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

Moving accommodation in old age challenges the idea of aging in place. This study describes older people’s (M = 80 years) reasons for moving to senior housing in Sweden and whether different reasons were related to the participants’ background characteristics. The study was based on data from questionnaires and interviews. The results show that the two most frequent reasons for moving were ‘age and lack of energy’ and ‘planning for the future’. Moving because of ‘age and lack of energy’ was related to being older and in need for help with daily living. The interviews revealed underlying motives behind the expressed reasons to move which were: to avoid loneliness and to achieve easier maintenance of the home. The results can be used for planning purposes and future research on aging in place.

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][18][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 companies 2 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?

Methods 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 in 3 .The questionnaire was sent out by post to all tenants who were not participating in the interview study 4 .
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).

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

Questions Answers
When were you born*?
Year of birth  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.
Participants had moved from detached houses (38%) owner occupied apartments (31%), rental housing (26%) or residential care 5 (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.

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 data 6 .
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.

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

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 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'.

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

Discussion
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.

Implications
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.

Limitations
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.