Perceptions and Practices of ‘Having Part’: An Ethnography on Participation of Older People in Assisted Living

Introduction and background

The growing aging population presents challenges for long-term care in Switzerland. In addition to home-based and residential care, assisted living is as a key intermediate model, offering older adults autonomy in barrier-free settings with varying levels of support. Demand is expected to rise, as assisted living is seen as a cost-efficient alternative to residential care. While social participation in old age is widely promoted, little is known about how participation is understood and practiced in assisted living, or how structural conditions support or hinder older adults’ participation. This PhD project addresses that gap by exploring participation in Swiss assisted living contexts.

Objectives

This PhD project aims to:

1. provide an overview of current academic and societal discourses on assisted living and resident participation.

2. ethnographically map meanings and practices of participation of older people staying in assisted living from the perspectives of residents, relatives, care providers, and institutional managers.

3. identify and analyze potential inequities in participation in assisted living.

This PhD project contributes to the overaching goals of EPICENTRE-PARTICIPATIO by offering in-depth empirical insights into participation in Swiss assisted living. Focusing on multiple actors’ experiences, this study supports the co-development and design of ideas and approaches to promote more equitable participation of older adults in long-term care.

Methodology

This study employs an ethnographic approach to investigate how participation is conceptualized, experienced, and practiced in Swiss assisted living, drawing on insights from residents, relatives, care providers, and institutional managers. A narrative review frames key discourses, followed by 12 months of ethnographic fieldwork in four assisted living using ethnographic methods, such as observation, participant observation, informal conversations, and semi-structured interviews. This methodology captures the complexities of everyday participation and interaction by considering both explicit and implicit dimensions in assisted living. Regular reflection and the co-creation of knowledge are achieved through ongoing collaboration within the research team and a transdisciplinary advisory group, ensuring that emerging insights are grounded in multiple experiences.

Relevance of thesis

As the demand for long-term care services rises, understanding the dynamics of participation is crucial for developing equity within this diverse sector. While institutional care models are well studied, residents’ experiences in long-term care, especially in assisted living – particularly regarding participation – remain underexplored. By exploring enabling and limiting factors and highlighting diverse perspectives and structural conditions, this study contributes valuable insights for developing strategies that promote equitable participation of older adults in assisted living.