“I had no choice. I had to come somewhere”: The Journey to New York’s Assisted Living Program for low-income older adults

“I had no choice. I had to come somewhere”: The Journey to New York’s Assisted Living Program for low-income older adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “I had no choice. I had to come somewhere”: The Journey to New York’s Assisted Living Program for low-income older adults Kimberly Hadson, Neha Tungaturthy, Daniel David This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9076750/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 2 You are reading this latest preprint version Abstract Low-income older adults represent a growing proportion of assisted living residents in the United States. In this study, residents of New York State’s Medicaid-supported assisted living program (ALP) recount their arrival stories, revealing how their experiences and needs differ from traditional assisted living populations. A purposeful sample of 72 participants in three ALPs in New York City were interviewed from September 2021 to November 2024. The first question (“Tell me how you came to live in assisted living?”) was qualitatively analyzed using narrative thematic analysis. Three themes describe the unique challenges for these urban dwelling low-income older adults. Participants experienced tumultuous healthcare and living situations before assisted living (“aging in motion”), with families who were restrained in the emotional and material support they were able to provide (“amplified family challenges”). Participants held these considerations in mind when choosing or being guided to enter assisted living (“contextualized and constrained choice”). These settings represent an alternative to more restrictive nursing home placement. However, residents' prior lived experience and current limitations in low resourced ALPs impact optimal care delivery to this vulnerable population. This study has implications for policy makers looking to support urban dwelling low-income older adults and for clinicians tailoring their care. Recommendations include evaluating the feasibility for expansion of access to housing and community-based healthcare, and for clinicians to consider residents’ whole life trajectory, the cumulative effects of financial strain across lifespan, and healthcare mistrust based on past experience to develop effective interventions for them to “age in place.” Full Text Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 11 Mar, 2026 First submitted to journal 09 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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