Environmental Choice and Control In Community Care Settings for Older People1


  • Rudolf H. Moos

    1. Stonford University and the Veterans Administration Medical Center
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    • 2

      Requests for reprints should be sent to Rudolf H. Moos, Department of Psychiatry, Stanford University Medical Center, Stanford, CA 94305.

  • 1

    Mary Gauvain, Sonne Lemke, and Barbara Mehren were responsible for organizing the data collection in the facilities. Joan Kahn, Wendy Max, and Bernice Moos carried out the data analyses and Josh Holahan provided helpful comments on the manuscript. The work was supported by NIMH Grant MH28177 and by Veterans Administration Health Services Research and Development Service funds.


This study focuses on the long-term stable levels of environmental choice and control available in community care settings, and explores how variations in these factors affect elderly residents of such settings. New methods to evaluate naturally-existing levels of policy choice and resident control are developed and applied to a representative sample of residential care facilities. The findings showed that residents with more functional resources, and women residents, were inore likely to live in facilities high in choice and control, and that these personal and environmental factors were associated with better resident functioning and more cohesive, independence-oriented social environments with relatively little conflict. Functionallyable residents reacted more positively to high control and women residents reacted more positively to high choice. Investigators who attempt to manipulate perceived control in institutional settings need to consider the existing opportunities residents have to exercise control, as well as the levels of other relevant personal and environmental resources.