End-of-Life Perspectives Among Couples Aging Together in Assisted Living: A Narrative Approach Open Access

Abstract

As the population ages and caregiving trends change, assisted living (AL) is increasingly becoming a place where people spend the final years of their lives. While the majority of AL residents are widowed women due to gender gaps in life expectancy, couples may represent an increasing proportion of residents as the life expectancy gap narrows. Considering these dynamics, couplehood in AL represents an important avenue of research and has received increased attention in recent years. This ethnographic thesis examines the end-of-life perspectives of two Jewish couples aging together in an AL community in suburban Atlanta. The research addresses the following factors: Individual-level factors (e.g., life history and Jewish ancestry), marital-level factors (e.g., marital history and caregiving roles), AL community-level factors (e.g., its social and religious culture), and societal-level factors (e.g., a global pandemic, societal attitudes regarding death and dying). A variety of qualitative methods were used to examine these factors, including analysis of previously conducted, in-person, in-depth interviews, COVID-safe field visits to important places in the couples’ lives, and Zoom interviews with a key informant. Findings show that AL can be a highly beneficial and supportive environment for couples and that less impaired spouses need occasional breaks from caregiving responsibilities. Couples’ life experiences and end-of-life perspectives surrounding mourning and burial were highly variable, but there were similarities in their attitudes toward death as well as their ideal deaths and attitudes toward cognitive decline. Implications for research and family decisions are discussed.

Table of Contents

Chapter 1: Introduction...................................................................................1

I. Why Couples................................................................................................3

II. Personal Interest.........................................................................................4

III. Positionality..............................................................................................6

Chapter 2: A Review of the Literature...............................................................8

I. Evaluating Assistance Needs.........................................................................8

II. Understanding Assisted Living.....................................................................9

III. Relationships in Assisted Living.................................................................13

IV. Married Couples in Later Life......................................................................17

a. Couplehood and Health...............................................................................17

b. Socioemotional Support..............................................................................18

c. Caregiving..................................................................................................19

d. Couplehood in Assisted Living.....................................................................21

V. Jewish Perspectives on Death and Dying.......................................................23

a. Pikuach Nefesh in Practice...........................................................................23

b. Religious Practices......................................................................................23

VI. Concluding Thoughts on the Literature Review............................................27

Chapter 3: Ethnographic Setting, Participants, and Methodology.......................28

I. Ethnographic Site -- Haber Gardens..............................................................28

II. Participants................................................................................................31

III. Sociodemographic Information...................................................................32

IV. Data Collection..........................................................................................33

a. Semi-Structured Interviews.........................................................................33

b. Participant Observation..............................................................................35

c. Memo-Writing............................................................................................38

d. COVID-Safe Field Trips...............................................................................38

V. Data Analysis.............................................................................................39

Chapter 4: Abe and Freida Buchsbaum.............................................................42

I. Courtship and Marriage................................................................................42

II. A Field Trip to Augusta...............................................................................43

III. Business...................................................................................................43

IV. Jewish Community.....................................................................................48

V. Leaving Augusta.........................................................................................51

Chapter 5: Max and Edith Kopman...................................................................53

I. "The Mayor"................................................................................................53

II. Courtship and Marriage..............................................................................54

III. Career and Community Activism................................................................55

IV. Jewish Life................................................................................................56

V. Family.......................................................................................................57

Chapter 6: Findings on End-of-Life Perspectives..............................................60

I. Caregiving and Taking a Break.....................................................................60

II. "It is what it is"..........................................................................................70

III. "I'm not interested in living a life that's half a life".......................................74

IV. Burial, Mourning, and the Afterlife.............................................................77

a. Burial.........................................................................................................78

b. Mourning and Legacy..................................................................................81

c. The Afterlife...............................................................................................87

Chapter 7: Discussion and Conclusions............................................................90

Chapter 8: Implications, Limitations, and Future Directions..............................96

I. Implications................................................................................................96

II. Limitations................................................................................................97

III. Future Directions......................................................................................98

Appendix A (Sample Memo)............................................................................99

Appendix B (NVivo Codebook).......................................................................101

Appendix C (Lerman's Home Fashions)..........................................................108

Bibliography.................................................................................................109

About this Honors Thesis

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School	Emory College
Department	Anthropology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Jewish Studies Gerontology Anthropology, Cultural
Keyword	older couples qualitative analysis end-of-life assisted living
Committee Chair / Thesis Advisor	Perkins, Molly M., Emory University Konner, Melvin J., Emory University
Committee Members	Bender, Alexis A., Emory University

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