‘By the hook or the crook’: a qualitative descriptive study of meaning in life for low-income older adults residing in assisted living facilities

OBJECTIVES: Meaning in life is closely linked to physical, cognitive, and mental health in older adulthood, yet little is known about how low-income older adults residing in Medicaid-funded assisted living facilities (MALF) experience and sustain meaning. This qualitative descriptive study explored how MALF residents make and ascribe meaning in their lives to inform person-centered care and intervention development in this understudied population. METHOD: We conducted a qualitative descriptive study guided by Wong's PURE Model of meaning in life (Purpose, Understanding, Responsible action, Enjoyment). We completed semi-structured interviews with residents from three MALF in the New York City metropolitan area. A purposive sample of 24 interviews was analyzed using a five-phase process, combining deductive and inductive content analysis methods. RESULTS: Participants were diverse in age, race and ethnicity, and length of residence, with many experiencing functional impairment, depression, hopelessness, or stress. Two cross-cutting themes - (in)dependence and (dis)connection - shaped residents' experiences of meaning across all PURE domains. Maintaining independence and surviving within physical, financial, and environmental constraints were central to purpose and understanding, while meaningful relationships and opportunities for reciprocity supported connection, enjoyment, and responsible action. CONCLUSION: Findings highlight the central role of independence and connection in meaning making among low-income assisted living residents while highlighting key issues critical to this population. Assisted living environments and care practices that support autonomy, accessibility, and sustained relationships may enhance meaning in life and well-being for this population.