‘The Primacy of ‘Home’: An exploration of how older adults’ transition to life in a care home towards the end of the first year

Abstract This grounded theory study sought to explore how older adults’ experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi‐structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions ‘They helped me make my mind up’ (b) On a Journey ‘I just take it one day at a time’, (c) Staying connected and feeling ‘at home’ ‘You get something good out of it you know…you get hope’. (d) Managing loss and grief ‘It was important for me to say cheerio to the house’ and (e) Caring relationships ‘I didn't realise that I was lonely until I had company’. Together these five categories formed the basis of the core category ‘The Primacy of ‘Home’ which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of ‘home’. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well‐being needs of older people which should be considered in policy directives and clinical practice.


| INTRODUC TI ON
The experience of ageing may require older people to make transitions in their living environments, either by adaptations to current homes or through relocations to more supportive environments (Perry et al., 2014). 'Ageing in place' relates to an older person' sense of identity through their independence and autonomy alongside caring relationships and roles in the places they live (Wiles et al., 2012). Older people want choices about where and how they age in place, therefore the importance of involving 'the person' in making the decision to move and having a choice of a care home is significant. Furthermore, having a sense of attachment or connection to their existing home or community maintains security and familiarity (O'Neill et al., 2020a(O'Neill et al., , 2020bWiles et al., 2012).
The extent to which individuals, who need 24-hr care exercise control over the decision to move to a care home is recognised as an important determinant of their relocation experience (Chao et al., 2008;Fraher & Coffey, 2011;Johnson et al., 2010;Lee et al., 2013;O'Neill et al., 2020aO'Neill et al., , 2020bRyan & McKenna, 2015).
Individuals have reported that greater involvement in the decision to move to a care home could have eased the negative feelings surrounding the move (Nwe et al., 2011;Sury et al., 2013). Similarly, whether the decision to move was made by the individual or imposed by others adversely affects residents' transition experience and their related grief reactions to the move and to the loss of their home (Crawford et al., 2015;Pritty et al., 2019;Zizzo et al., 2020).
Most studies report that care home environments can be restrictive, therefore making adjustment and adaptation more challenging for the individual as feelings of institutionalisation can occur (Bradshaw et al., 2012;Cooney, 2012;Ericson-Lidman et al., 2014;Križaj et al., 2018;Tsai & Tsai, 2008). In contrast to the negative assertions, the literature also suggests that the potential benefits for older people entering into care homes include improved selfworth, morale, physical functioning, feeling less lonely and feeling more secure (Katz et al., 2011;Lee et al., 2013;O'Neill et al., 2020aO'Neill et al., , 2020bWadensten et al., 2007). A major challenge associated with the transition into a care home is the loss of the individual's home, therefore threatening identity, belonging and sense of self (Brownie et al., 2014;Lee et al., 2013;Westin, 2007). Home is not only fundamental to a person's self-identity and social relationships, but homely environments are essential to promote recovery, well-being and quality of life (Böckerman et al., 2012;Molony, 2010;Rioux & Werner, 2011). Additionally, individuals may lose previous social and communication networks (Zamanzadeh et al., 2017) putting them at risk of feeling lonely and isolated (Brownie et al., 2014).
Research undertaken by Cooney (2012) identified four categories as significant to 'finding home' in long-term care settings. These were: 'continuity', 'preserving personal identity', 'belonging' and 'being active and working'. What made it simpler or more problematic for older people to 'find home' was either unique to the individual (adaptive responses, expectations and/or past experiences) or at an institutional level (ethos of care, institutional culture, environment of setting). Rijnaard et al. (2016) undertook a systematic review of seventeen mainly qualitative research studies. The aim of the review was to provide an overview of factors influencing the 'sense of home' of older adults residing in the nursing home. They found that a nursing home resident's 'sense of home' was influenced by fifteen factors, divided into three themes: (a) psychological factors (sense of acknowledgement, preservation of one's habits and values, autonomy and control, and coping); (b) social factors and activities (interaction and relationship with staff, residents, family, friends and pets) and (c) the built environment (private space and quasi-) public space, personal belongings, technology, 'look and feel' interior design and the general maintenance, and 'the outdoors and location' which relates to the home's outdoor space and the neighbourhood at large. Similar findings were reported in a systematic review by Fitzpatrick and Tzouvara (2019) which used Meleis's Theory of Transition (2010) to explore facilitative and inhibitive influences on older peoples' transition to long-term care. Data synthesis of 34 studies identified that the transition featured potential personal and community focused facilitators and inhibitors which were mapped to four themes: 'resilience of the older person', 'interpersonal connections What is known about this topic?
• The extent to which individuals exercise control over the decision to move to a care home is recognised as an important determinant of their relocation experience.
• Most studies report that care home environments can be restrictive, therefore making adjustment and adaptation more challenging.
• There is a dearth of research on the extent to which residents can be facilitated to feel 'at home' in a care home environment What this paper adds • Positive adaptation is connected to older peoples' perceived quality of life, continued connection to home, family and community, and having opportunities to develop meaningful relationships with staff and other residents.
• Facilitating difficult and caring conversations with individuals and their families is required to manage individual expectations of the move to promote a positive adaptation process.
• Failure to engage early with these difficult conversations can negatively impact on the adaptation process over the course of the first year of life in a care home.
• Older people do not always have existing social supports to cope with bereavement and loss in the care home which has a significant impact on their psychological well-being. and relationships,' 'this is my new home' and 'the care facility as an organisation'.
Complex and multidimensional factors can influence the adaption process for older people when relocating to a care home (Bradshaw et al., 2012;Brownie et al., 2014;Križaj et al., 2018;Roy et al., 2018).
There is a dearth of research on the extent to which residents can be facilitated to feel 'at home' in a care home environment, particularly during the first year of the move. This study sought to address this imbalance.

| Aim
To explore how older adults', experience the transition from life at home to life in a care home with a specific focus on the latter part of the first year of the move.

| Study design
A grounded theory approach, consistent with the work of Strauss and Corbin (1990Corbin ( , 1998, was chosen as it facilitated the development of a new perspective on the experiences of older people living in a care home with a particular focus on the latter part of their first year after the move. Grounded theory is recommended when investigating social problems or situations to which people must adapt (Corbin & Strauss, 2008;Maz, 2013;Morse, 2009). Grounded theory is an ideal methodology to understand actions and processes through transitions (Morse, 2009) and has been used by qualitative researchers to study processes engaged in by service users (Grant et al., 2009). A semi-structured interview schedule was designed to stimulate discussion of individuals' perceptions, thoughts and feelings about their experiences of living a care home during this specific time period.

| Participants and recruitment
The study was carried out within a large Health and Social Care Trust in the UK which provides health and social care services including 1,800 residential and nursing home placements to a population of approximately 300,000 people across rural and urban areas.
Purposive sampling was used to recruit participants for the initial interviews. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to recruit a sample of 17 individuals who had resided in a care home for a time period of between 5 and 12 months. The 5-month inclusion criterion was important as this was consistent with the time frame for confirmation of permanent residency. Residents who met this criterion were identified by community-based care managers and through direct contact with care home managers (Table 1).

| Data collection
Detailed information about the research study was presented in writing and verbally to each participant and a binder provided which included information about the study printed in large font with contact details of the research team. Information details included how to lodge a complaint, a consent form and the procedure to be followed in specific situations, for example if the older person became upset or distressed. A tape-recording of this information was made available to visually impaired residents if required. Individual face-to-face interviews were arranged at a time convenient for each participant. All interviews were conducted between August 2017 and May 2019. Semi-structured interviews were conducted with 17 individuals from eight care homes across the study site. Written consent for each interview was provided by participants. The audio-taped interviews were transcribed verbatim with each interview lasting approximately 60 min. Field notes were taken by the interviewer. Consistent with a grounded theory approach, the semistructured interviews provided both focus and flexibility (Corbin & Strauss, 2008). Simultaneous data collection and constant comparative analysis were repeated until data saturation was accomplished along with the advancement of theoretical concepts. The interview schedule evolved commensurate with category and subcategory dimensions using grounded theory approach (see Appendix 1).

| Ethical considerations
Ethical approval for the study was initially obtained through the ethics committee of the university leading the research. Ethical approval was subsequently gained from the regional ethics committee and from the health and social care trust where the study was based.
The researcher made concerted efforts through recruitment to ensure that the voices and experiences of older people were given due attention and that participants themselves found their involvement meaningful (Dewing, 2009). Minimal or no cognitive impairment as defined by the Mini Mental State Examination (MMSE > 24) was a criterion for participant's inclusion in the study. The study was carried out over a 12-month period and relied upon participants ability to recall and reflect upon their experiences over this time frame. By undertaking the MMSE prior to interview the researcher was able to ascertain participant's cognitive ability prior to each interview and any changes over time. Informed consent was provided by each participant with additional consent obtained to use a digital recorder for the interviews. Assurances of confidentiality and anonymity were provided and supported by the allocation of pseudonyms in the presentation of the study and its findings.

| Data analysis
NVivo 12 qualitative data analysis programme software (QSR International, 2018) facilitated the organisation, management and TA B L E 1 Characteristics of the Interviewees and details of admission Social worker arranged admission. Ellen wanted sheltered accommodation, but care home was offered as only accommodation available. Did not see care home prior to admission.

David 88
Lived alone in family home.
Chose care home as wife already there a year previously. Health deteriorated after a fall at home "I'm too old to be on my own" Chose care home for his wife in the first instance then when his health deteriorated he planned the move.
Bernadette 92 Lived alone in family home.
Had fall at home admitted to hospital. "Family thought it was not right for me being on own. Mobility poor-"Doctor says move in".
Daughter's visited the home and recommended it to Bernadette. G.P and social worker decided. Bernadette did not visit home prior to admission. Arranged through social worker who took Tracey to see a few care homes and she chose the one she liked the most.

Molly 80
Lived alone in rented accommodation "Developed anxiety". G.P advised admission "feeling safe now" Was being placed by social worker in a care home a few miles away from her family. Molly waited on a vacancy becoming available locally. Did not visit care home prior to admission.

83
Lived with wife in rented accommodation Wife died suddenly who was carer. Had been in a wheelchair for many years due to war injury. Admitted to care home on day of wife's death in a taxi.
Charles was admitted to the care home the night his wife died as she was his carer. It was an emergency admission and he had no say in the move nor did he visit the care home prior to admission. Recent stroke. Sister and brother were "too old to care for me at home".
Therese chose nursing home as she had spent 2 weeks convalescing post-surgery 3 years previously. Did not visit home prior to admission day.

Tony 87
Lived alone in family home.
Developed pneumonia and was admitted to hospital. G.P advised admission to care home.
G.P and social worker arranged admission. Tony knew of care home because it was local but did not visit the care home prior to admission.

83
Lived alone in family home Accident at home, admitted to hospital. Reduced mobility-niece lives far away.
Hugh stated pressure 'to release hospital bed' so his Niece visited a few care homes and made arrangements for admission which is 30 miles from, Hugh's home. Did not visit care home prior to admission.
(Continues) retrieval of transcribed interviews and field notes and provided tools for coding, categorising and linking qualitative data. Data analysis was informed by open, axial and selective coding principles as espoused by Corbin and Strauss (2008). Simultaneous data collection and constant comparative analysis were undertaken and repeated until theoretical saturation was achieved when no new categories were identified, and until no new instances of variation for existing categories ceased to emerge. The final stage of selective coding was the process of integrating and refining categories, a core category was identified that related to the other categories, validating those similarities and relationships (Strauss & Corbin, 1998).

| Ensuring rigour
The initial interviews were recorded and checked to ensure the rigour and confirmability (Lincoln & Guba, 1985). In keeping with one of the tenets of grounded theory (Corbin & Strauss, 2008), individuals' own language at all levels of coding was used to further ground theory construction and add to the credibility of findings.

| Profile of participants
A total of 17 participants in this study comprised of ten females and seven males with an average age of 83.3 years. Seven participants were admitted directly from the hospital. Four of these individuals were female and three were male. In comparison, six female and four male participants were admitted to the care home directly from home (one female and one male moved to the care home when their respective carers became ill). The main reasons cited for prompting the relocation to a care home were deterioration in physical health (n = 11), recent bereavement (n = 3) and no-one to take care of me/ changing family circumstances (n = 3). The majority of the individuals (n = 15) did not visit the care home prior to the move; one participant chose the home previously for his wife and one participant was accompanied by a social worker.

| FINDING S
This paper reports key findings pertaining to the experiences of older people between 5 months and 12 months after the move to a care home. Identified categories were as follows: (a

| The lasting effect of first Impressions -'They helped me make my mind up'
A good Move-'I was positive from the start'. "I have always loved it here. Ever since I was told by the staff in the Hospital that I was coming here….

Pseudonym Age
Living arrangement prior to move

| On a Journey-'I just take it one day at a time'
Coming to terms with the move 'It's not home but what can you do'.
It was evident during interviews that some participants were re- "I love it here now; I think that I have settled in well.
It is the best place for me. I couldn't be on my own. I

Loss of Home and independence 'I can't live the life that I want to'.
Saying goodbye to home was very important for some partic-

| Caring relationships: 'I didn't realise that I was lonely until I had company'
Maintaining existing relationships and building new ones-'I like having the company'.
Relationships with family and friends were imperative in determining the quality of life for participants. These relationships enhanced their continued emotional well-being and sense of fulfilment within the care home.
"Well my family are good to me; they do anything I ask and take me out home to visit and come in here too. Many participants spoke about getting to know other residents' families and friends when they came to visit and how this enriched their lives also. These interactions contributed to their appreciation of a 'care home family'. One participant recounted losing 'care home family friends' after their relative had died which upset her emotional well-being leading to isolation and loneliness.
"A man I knew whose wife was upstairs died there recently; it was very sad. The family used to come in to see me too every day at dinner time. I miss them coming in, as I feel lonely some days. I don't really have anyone here to talk to" (Bernadette, 11 months).

| D ISCUSS I ON
This study set out to explore the experiences of 17 older adults following transition from home to living in a care home with a specific focus on the latter part of the first year of the move. Given the paucity of research concerning the adaption process for older people moving to a care home (Bradshaw et al., 2012;Brownie et al., 2014;Križaj et al., 2018;Roy et al., 2018), the aim was to discover more about the extent to which older people can be facilitated to feel 'at home' in a care home environment. Five distinct categories captured the experiences between 5 and 12 months after the move to a care home. Additionally, the loss of an individuals' previous social and communication networks (Zamanzadeh et al., 2017) can put older people at risk of feeling lonely and isolated (Brownie et al., 2014).

| The primacy of home
Establishing a sense of belonging or 'finding home' in a care home involves a process of adjustment (Cooney, 2012;Lindley & Wallace, 2015) and has a significant psychological and emotional impact for the individual concerned (Cooney, 2012;Falk et al., 2013;Marshall & Mackenzie, 2008). Moreover, the aptitude to feel at home in care home settings is said to influence residents' perceived quality of life (Bowers et al., 2009;Hedayati & Khazaei, 2014;James et al., 2014;Tester et al., 2004). The concept of 'home' is complex, and has been explored from gerontological, environmental and psychological viewpoints (Moe et al., 2013). Home is not simply a physical space, but it also denotes a meaningful 'place' which embodies physical, personal and social dimensions (Wahl & Oswald, 2010); extending beyond the household itself to encompass the neighbourhood and wider community (Bigonnesse et al., 2014). Additionally, Lovatt (2018), found that rather than the meaning of home being inherent in objects, or felt subjectively by residents, meaning is generated through ongoing, everyday interactions between the two. She suggests 'that life goes on', and that residents continue to 'do home' by actively turning the spaces of their rooms into places of home through habitual practices and by adding to their material surroundings albeit within a different setting and with more limited capabilities.
Participants spoke about the importance of maintaining the connection to their own home, family, friends and community which enabled them to move towards a positive adaptation and acceptance of living in the care home. Even 12 months after the move to the care home, participants identified the positive effect on psychological well-being of getting a visit home and having respite visits from the care home. This is significant as often the focus of family and care home staff is on trying to 'replace' home by creating a 'home from home' environment rather than embracing the importance of an older person maintaining their connections to home, family and community which enhances their continued emotional well-being and sense of fulfilment within the care home.
Within this study, 11 out of the seventeen participants visited their own home or a relatives' home on a regular basis (1-3 monthly) and three participants undertook activities in the community on a weekly basis. All these participant visits were instigated, planned and participants accompanied by family and friends.
'These findings generally resonate with research undertaken by Cooney (2012) who identified the determinants for 'finding home' as being 'continuity', 'preserving personal identity', 'belonging' and 'being active and working. Cooney informs that the potential to 'find home' is affected by mediating and facilitating/constraining factors.
In addition, Rijnaard et al., (2016) found that a sense of home is influenced by psychological factors including preservation of one's habits and values, autonomy and control, coping and social factors, interaction and relationship with staff, residents, family and friends. The importance of maintaining the connection to home, family and community has also been recognised within Paddock et al. (2019)  This may, however, present challenges for healthcare professionals who have a responsibility to ensure residents' safety and may influence their decision-making when accommodating clients' requests for outdoor activity (Mapes, 2017). Furthermore, it is recognised that despite risk being part of healthcare, nurses may be opposed to taking risks with innovative approaches to care provision due to public or professional criticism should things go wrong (RCN, 2013).
It is also recognised, however, that residents are normally dependent on family and friends to support their engagement with activities outside the care home and without this input they may not leave the care home (Paddock et al., 2019). In essence, care home staff usually do not have the staffing levels to make community connections a reality for residents. Furthermore, care homes are highly regulated environments and nursing, and healthcare staff must follow policy directives, guidelines and recommendations for best practice. That said, there is a need to balance people's human right to make choices by facilitating the needs and preferences of older persons and involving them in decision-making. Commissioning bodies have capacity to influence the way care services are organised and delivered and can stipulate specific practice and outcomes aimed at protecting and promoting human rights. in participants feeling 'at home' was whether they were involved in the initial decision to move and choice the facility which appeared to permeate their experience of the move thereafter. This finding is also firmly endorsed within the literature (Chao et al., 2008;Cooney, 2012;Fraher & Coffey, 2011;Johnson & Bibbo, 2014;Johnson et al., 2010;Lee et al., 2013;O'Neill et al., 2020aO'Neill et al., , 2020bRyan & McKenna, 2015;Tanner et al., 2015).

| A sense of belonging
It has been identified that key indicators of residents' acceptance and adjustment to the care home include the ability to establish a sense of home, maintain self-identity and self-worth and develop positive relationships with peers and staff (Cooney, 2012;Falk et al., 2013;Graneheim et al., 2014;Križaj et al., 2018;Molony, 2010;Mortenson et al., 2016;Roberts & Bowers, 2015;Shin & Hyun, 2015). Within this study, participants identified the importance of having good relationships with staff and residents with most participants describing staff as caring, kind and influential in making them 'feel at home'. However, some participants also perceived that some care staff were authoritative and uncaring. One participant (Charles) stated, 'the staff can make or break the place'. Furthermore, participants articulated that fellow residents and their families and friends had the potential to influence their lives positively, encouraging a sense of well-being for themselves making them feel at home amongst the 'care home family'. These attributes are reflected within Nolan et al.'s (2006) Senses Framework when considering how positive relationships can be created and sustained.
They put forward that in order to have a'sense of belonging', older people need to have 'opportunities to maintain and/or form meaningful and reciprocal relationships, to feel part of a community or group as desired'.

| Making a good move
Some participants in this study expressed positive feelings about living in the care home from the outset of the move. This optimism was fostered by the participant themselves and by hospital and care home staff who promoted and endorsed the positivity of the move for the individual concerned. For other participants, their own a personal level of resilience and positive thinking promoted positive adaptation and acceptance experiences to living in the care home over time. However, it is clear that for some participants in this study the move was not of their choosing, had not turned out the way that they had hoped, or felt 'cheated' that they had not been placed in the type of home or locality they wished to be. These core issues prompted one participant (Ellen) to make plans to leave for Australia and another (Sean) to spend his days longing for home and waiting on a care package that did not materialise, perpetuating his unhappiness. It is evident from the literature that a more successful transition or adjustment to a care home is associated with a planned admission rather than unplanned admission, (Gilbert et al., 2015;Koppitz et al., 2017;Walker & McNamara, 2013).
Furthermore, it has been positively endorsed within the literature that a person will perceive their relocation more positively after being introduced to a care home prior to the move (Graneheim et al., 2014;Sury et al., 2013;Sussman & Dupuis, 2014 (Bradshaw et al., 2012;Brownie et al., 2014;Križaj et al., 2018).

| Psychological and emotional well-being
Within this study, 'The Primacy of 'Home' is identified as the importance of residents making and maintaining 'connections' thus promoting their mental health and well-being. Core to understanding how a positive adaptation can be made is recognising the significance of the need for a continuing relationship and continuing connection with home, family and community. Residents need and want something to look forward to, either in terms of getting out for a while with family; or family coming in to visit and spend time; and the opportunity to form relationships with other residents and care workers. It is recognised that loneliness and isolation are key issues associated with admission to long-term care (Brownie et al., 2014;Cooney, 2012;Hanratty et al., 2018;Križaj et al., 2018;Sury et al., 2013). Conversely, many participants in this study experienced loneliness prior to moving to the care home and friendships developed thereafter significantly contributed to their 'sense of home', quality of life and emotional well-being.
However, some participants still experienced loneliness up to a year after the move, particularly those who had no family of their own, or individuals who had no shared interests with other residents. Moreover, those participants who felt that they 'had no choice' about the move or choice of care home were still reporting feelings of sadness, regret and lowered mood Brownie et al., 2014;Thein et al., 2011). Grief is a normal process of reacting to a physical loss, such as a death, or a social loss including a relationship. Bereavement is the period after a loss during which grief and mourning occur. The time spent in bereavement for the loss of a loved one depends on the circumstances of the loss and the level of attachment to the person who died (Cassarett et al., 2001). It is noted that a higher prevalence of complicated grief is indicated in the age range of 75-85 years (Newson et al., 2011), denoting more difficulty coping with a loss. Research indicates that older people go through multiple losses of family and friends within their lifetime (Shear et al., 2013) with the transition to widowhood considered the most stressful adjustment to make in later life (Silverstein & Giarrusso, 2010). Moreover, many older people experience bereavement, loss of home and loss of physical function when they move to a care home and also when other residents die within the home (Reed et al., 2002). Within this study, some participants were also grieving loss of family members and others were trying to cope with loss associated with ageing, loss of home and loss of independence. These findings resonate with literature that suggests numerous losses including bereavement are common in old age and present emotional, physical and practical challenges (Ebrahimi et al., 2015;Nicholson et al., 2012;Shear et al., 2013;van Humbeeck et al., 2016).
Some participants identified how they were positively supported by social workers and care home staff to control how and when they said goodbye to their house when they were 'letting go of home' and how this enabled a successful adaptation to their 'new home'. In contrast, not all participants had existing social supports to cope with bereavement and loss in the care home. This study suggests that the grief and loss experienced by participants when family, friends or a member of 'care home family' dies is not always understood by staff.
The findings from this study clearly identify that older people's experiences of care transition vary, in terms of their support needs and their adaptation to the care home. Our study has identified that individuals' perceptions of 'The Primacy of 'Home' is connected to their perceived quality of life, continued connection to home, family and community, having opportunities to develop meaningful relationships promoting a sense of belonging amongst their 'care home family'. The aptitude to feel at home includes control, autonomy and supportive staff relationships and is endorsed within the literature, (Bowers et al., 2009;Bradshaw et al., 2012;Brandburg et al., 2013;Cooney, 2012;Ericson-Lidman et al., 2014;James et al., 2014;Krizaj et al., 2018). This study is significant because the data were collected up to a year after moving to the care home and there is limited research that has explored the experiences and perspectives of older people up to this time period.

| CON CLUS IONS
In this study 'The Primacy of 'Home' is identified as a place where participants feel valued, nurtured and have a sense of belonging.
Older people living in care homes should not be seen as a homogeneous group with a single set of requirements. Moreover, it is very important that older people are enabled to realise their individuality, ability and potential, should that be within the care home or by having continued connection to family and community. Managing individual preferences and expectations from the outset can enable older people to move towards acceptance rather than disabling them which leads to disillusionment and unhappiness. First impressions are very important and have been shown within this study to influence participants' experiences throughout the first year of the move leading to a more positive adaptation journey.
Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be con-

ACK N OWLED G EM ENTS
The author/s thank all the older people who participated in the study and the care managers and care home managers who assisted with recruitment.

CO N FLI C T O F I NTE R E S T
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

AUTH O R CO NTR I B UTI O N S
All authors have agreed on the final version and meet all four criteria for authorship of the following criteria (ICMJE [http://www. icmje.org/recom mend ations/browse/roles-and-responsibilities/ defining-the-role-of-authorsand-contributors.html]): Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. Drafting the article or revising it critically for important intellectual content.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.