The vast majority of elderly Americans want to stay in their homes as long as possible, even if they become ill or disabled. But significant psychological benefits can be gained by planning ahead, well before the onset of infirmity. "Senior citizens who plan ahead report a high degree of control over their moves and a greater sense of mastery than those who don't plan ahead," says Elaine Wethington, associate professor of human development and of sociology at Cornell University. "Our research also shows that this sense of control is linked to feeling physically and psychologically healthier over time."

The findings, from a six-year longitudinal study that began in 1997, are detailed in the new book, Residential Choices and Experiences of Older Adults: Pathways to Life Quality ( Springer Publishing, 2003). The study is a joint project of the co-editors, Wethington, John Krout of Ithaca College's Gerontology Institute and Phyllis Moen, now at the University of Minnesota.

"We are on the brink of a national crisis as many baby boomers approach retirement with small or nonexistent family networks to rely on," warns Wethington. "We don't have adequate assisted housing arrangements for the growing numbers of older Americans, many of whom cannot afford premier continuing-care retirement facilities. Nor do we have adequate knowledge about how older people decide when to leave their longtime homes and to what kind of housing they might move, or about the types of modifications they are making to their current housing so that they can remain in place."

In their book, Wethington and Krout explore how older Americans make decisions about whether and when to move and how various housing decisions affect their health, well-being and quality of life. "We find, for example, that older people are remarkably resilient and capable of managing multiple life stressors while maintaining good well-being. Inequities exist, however, according to income, as do options for housing," Wethington explains. "Residents of facilities that offer fewer services, for example, come to housing facilities with greater needs for services because of their health, income, health behaviors, fewer social resources, and lower well-being and perceived health."

She adds: "The challenge is to identify areas for improvement and to engage institutions from within communities to provide senior housing residents who have fewer resources with the kinds of social activities and resources that residents of service-rich facilities receive. Whereas Medicare and Medicaid ensure access to nursing homes, comparable efforts are needed to focus on making home-care services more available, such as offering more skilled care in neighborhood settings. What local communities will be able to afford to offer older people is a very serious problem for the future."

More than two dozen researchers, primarily from Cornell and Ithaca College, contributed to the 240-page book, covering plans and adjustment to moving; role identities, social relationships, participation and integration; health and activity patterns; and coping with life events. The book concludes with detailed policy and practice recommendations.

The study, "The Pathways to Life Quality," involved interviews with 800 residents (age 60 and over) in an upstate New York community who live on their own, in a continuing-care retirement facility or in service-poor facilities, such as adult homes, income-subsidized housing and senior apartments. Study participants were interviewed in depth every two years.