Stigma & Separation: Social Issues Surrounding Multiple Levels of Care in Senior Housing

Although Life Plan Communities and other multilevel senior living residences offer older adults the ability to age in place as care needs change, transitions from one level of care to another and interactions across levels of care pose challenges for residents and staff. Research has shown these transitions to often be more disruptive than expected in terms of social consequences. A recent study examined experiences of residents and staff at seven multilevel sites to identify the main social features of such transitions and interactions.

The first finding was that there is often a stigma surrounding the floors or units offering intensive levels of care. Residents in lower levels of care would label such areas “Death Valley” or “the Twilight Zone.” This stigma contributed to residents being uncomfortable visiting friends in higher levels of care.

The next major theme was that housing the levels of care in one building or campus posed challenges to socializing across levels of care, especially when cognitive differences existed between residents. This situation can lead to residents making comments such as, “Why is she here? She doesn’t belong here.”

The third finding was about the impact of different levels of care on resident identity. Residents in independent living expressed a need to clearly identify as independent. Behaviors might include concealing signs of decline. In some cases, this can involve acting preemptively to avoid rejection, such as eating meals in one’s room.

Lastly, the study described resident concern about surveillance by staff, which could result in being moved to a higher level of care. The power of staff to make or influence such decisions can even lead to adversarial relationships between residents and staff, as well as residents living in fear and isolating themselves from staff.

All of the above suggests the critical importance of creating a culture within multilevel senior housing to counteract or reduce the phenomena described above. The researchers conclude, “there needs to be greater recognition and understanding by developers, operators, staff and potential residents of the personal and social challenges that are typically encountered.” Senior living organizations need to consider strategies and policies that can address the negative social issues that emerge in multilevel care settings so that staff and residents can work to combat these issues.


Roth EG, Eckert JK and Morgan LA. Stigma and discontinuity in multilevel senior housing’s continuum of care. The Gerontologist. (gnv055 (2015). DOI:10.1093/geront/gnv055

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