what is the coping mechanism
and response? Outcome positive or
negative?

8. Describing Person—Environment Interactions
Common Theoretical Themes and
Everyday Competence
• Everyday competence is a person’s
potential ability to perform a wide range
of activities considered essential for
independent living.
– Broader than just ADL or IADL
– Necessary determinate for whether an
elderly person can take care of themselves

9. The Ecology of Aging
Learning Objectives
• What is aging in place?
• How do people decide the best option?
• How can a home be modified to provide a
supportive environment?
• What options and services are provided in adult day
care?
• What is congregate housing?
• What are the characteristics of assisted living?

10. The Ecology of Aging
• Aging in Place
– Balancing environment press and competence
through selection and compensation.
– How a place becomes a home.
– Cluster housing.

11. The Ecology of Aging

12. The Ecology of Aging
• Deciding on the Best Option
– Does the individual have significant cognitive or
physical impairment requiring intervention?
• What is the severity?
– The individual needs to be an integral part of the
decision making.
– Get a physician’s diagnostic evaluation (required in
many states).

13. The Ecology of Aging
• Home Modification
– Helping people deal with tasks of daily living by
modifying the environment
• Hook for car keys near the door
• Hand rails in bathrooms
• Door handles that are easier to grasp
• Widening doorways
• Lowering countertops
• Wheelchair ramps

14. The Ecology of Aging
• Adult Day Care
– Designed to provide support, companionship, and
certain services during the day
– Goal is to delay placement in more formal care
setting.
– Three types of adult day care
• Social services, meals, recreation, and minor health
care
• More intensive health care, therapy, for serious medical
problems
• Specialize care for dementia or developmental
disabilities.
Profit (22%) or non-profit (78%)

15. The Ecology of Aging
• Congregate Housing
– Apartment complex for older adults
• Shared meals
• Affordable
– Differs from assisted living in level of services
– Residents must be capable of independent living
and:
• Not require continual medical care
• Know where they are and oriented to time
• No evidence of disruptive behavior
• Able to make independent decisions
• Be able to follow specific service plans

16. The Ecology of Aging
• Assisted Living
– Provides a supportive living arrangement for
people who need assistance with personal
care (bathing, taking medication) but are not
physically or mentally impaired to require 24-
hour care.
• Has three essential attributes
3. As much like a single family house as possible
4. Emphasizes personal control, choice, dignity, and autonomy
5. Should meet routine services and special needs

17. The Ecology of Aging
• Assisted Living (continued)
– Utilize check list to ensure the selected
facility meets specific requirements of the
individual
– Costs average about $35,000 per year.
– Not offset by Medicare
• Specialty Care Assisted Living

18. Living in Nursing Homes
Learning Objectives
• What are the major types of nursing homes?
• Who is most likely to live in nursing homes?
• What are the key characteristics of nursing homes?
• What are special care units?
• How can a nursing home be a home?
• How should people communicate with nursing home
residents?
• How is decision-making capacity assessed?
• What are some new directions for nursing homes?

19. Living in Nursing Homes
Types of Nursing Homes
• Two levels of care are defined in
federal regulations.
– Skilled nursing care consisting of 24-hour care,
including medical and other health services
– Intermediate care also 24-hour but at a less
intensity

21. Living in Nursing Homes
Who is Likely to Live in Nursing Homes?
• Characteristics of People Most Likely to Be
Placed in a Nursing Home
– Over age 85
– Female
– Recently admitted to a hospital
– Lives in retirement housing rather than being a
homeowner
– Widowed or divorced
– Has no children or siblings nearby
– Has some cognitive impairment
– Has one or more problems with IADL

22. Living in Nursing Homes
Who is Likely to Live in Nursing Homes?
• Health issues and functional impairment
– Average resident has significant mental and
physical problems
– Main reason for placement (80%)
– One third of residents have mobility, eating or
incontinence problems.
– 30 to 40% show signs of clinical depression.

24. Living in Nursing Homes
Characteristics of Nursing Homes
• The competence-environmental press
model
– Goal is to find the optimal level of environmental
support for people of low levels of competence
– In selecting a nursing home relatives should keep the
following in mind:
• Level of skilled nursing care
• Be mindful if facility is primarily Medicare or Medicaid
• Is the director and upper staff fully licensed?
• Is the care plan put in place by professionals?
• Ask questions about staff educational levels and staff
turnover.

25. Living in Nursing Homes
Special Care Units
– Does the facility have well-designed special
care units for people with dementia?
– Special care units must have the right level of
environmental support to provide additional
care when the person’s competence level
continues to decline.
– Memory aids should be built into the unit.
– Special care for severely cognitive impairment
residents

26. Living in Nursing Homes
Can a Nursing Home Be a “Home?”
• What can be done to foster the sense of “home?”
– Being included in the decision and selection of a
specific nursing home
– Having prior knowledge of, and positive experience of a
specific facility
– Defining the home in terms of family and social
relationships rather than place, objects, or total autonomy
– Establish a continuity between home and nursing home
– Reminiscing about home may facilitate adjustment

27. Can a Nursing Home Be a “Home?”

28. Living in Nursing Homes
How Not to Communicate with Residents
• Patronizing speech
• Infantilization or baby “talk”
• Inappropriate use of first names
• Terms of endearment—“Honey,” “Sweetie”
• Assumption of greater impairment than may
be the case
• Cajoling to demand compliance
to persuade with flattery or gentle urging especially in the face of reluctance

30. Living in Nursing Homes
Decision-Making Capacity and Individual
Choices
• How well can a nursing home resident
make decisions regarding their care?
– Cognitive impairment
– Patient Self-Determination Act (PSDA)
– Provide written information at time of admission
concerning their right to make treatment decisions
– Living will
– Patients normally give the decision to family
members.

31. Living in Nursing Homes
New Directions for Nursing Homes
• The Eden Alternative
– The ten principles of the Eden Alternative.
– Use of pets and other approaches seem to make
stronger associations between current and former
living situations.
• Research (Coleman et al. 2002) does not
support this view.
• Quality of Life difficult to assess using
traditional methods.
• Further research needed in this area.

32. Living in Nursing Homes
New Directions for Nursing Homes
• Green House Project
– Radical departure from the idea of large residential
facilities
– Encourages residents to participate in their care
through helping with daily tasks
– Personal dignity is maintained and quality of life is
improved.

33. Living in Nursing Homes
New Directions for Nursing Homes
• The Pioneer Network
– Similar values
– Older persons are valuable to society.
– Treating all people with dignity
– Everyone deserves that.