Qual Sociol (2008) 31:407–424

DOI 10.1007/s11133-008-9116-y

Interviewing Elderly Residents in Assisted Living

Carol A. B. Warren & Kristine N. Williams

Published online: 24 September 2008

# Springer Science + Business Media, LLC 2008

Abstract The interpretation of interview data requires an understanding of its context. In this
study, the context was Assisted Living (AL). Twenty-one interviews were conducted with
elderly residents of 4 Midwestern Assisted Living Facilities (ALFs). Institutional fear and
loneliness associated with ALF living framed residents’ interpretation of and responses to the
interview questions. Residents feared transfer to a nursing home, and they experienced the
loneliness of being cut off from their homes and put into the care of busy staff members. Their
framing of and responses to questions (both qualitative and quantitative) reflected this context,
and included the invocation of impairments, the reluctance to criticize staff, and the refusal to
complain about the ALF or their present situation.

Keywords Interviewing . Elderly . Assisted living . Communication

There is a large and growing literature on the interview as social interaction in context, and
the interpretive issues associated with both qualitative and quantitative interviewing
(Gubrium and Holstein 2002; Warren and Karner 2005). In the typical interview, one or
more interviewers ask questions of one or more respondents in a particular social context.
Interviews have a life history, with variable responses at the beginning, middle and end
(Warren 2002, p. 98). In open-ended interviewing the intent is to explore the respondent’s
interpretations; in survey or scale interviewing, the intent is to categorize responses into
predetermined categories, and perhaps to quantify them.
This study of interviewing is based on interviews with elderly women residents of four
Assisted Living Facilities (ALFs). Twenty-one qualitative interviews were conducted by the
Principal Investigator (identified as KW in the transcripts) who is a gerontological nurse

C. A. B. Warren
Department of Sociology, University of Kansas, Lawrence,
KS 66045, USA
e-mail: cabw@ku.edu

K. N. Williams (*)
University of Kansas School of Nursing, Mail Stop 4043, 3901 Rainbow Blvd., Kansas City,
KS 66160, USA
e-mail: kwilliams1@kumc.edu
408 Qual Sociol (2008) 31:407–424

researcher. The aim of the study was to gain an understanding of the experience of assisted
living for residents (and staff) as well as to identify issues or problems common in ALFs.
Five open ended questions were asked, starting with “How did you come to live in this
ALF?” and ending with “What if anything could be done to improve the ALF?” Following
the guided interview questions, a depression scale and a health-related quality of life scale
were administered to elicit quantitative data.
The focus of our analysis is how the interview context shaped the residents’ interpretation of
questions, their answers, and the negotiation of numbers. By context, we mean the
autobiographical (Wortham 2001) as well as the situational (Adler and Adler 2002). These
women were elderly (mean age was 85), many of them widowed after years of marriage. Each
interview was situated in private or public rooms of ALFs, punctuating daily routines of
grooming, mealtimes, television or computer, and activities. The interviewer was introduced to
residents by the Directors of Nursing, so she had some association with the ALF administration.

Methods and settings

This paper is part of a larger study focused on the experience of Assisted Living for both
residents and staff in four Midwestern facilities. The purpose of the larger study was to
determine how resident and staff experiences in assisted living differ from other residential
settings, and to identify whether assisted living is successful in maintaining autonomy—
independence, privacy, and quality of life for older adults. Autonomy is one of the most
important themes in recent qualitative and quantitative research on ALFs (Carder 2002;
Morgan et al. 2006; Moss and Moss 2007; Sikorska-Simmons 2006).
Informed consent was obtained from residents under the Human Subjects Protection
guidelines of the University Medical Center. The methods of the study included guided
individual interviews with residents, except for two women who were interviewed together
and two women who were interviewed in the presence of their husbands. Five open-ended
questions were used to guide the interviews, starting with “What brought you to live in this
ALF?” and concluding with “If you could change something to improve AL, what would it
be?” At the end of the interviews, two scales were used to elicit quantitative data about
depressive symptoms and health related quality of life. The scales included an adaptation of
the Dartmouth COOP Functional Health Assessment Charts (Nelson et al. 1996) and the
Center for Epidemiological Studies Depression Scale (Radloff 1977).
The Dartmouth COOP Functional Health Assessment Charts: Brief Measures for
Clinical Practice (Nelson et al. 1996) addresses the older adult’s perceived satisfaction with
their health and relationships with others within the assisted living residence. This scale was
used to gauge these psychosocial domains within the experience of the assisted living
resident. An additional question, asking the participant to indicate their life satisfaction on a
ladder was used to determine how life satisfaction had changed since moving into assisted
living, and how the future looked.
The Center for Epidemiological Studies Depression ten-item scale was used to measure
depression (Radloff 1977). Designed for screening and research, it assesses for six
components of depression including mood, feelings of guilt and worthlessness, feelings of
helplessness and hopelessness, psychomotor retardation, and sleep disturbance during the
past week. Higher scores reflect greater risk of depression. The CESD has been established
as reliable and valid in older adult populations (Radloff and Teri 1986).
The four assisted living facilities are located in the Midwest. Arden, Compton Hills, and
Denleigh Manor (all pseudonyms) are within suburbs of a large metropolitan area, and West
Qual Sociol (2008) 31:407–424 409

Meadows is in a rural town approximately 1 hour from the metro area. Arden is part of a
continuous care retirement community sponsored by a religious organization. The other three
facilities are part of a corporation group of lower cost, free-standing facilities. All facilities
housed about 40 residents. Monthly costs of the residences ranged from $2,000 per month for
West Meadows to $5,000 or more for Arden. All except Arden accepted partial payment from
the Medicaid program (for low income clients); most ALF financing comes from private
payments. With the exceptions noted below, the experience of ALF living was similar for the
residents of all these facilities, despite their cosmetic and cost differences.
The resident interviews were tape recorded and transcribed verbatim. We identify
residents by pseudonyms, using both a first name and surname. The interviews were, in the
main, welcomed by both staff and residents, but particularly by residents. The interviews
gave residents the opportunity to engage in social interaction with someone other than
fellow residents, family or staff, and to see themselves as “helping” someone else. Doris
Wilkerson, a resident of Arden, said of the interview, “I’m glad you helped fill in my
morning.” When KW apologized that she had overstayed the interview’s promised time by
30 min, Ellen Hardy said, “I’m here to help you.”
Analysis of the qualitative data was done by the inductive method: generating concepts
from the data rather than deducing hypotheses from theory. The inductive method is often
referred to as the grounded theory or constant comparison (Bernard 2006; Charmaz 2002;
Warren and Karner 2005). As Holstein and Gubrium (1995, p. 79) note, in the inductive
interpretation of interview data:
Respondents’ talk is not viewed as a collection of reality reports delivered from a
fixed repository. Instead, the talk is considered for ways that it assembles aspects of
reality in collaboration with the interviewer.
In collaboration, yes; but, as we shall see, often with different frames of reference.
Issues of validity and generalizability are differentially relevant for quantitative and
qualitative research. In quantitative research, valid data are those that can be stripped of
their context; thus, the measures obtained by depression or satisfaction scales are the
equivalent of taking blood pressure. Since this is a qualitative analysis of quantitative and
qualitative data, this is not our definition of validity. Instead, we take validity to be
inseparable from context. Thus, findings are generalizable only to other, similar contexts—
other ALFs with similar features—and, even then, only tentatively.

Interviewing the elderly in assisted living facilities

There is a considerable body of literature on interviewing in the social sciences, from

sociology, anthropology, communications, and other fields. Some of this literature focuses on
the interview as conversational or speech event (Baker 2002; Mischler 1986), some on its
epistemology (Briggs 2002; Gubrium and Holstein 2002), and some on the social context of
the interview (Adler and Adler 2002; Warren 2002). This study focuses on the context of the
interview, and the interpretations, answers, and negotiations that occur within that context.
There are also a number of studies that reflect upon issues of interviewing people in
institutional settings or interviewing the elderly. ALF care provides a living environment
that is part-way between independent living and a nursing home. Because ALFs are the
fastest growing residential care option for frail older adults—expected to double to reach 2
million residents over the next decade (Mollica and Johnson-Lemarche 2005)—interview
research may be critical to understanding and improving ALF living.
410 Qual Sociol (2008) 31:407–424

Over the past twenty years institutionalized populations have been increasingly protected
from social science as well as biomedical research, sometimes to the consternation of social
scientists (Warren and Karner 2005). With adequate human subjects protections in place,
however, interviewing institutionalized populations may provide important information
about the institutional experience (Adler and Adler 2002). Residents of ALFs may or may
not be autonomous and independent enough to be able to choose to be interviewed (see also
Carder 2002; Morgan et al. 2006). The residents interviewed for this study were competent
to provide consent and volunteered to do so.
There is some research on interviewing elderly respondents. In her work on interviewing
people over 65, Wenger (2002, p. 261) notes that it is useful to distinguish between the
young elderly (65–74), the elderly (75+) and the oldest old (85+). As Wenger notes,
Clearly, interviewing well people in their 60s and 70s is comparable to interviewing
younger well adults, while interviewing frail and impaired people in their 80s and 90s calls
for an approach that is sympathetic to the physical and mental energies of the respondents.
Most of our respondents were either the oldest old, or the upper range of the elderly. Some
elderly residents of ALFs are impaired in one way or another, and suffer from chronic or
acute illness. Impairment may make elderly people reluctant to be interviewed, resistant to
being interviewed for the full length of the interview, or uncomfortable in the interview
(Wenger 2002). Impairments such as forgetfulness, loss of hearing, speech problems, and
cognitive impairment may have an impact on question and answer sequences (Wenger 2002).
Although impairment, tiredness, illness, and other conditions of late life may make
elderly people less willing participants in the interview process, paradoxically they may
also make them more willing. Morse (2002, p. 320), in her discussion of interviewing the
chronically ill or handicapped, says that these respondents may “report in considerable
detail the shape of even minor events and daily routines,” and that they may also tell long
stories not directly related to the interviewer’s questions. Although a few of our ALF
respondents expressed resistance to being interviewed or continuing the interview, most
were more inclined to participate in or even prolong it.
Black (2006) refers to the ALF setting as “liminal” in two interconnected ways: between
lesser and greater frailty, and between the resident’s current AL and the two less preferable
future options: death, or the nursing home. This liminality forms part of the context of this
interview research: elderly women interviewed—by a woman with whom they were
ethnographically familiar—in an ALF in which they often look back with nostalgia, look
forward with fear, and live in a present sometimes characterized by isolation and loneliness.
As Wortham (2001, p. 137) says of respondents’ interview narratives:
This…voicing of the self yields a trajectory for the narrator, as the positions of past
selves lead toward the self narrating the story here and now.
Before the “here and now” of Assisted Living, elderly residents may have been in other
ALFs, independent living facilities, or in their own homes. The next stop on the trajectory
of aging after the ALF may be, for some, the nursing home. What these elderly people in
ALFs feared most—aside from death—was having to move from an ALF to a nursing
home (Aud and Rantz 2005; Dobbs 2004; Williams and Warren 2009). Brenda Johnson,
who was back in the ALF from a temporary stay in the nursing home focused on the noise
and (ironically) the lack of assistance:
That’s terrible up there! That’s terrible! They don’t have enough help. And constantly
that buzzer is going off. Constantly. All day long. And when you did buzz for help or
push the button, they were forever in coming.
Qual Sociol (2008) 31:407–424 411

And as another resident says:

We talk about [other residents] going to health care…. No one wants to go there….
It’s a nightmare compared to what’s here.
And it is, of course, staff who make the determination that residents need to transfer to
the nursing home, often insisting upon this despite the expressed wishes of the resident and
her family. Although the decision to transfer is ostensibly made in the context of certain
clinical or practical issues—most notably incontinence, falling, and the onset or worsening
of dementia or Alzheimer’s—there are also social, cultural and situational factors that feed
in to the decision. Staff members have the power to recommend transfer out of the ALF,
and residents are well aware of this. The interviewer’s questions—involving a critique of
the staff and facility—were potentially dangerous to the residents—what we refer to as the
ALF context of institutional fear.
On the other hand, the presence of the interviewer was also potentially valuable as
sociability. One of the complaints frequently voiced by residents of ALFs is that staff
members are too busy to talk to them, and that—aside from the links to family and friends
some of them have outside the ALF—they are lonely. The interviewer is often welcomed
by the residents as someone to talk to. The resident may stretch out the interview or, as
Warren et al. (2003) note not want it to end. This is what we refer to as the ALF context of
institutional loneliness. There is sometimes tension between institutional fear and
loneliness, with fear prompting more, and loneliness less, talk—and each prompting
different topic areas and avoidances.
In addition, interviewers often have one set of agendas, while respondents have
another. Although the researcher’s depression and quality of life scale questions sought
responses concerned with the past four weeks, the residents’ answers were situated in
both the ALF institutional context and the immediate present; they sometimes had
quite different frames of reference than the ones presupposed by the interviewer or
those responsible for the construction of satisfaction and depression scales. And,
although “impairment” is certainly a physical and/or mental reality, residents could
also invoke impairment to avoid answering questions or to influence the negotiation
of numbers.
Many of these interviews had a natural history in which initial hesitation to criticize the
institution was followed by some criticisms, and—in those interviews that included the
scales—the interpretation of questions and the negotiation of numbers were set against a
background of “reasonable expectations” of ALF living. Moreover, although the scale-
designers and the interviewer sought information on depression and quality of life from a
clinical–medical and policy perspective, the residents answered from the context of the
relativity of well-being in an ALF.

Institutional fear

Although the purpose of the interviews was not to elicit criticism of the facility or its staff
on the part of residents, the institutional context framed the topic of staff precisely in this
manner. Since the interviews were tape recorded, any criticisms made were preserved and
could be replayed. The interviewer assured the respondents that their words would not be
passed on to the ALF staff (as stated in the consent forms); however, there is no reason to
assume that all residents believed this.
The interviewer asked about how the residents liked the ALF and their
interpersonal relationships with the staff. These questions were asked in an
412 Qual Sociol (2008) 31:407–424

institutional context in which residents had already learned that complaining and
criticizing were discouraged. Margaret Smith was one of several residents who told
the interviewer that they were routinely reprimanded by the Arden Director of
Nursing for “dwelling on the past”:
KW: During the past four weeks, have you been bothered by emotional problems or
feeling anxious, depressed, irritable, or downhearted and blue?
MS: Well, you can always feel that way when you have to give up your old home and
everything else.
KW: Uh huh.
MS: That’s normal for me, to wish I still had it.
KW: Yeah, that’s true.
MS: That’s what I think. [Director of Nursing] doesn’t like that very well, but it’s
normal. You just like things that you had before.
Residents of all the facilities were aware that they weren’t supposed to “dwell on the
past.” Although resident nostalgia was a constant feature of the Principal Investigator’s
ethnographic encounters and interviews with the residents, staff encouraged engagement
with the present—socializing, conversing, participating in activities—rather than with
the past. Resident rooms, however, generally featured walls of family photographs, and
closed doors, symbolizing the primacy of past over present in their most intimate
spaces.
Residents were also cognizant of the rules staff enforced to promote participation.
Although residents were supposed to get out of their rooms and socialize, they were not
allowed to dress in night clothes; to do so was deemed socially unacceptable and might be
taken as a sign of dementia. In a joint interview discussion of watching TV either in the
public room or in their private rooms, Geraldine Paget and Nora Bates, residents of
Denleigh Manor, opted for the latter at night:
KW: This is pretty nice out here.
GP: Yeah, but I like to go to my room.
NB: ….Well, they don’t want you to come out in your nightgown or your robe. We
can’t do that.
GP: You have to be fully dressed.
Although rules such as these were spoken of as facts, there was a critique of them
embedded in the descriptions.
Residents of all the facilities, however, told the interviewer—usually in the first part of
the interview, that “I can’t complain.” If complaining was mentioned, it was, for the
respondent, the provenance of other residents. Mabel Harwood, a resident of Compton Hills
said that “I don’t have any complaints” although “I hear an awful lot of grumbling” from
other residents. If residents did complain, they reminded themselves not to. Alice James, an
Arden resident said of staff:
I think they just need to be trained to take care of people…the girls that come in the
morning that help you bathe. They’re OK, but they just don’t know how to take care
of a person…. They’re—I can’t complain about them.
Qual Sociol (2008) 31:407–424 413

Some residents did voice complaints, usually later in the interview. Pat LeBlanc, a 70
year old resident of West Meadows, said that staff were too busy and rushed to talk with
residents. In her view, staff’s “not taking the time to visit with you” was also institutional
policy:
PB: And for some reason, you know, some of this I don’t want repeated.
KW: Okay, I’m not going to be sharing it with anyone here.
PB: Well it seems like [Director of Nursing] doesn’t want them talking about
anything…to residents.
In this interview, as in a few others, there were moments in which the interviewer had to
reassure the resident that she was not a spy for the ALF administration.
It was commonplace for residents to begin the interview with positive statements about
their current lives, then shift gears as the interviews progressed (Holstein & Gubrium 1995).
The interview with Mabel Harwood, a seven year resident of Compton Hills, demonstrated
this natural history. Early in the interview she said that “I am very happy here; I go to
almost everything they have here. I don’t have any trouble keeping busy.” She insisted that
“I don’t have any complaints” about the food, and “the staff are real kind…. I really think
it’s fantastic.” Later in the interview, however, this resident said about the mostly African
staff:

MH: Well, some I can understand better than the others. Eventually….
KW: Do they treat you like an individual person?
MH: Oh no. They’re just nice…. I wondered, I know sometimes they hurry us in the
dining room.

In a joint interview in the public area of Denleigh Manor with Nora Bates and Geraldine
Paget, Geraldine Paget said that “There’s a lot of love here…. The nurses are real good to
you…. We couldn’t want any more.” Later in the interview these residents said of
communication with the mostly foreign staff:
NB: They learned our [language] so perfectly.
GP: It’s a little hard to understand them.
NB: Yeah, I do, I have a hard time understanding them.

Carol Fenshaw, a resident of Denleigh Hills, answered a question about staff by saying
that “really, the staff is really nice…. They are.” But when asked specifically about
communication, she hedged somewhat:
KW: Have you experienced any challenges with the communication…? How about
with the staff?
CF: No I don’t think so.
KW: Okay.
CF: Well, you’re bound to have some disagreements, you know.
KW: Uh huh.
CF: But I think the staff is real good.
414 Qual Sociol (2008) 31:407–424

KW: Good. Okay, is there anything that you would change that would make it easier
to live here?
CF: Of course there’s always something you want to change.
KW: Uh huh.
CF: But I can’t put my finger on it right now.

This last response could either be evasive, in the context of not wanting to complain about
the facility or the staff in the context of institutional fear. Or it could be, simply, a matter of
an old person’s memory, which we will discuss later in the paper.
Many of the residents felt free to—and did—criticize the food in the ALFs. This was
seemingly a safe arena of criticism, in contrast to the dangerous territory of staff and
facility. One resident of West Meadows, however—Mary Moore—seemed a little nervous
even about food criticism. She said that “I don’t know whether I dare mention it or not, but
somebody needs to show somebody how to cook.” Later in the interview, when asked if
there was anything she would change about communication with staff, this resident said:

MM: No, I think everything is very good. I would just like to give whoever does the
cooking some recipes or what.
KW: Okay, okay, I understand. Well, maybe you’ll get to. I don’t know.
MM: Well, don’t suggest it.
KW: Oh, I won’t.
MM: Because it might get me [unintelligible].

The bottom line of institutional fear is the necessity of adaptation, adjustment, or attitude—that
if residents do not do adapt, they will end up in a nursing home.
Priscilla Davis, who had lived at Denleigh Manor for less than a year, said that “It was a
very hard adjustment for me—it was, in the past, an adjustment—it had to be made.” Mary
Moore of West Meadows said that “I just made up my mind that I was going to be happy
here and that was it.” When asked “Sounds like you’re pretty well adjusted?” this resident
replied “Well I don’t know adjusted. I just decided I was going to make good of it, that’s
all.”
These ALF residents saw themselves as stuck in their current situations, with only worse
to come if they leave—death, or the nursing home. There are a few residents that do
complain, or balk at doing what they know needs to be done. Mary Moore of West
Meadows complained that her 91 year old husband “doesn’t care about associating with
people. He doesn’t want to be bothered to go. He wants to sit, which I think is detrimental.”
Outside an ALF context, “detrimental” might refer only to the detriment of the marital
relationship. Within the ALF context, however, “just sitting” is detrimental to the front that
these elderly residents must exhibit in order not to be seen as candidates for nursing home
transfer.
Although staff may view not participating as “detrimental”; for the residents it may
function to help preserve the resident’s sense of self. Enid Rowan of Denleigh Manor said
in response to the question about attending activities:

ER: No.
KW: No?
Qual Sociol (2008) 31:407–424 415

ER: I’m not an activity person…. They have a splendid bunch of activities. But I just
never have been…. Most of the time I don’t bother. I’m just not that kind.
Enid Rowan got away with “not bothering” on the grounds of “not being that kind”—for
the moment.
Mostly, however, residents have to suck up and get by, do for themselves as much as
possible, comply with staff directives, socialize and participate in activities, and refrain
from complaining or criticizing the facility or its staff. Given this institutional fear factor,
these recorded interviews may be somewhat threatening—the interviewer could be a spy for
the facility, or report back to the facility, no matter what she says. On the other hand, many
of these residents are lonely, and the interview has a more positive meaning—filling time,
someone listening to them.

Institutional loneliness

Institutional fear involves wanting to stay in place and not go to the nursing home;
institutional loneliness exemplifies the social situation of most of these residents in ALFs.
They are not at home, they are in a home, without their children and (except in a few cases)
husbands. Pat LeBlanc said of West Meadows that staff not talking to residents was:
One of the problems, I think. It just seems like that would help a lot with a lot of the
people because, you know…A lot of people are just lonely.
In saying that she was “never lonely, never,” Mabel Harwood could have been reflecting
staff’s expectations for resident attitude. Many of the ALF residents answered the
interviewer’s questions about loneliness with either a definite or slightly moderated
“yes.” In saying that she felt lonely “probably one day a week,” Carol Fenshaw was on the
low side of loneliness. The presence of the interviewer lessened loneliness for an hour or
so. When the interviewer terminated her interview with Doris Wilkerson, saying, “I don’t
want to hold up your lunchtime,” the resident replied, “Well, I’m glad you helped fill in my
morning.”
There were two exceptions to loneliness: those elders who still had spouses living with
them—and whose spouses were satisfactory—and the social situation of some of the
residents of West Meadows, the rural facility. Black (2006) points out that elders who move
into ALFs that are part of the rural community in which they have lived all their lives are
not lonely. Jean McKellan, a West Meadows resident, illustrated this difference. She
indicated in her interview that many of the residents in this rural ALF had known each other
and the parents of many of the staff before they entered the ALF, and described staff as “so
friendly and helpful.” She added that residents “have to be careful not to hold them too
long…. They’re not supposed to be just visiting.”
But most of the residents in all the four facilities described themselves as lonely
during either the qualitative or scale-administration part of the interview, or both. Those
without spouses or community ties had two possible sources of companionship from
within the ALF: other residents, and staff—and occasionally the interviewer. Residents
may be reluctant to seek companionship among other residents they perceive as more
impaired than they (Dobbs 2004). Although many residents expressed an interest in
conversing with staff, most of them said that the staff were too busy to talk to them about
anything but matters at hand. So the interviewer provided an opportunity to talk about
matters of everyday life that were important to the resident: stories about past selves or
family members, what is on the news or television. Photos in the resident’s room
416 Qual Sociol (2008) 31:407–424

prompted stories; television programs prompted retellings that weren’t relevant to the
interviewer’s purposes. During her Denleigh Manor interview, Enid Rowan describes the
CNN news:
That shooting there in Las Vegas…. It was the Las Vegas school kids…. They thought
it was road rage. And the guy followed them into their school yard and shot them….
You never know what kind of lunatics are running around.
Elders may be among the lonely respondents who are reluctant to have the interview
come to an end (Warren 2002). Some residents of these ALFs did not pick up interviewer
cues that the interview, or a segment of the interview, was at or coming to an end. At the
conclusion of the open ended questions (this interview did not include administration of the
scale) the interviewer provided a termination cue:
KW: All right, is there anything else you can think of that you would like to tell me?
EH: No, I think I have said it all.
KW: I certainly know to come to you for advice!
But this resident had not said it all. She raised a new topic:
And you know what really bothered me at one time? Doesn’t bother me anymore. I
think these people have too much religion….I says to [the Director of Nursing] ‘This
place is getting to look like a church.
The next topic:
And another thing is the activity. Why I don’t do all their activity? They treat them or
treat us like kindergarten children.
Pat LeBlanc, too, talked a little longer after the interviewer had finished administering the
scales, saying that “this wasn’t as hard as I thought it was going to be.” This resident—who had
referred to other residents as lonely—had not known anybody when she entered West Meadows
two years earlier. She said that “most of the people that come in know each other,” adding:
And so that makes a big difference. So I really wish, well, every town certainly
couldn’t have one. But I mean, I think it makes a difference if you know people. They
sit at the same table and they eat and they help each other….They knew each other,
you know…. And there’s other people like that.
Jean McKellan concurred with Pat LeBlanc’s view of West Meadows, saying that she
and her husband Peter “knew some of the fellow residents in the community”; “We’ve
known a lot of these people before they ever came here.” With the company of her husband
and a number of her former neighbors, this resident was never lonely. But for Pat LeBlanc
herself, and some other residents of West Meadows, institutional loneliness—along with
institutional fear—formed the background to her everyday life there, and to the interview
process and the data it generated.

Invoking impairment

In the context of institutional fear, respondents might wish to avoid answering evaluative—
qualitative or quantitative—questions concerning the facility or its staff; impairments of
hearing, memory or understanding could be invoked in these cases. In the joint interview
Qual Sociol (2008) 31:407–424 417

with Nora Bates and Geraldine Paget at Denleigh Manor, impairments of understanding
were both part of the interview questions and part of the interview:
KW: Do you ever have trouble understanding the girls that are from the other
countries?
GP: Maybe a little, but not, you know, not too much.
NB: I didn’t understand what you said.
Geraldine Paget answered the question with slight criticism, while Nora Bates claimed not
to understand it.
In an interview at West Meadows the interviewer asked Pat LeBlanc about staff’s
communication with residents. The resident indicated that although “I like all the staff”
“We’ve had a big turnover and, you know, you just get to know somebody and they’re
gone.” Unlike most residents’ comparisons with nursing homes, this resident said that staff
were more interested in residents in nursing home or hospital settings than in ALFs. The
following exchange ensued:
PB: And well, I’m trying to think now whatever came up or what we were even
talking about…. Right now I don’t even remember.
KW: But especially since you’ve had the experience of being in a nursing home, you
think it’s a lot different here?
PB: Yes, can I just kinda pass on that?
From this exchange it is unclear whether this 70-year old resident had become
momentarily forgetful, or, in the context of institutional fear, wanted to retract her
comparison of West Meadows with other staff. Similarly, in the interview with Alice James,
the resident “forgot” the scaling question:
KW: Okay, this next one’s social activities. During the past four weeks, has your physical
and emotional health limited your social activities with family, friends, neighbors, or
groups? It ranges from not at all, slightly, moderately, quite a bit, extremely.
AJ: Okay, what did you say? What was the question? I forgot.
Poor hearing was invoked by some residents—perhaps instead of institutional criticism—
in their number negotiations. In the interview with Alice James:
KW: You said, now, that you’re in assisted living you were around a 5.
AJ: Yeah.
KW: But before you came here you said you were much better. Would you say you
were like an 8, 9, 10, Or 7? 6?
AJ: What did you say? For what?
Doris Wilkerson, an 87-year-old college graduate and former teacher discussed her
problems with hearing and vision impairments.
KW: I have actually a questionnaire and I don’t know, you’ll probably be able to see it
okay. I’m just trying to get some ratings. You don’t have to answer these if you don’t want
to. Basically it’s asking about your overall health in the past four weeks, would you say
your health in general has been excellent, which is the smiley face, or down to poor?
418 Qual Sociol (2008) 31:407–424

DW: Well, I tell people I am good considering the shape I’m in.
KW: Uh huh. Well, that’s…
DW: Is that what you mean?
KW: Yeah, I think it’s a good attitude.
DW: Should I say very good because of course I say I have hearing and vision
problems? Or should I just say very good to allow for those?
KW: Well it’s just kinda how you think. There’s no right or wrong answers.
DW: That’s why I don’t like this kind of a question.
KW: I know. It’s kinda hard to know what they mean. So if you think you’re doing good.
DW: I think I’ll put very good. Now do I mark it or do you
From other parts of her interview, it was clear that Doris Wilkerson was not inclined to
rate her troubles using the researcher’s clinical frame. When asked to rate the help available
to her, she said that:
DW: There have been a few times that I didn’t get the help that I thought I should. But
what it’s been—how to rate this?
KW: Yeah, it’s hard.
DW: I got a nosebleed.
KW: Oh dear, that’s kinda scary.
DW: Nobody came.
KW: Oh no.
DW: I pushed my button.
This interview exchange continued with some more storytelling about other occasions
on which help was not forthcoming, and Doris Wilkerson never did provide a rating. In
small ways, these residents can and could resist the demands of the interviewer as well as
the staff, answering from other frames.

Framing questions and answers

Both qualitative questions and questions devised for scales are attempts to get at certain
contexts of meaning, which then are translated into categories or numbers. Sometimes, in
interviews, questions may seem meaningless to the respondent, or the meaning of questions
is interpreted differently by researcher and respondent, or the respondent’s answers do not
fit easily into numerical or quasi-numerical categories. As Holstein and Gubrium (1995, p.
14) point out:
The focus and emerging data of the research project provide orientation and framing
resources for developing both the subject and his or her responses…linking the topics
to biographical particulars in the interview.
“Biographical particulars” ensure that the interviewer’s and resident’s frames of reference
are sometimes different. In the following exchange, the interviewer’s question had to do
Qual Sociol (2008) 31:407–424 419

with health limits to social activities; Margaret Smith’s answer, however, referred to the
availability of activities at Arden:
KW: Okay, during the past four weeks, has your health limited your social activities?
MS: There’s not a lot of activities.
Similarly, in the following exchange between the investigator and Mabel Harwood, the
interviewer was interested in the emotional resources available to the resident when she
feels troubled, but the resident was thinking of her daughter’s troubles:
KW: During the past four weeks, how often did you talk about problems, feelings or
opinions with someone in your family? All the time, most of the time, some of the
time, a little of the time, or none of the time?
MH: Well my daughter, who is not well, I’m kinda concerned about her.
In an interview with another resident, the interviewer wanted to know about emotional
problems as they refer back to clinical depression caused by living in the ALF. Jean
McKellan, however, said:

I’m not normally down-hearted or blue, but I would have to say we’ve had some
moments. Our youngest son who takes care of us here has been in the hospital…. So
of course we’ve had some worries about that. I don’t know how to rank that.
These residents’ responses illustrate another difference between the researcher’s and the
respondent’s agendas: the researcher cares, and the respondent does not, about fitting these
“concerns” into the scale category or number options. Mabel Harwood makes this
difference evident:

KW: During the past four weeks, how much have you been bothered by emotional
problems such as anxious, depressed, irritable, or feeling down-hearted and blue? Not
at all, slightly, moderately, quite a bit, or extremely?
MH: Well, I’m never depressed.
KW: Well, that’s good.
MH: And I don’t get blue.
KW: So maybe not at all?
MH: And I’m not irritated.
KW: Alright, sounds like not at all.
MH: Well…
KW: Not at all, slightly, moderately, quite a bit, extremely?
MH: Well, I don’t care.
KW: OK. Well, I’ll put ‘not at all.’
Individual scale questions were also open to differential interpretation. One of the
questions is concerned with residents’ sense of having help available to them: “If you
needed someone to listen or help, was there someone there for you?” Carol Fenshaw of
Denleigh Manor responded “Yes” to this question initially, accepting the intended frame.
420 Qual Sociol (2008) 31:407–424

But then she questioned the question, and gave what was perhaps an ironic and certainly a
concrete answer:
KW: Was someone available to help you if you needed help?
CF: Yes.
KW: As much as you wanted or quite a bit?
CF: Now you mean what kind of help?
KW: Well, I don’t know. Just any kind of help.
CF: Well, like if I fall, they pick me up.
Another depression scale question, concerning people disliking you, has as a background
frame the clinical diagnosis of paranoia. As a few sociologists have recognized, however,
feelings that people dislike you are sometimes based on the fact that people dislike you. When
the interviewer asked Elizabeth Hedges if she felt that people disliked her there was laughter:
EH: Felt that people disliked you. That’s a big one.
KW. You do?
EH: Quite a big one.
This resident then proceeded to talk about the many reasons that residents and staff might
dislike her.
A third depression scale question, “Have you felt your sleep was restless” was answered by
Enid Rowan not from a clinical but from a self-frame. She replied, “Well, it’s always restless.
When pressed for a number—of days of the week—the following negotiation ensued:
KW: Really? 5 or 7?
ER: No.
KW: Oh.
ER: Yeah, that’s all right because it’s all the time
KW: Okay.
ER: It’s my own fault, that’s the way it is.
KW: It’s your own fault?
ER: Yeah [laughter]
KW: How come it’s your own fault?
ER: Because I like to read until midnight.
The resident eventually agreed on the number “5–7 days a week” of restless sleep.
For scale-framers, feelings that people dislike you and restless sleep function as signs of
clinical depression. For the disliked and the sleepless, however, they may be assertions of
the self in the context of the ALF. As (Wortham 2001, p. 5) says of the narration of self in
interviews:
Autobiographical narrative might have the power partly to construct or transform [the]
self…. [The respondent] might come to understand herself—and to act in her relations
with others—as an active, assertive woman.
Qual Sociol (2008) 31:407–424 421

Ironically, the ALF commitment to autonomy may, in some cases, be best served by
what might be interpreted from another framework as symptoms of depression and
dissatisfaction. It is clear from these interviews that the administration of scales is not
similar to taking blood pressure; the answers to scale questions must be interpreted as
qualitatively as the “qualitative” interviews—in the context of liminality, nostalgia, and
ALF residence.

The relativity of well-being in the ALF

As Doris Wilkerson’s interview illustrates, these residents’ scaled happiness and well-being is
relative to their age, health, residence in an ALF, and family ties—the factors of institutional
fear and loneliness. When asked about whether her health in the past four weeks had been
excellent, very good or good, Mary Moore replied “I think my health is very good
considering the fact that I have two broken hips and I just can’t walk.” Joyce Atkinson, also a
West Meadows resident, contrasted her own attitude with those of other residents:
We can’t control everything, but we can sure take care of the attitude…. Some of them
[residents] fail to tell themselves this is what’s best for them…. So they do have a difficult
time trying to adjust like that. It’s amazing. In six months, many of them get along just
fine. Others will probably be here years and will still be at the resentment stage.
Similarly, Louella Jones said of some of the West Meadow residents that:
People move in with the idea that they’re not going to like it. And they don’t like it.
And they make themselves miserable. And they make others around them feel bad,
too.
This resident attributed her—and her husband Joe Jones’s—adaptation to West Meadows to
having moved around a lot: “We learned to go with the flow.”
Other residents did express various kinds of “resentment” at some time during the
interview. Alice James said that “my life was pretty good until I came here, until my life fell
apart and I had to come here.” Priscilla Davis commented “I don’t think anyone really likes
to live like this. It’s just when you have to do it.” Margaret Smith said of Arden, “I didn’t
have any plans for this place or anything, no. You do what you have to do.” During the
administration of the scale, Iris Johanson, whose husband has Alzheimer’s, expressed her
view of being in a position to have to live in an ALF with him:
KW: Okay, this is supposed to be a ladder. And you’re supposed to say the top is the
best possible life for you and the bottom is supposed to be the worst possible life for
you. Where would you say you are on the ladder at the present time? At the top,
bottom, or middle?
IJ: Oh, I guess at the bottom.
KW: Okay, and before you moved here, where do you think you were?
IJ: Oh, I guess somewhere in the middle.
This resident, however, had never had to go to a nursing home for a temporary stay,
otherwise she might have ranked her life at Compton Hills a little higher on the ladder.
Early in her interview, as we have already seen, Mabel Harwood was quite positive
about Compton Hills, going so far as to say “it’s fantastic.” However, during the
422 Qual Sociol (2008) 31:407–424

administration of the scale, when the interviewer asked about her satisfaction with AL
living, the following negotiation ensued:
KW: Were you extremely satisfied, quite a bit, moderately, or not at all?
MH: I’m satisfied.
KW: So, extremely?
MH: I don’t know if I’m extremely.
KW: Quite a bit?
MH: Kinda an extreme word [laughter]
KW: Okay, we’ll put ‘quite a bit.’
MH: I’m not sure if I like that extremely word! [laughter].
Mabel Harwood, during the scale administration, began to contrast her current situation—
in a home—with her previous home and marriage. When the interviewer inquired “Do you
think you have the best possible life or the worst possible life or somewhere in between,” this
resident answers:
Well, it’s not the worst. But can anything replace your home? I don’t know how to
answer that one…. I’m not happy here.
Most residents give similar responses to the global questions about satisfaction with
ALF living. When the interviewer asked “Have you enjoyed life?” Mabel Harwood
responded in the past tense: “I had a good husband. I had a good home. I’ve been very
happy.” Priscilla Davis also harked back to home as she answered the question about the
past four weeks:
KW: During the past four weeks, how would you rate your satisfaction with living in
Assisted Living? Would you say you’re extremely satisfied, quite a bit satisfied,
moderately satisfied, slightly satisfied, or not at all satisfied?
PD: Moderately…. I don’t think anyone really likes to live like this. It’s just when you
have to do it…. So you’re not too much of a burden on your children…. I can’t think
of anyone who likes it. I know I’ve never heard anyone say that they like it.
When asked to give a number to her current life satisfaction, Enid Rowan selected a 10
on a scale of 1 to 10 with 10 high, meaning this is the best possible life for her. But what
this 10 means is the best possible life for someone who has to be in an ALF. She says
“Well, you know, it’s never the best possible life because you always want to go back to
your old ways…. But it is the best possible life for me.” Nevertheless, in the
decontextualized world of quantitative methods, a 10 is just a 10.

Conclusion

Interviewing takes place in a context: a place, a time, and a biographical trajectory for
the respondent (and for the interviewer). Interviews with elderly residents in ALFs
partake of the liminality of these quasi-institutions, between the nostalgia of the past
and the discomfiting possibilities of the future. Within the situated present of the
interview, the elderly resident’s interpretations, answers and responses—and perhaps
Qual Sociol (2008) 31:407–424 423

invocation of impairment—may be affected by institutional fear and institutional

loneliness. Fear may prompt the resident to invoke incapacity, or answer from
frameworks other than those presupposed by the questions. Loneliness—as part of the
context and part of the questioning—may be momentarily alleviated by the interviewer–
visitor who gives the elder a chance to spend time, and—perhaps—to be her (old) self
for a moment. The interviewer’s attempt to translate answers into numbers for scales is
as fully contextualized as the “qualitative” parts of the interview.
Context is at the heart of the knowledge produced by the interview. And in Assisted
Living, context is shaped by the institution and its staff as well as by the residents’
biography. For ALF staff, there are certain clinical and practical definitions of incapacity in
everyday living and transfer to the nursing home: falls, incontinence, wandering,
incoherence. There are compliance factors: socializing, participating in activities, getting
to meals on time, not complaining. But for the residents there is the biographical self—its
past, present, and future. The past is nostalgia and memories of home, the present is for
making do, and the future involves staying out of the nursing home as long as possible. In
the words of Enid Rowan, when asked if she felt that she could not get going in the
morning: “Oh no!….you always have to do that!” [laughter].
We found that laughter during these interviews highlighted the ironies of AL for the
elderly. When a resident said something that got both interviewer and resident laughing,
that something was—in Holstein and Gubrium (1995, p. 50) terms—a benchmark,
milestone or turning point: a guide to the resident’s self, to institutional demands that the
resident knows have to be met, or even to the imminence of death. Enid Rowan laughs with
the interviewer when she says that “you always have to get going,” ruefully sharing the
social control experiences of the ALF resident with the interviewer. Elizabeth Hedges
laughs with the interviewer when she says that yes, people dislike her—she derives energy
and a sense of self from their dislike. When Doris Wilkerson complains about staff’s
infantilizing of residents—“we don’t want to be treated like children”—she adds “although
we act like it sometimes!” and both the resident and the interviewer laugh. When Louella
Jones, a 6-year resident of West Meadows, says of herself and her husband Joe, “We’re the
oldest residents…. I mean, been here the longest… It’s quite an accomplishment!
[laughter]” she celebrates, for the moment, their cheating of death and the nursing home.
Shared laughter can, for the moment, enable respondents to transcend the context of the
interview: the fear, loneliness, impairment, and making do associated with ALF life.
Laughter demonstrates the residents’ ironic self-awareness: their liminality, isolation, and
captivity. Whatever the words of their critique of the institution and their present lives,
laughter marks their resistance to it, however momentary. Both the words of the interview,
and the laughter threading through the words, provide us with an understanding of the
biographical and institutional context of living in the ALF.

Acknowledgments This research was supported by the Building Interdisciplinary Research Careers in
Women’s Health (BIRCWH) K-12 Program (HD052027, P. Thomas, PI) at the Kansas University Medical
Center, School of Medicine.

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Carol Warren is Professor Emerita of the University of Kansas Department of Sociology; she also taught at the
Unversity of Southern California from 1972–1989. Her research interests are qualitative methods, the cultural
history of psychiatry, and gender and social control. Recent and forthcoming publications include Discovering
Qualitative Methods with Tracy Xavia Karner (2nd edition, Oxford University Press); a paperback edition of
Pushbutton Psychiatry: A Cultural History of Electroshock in America with Timothy Kneeland, (Left Coast
Press); and papers on assisted living in The Journal of Aging Studies and The Journal of Women and Aging.

Kristine Williams is Associate Professor at the University of Kansas School of Nursing. Her gerontological
nursing research, funded by the National Institute of Nursing Research and the John A. Hartford Foundation,
focuses on communication and aging and interventions to improve care for older adults in long term care settings.