“Not living together yet all the time together”: The construction of living apart together in continuing care retirement communities from perspectives of residents and CCRC staff*

Continuing care retirement communities

A CCRC is considered a residential community that functionally independent older adults move to for the remainder of their lives. Thus, it is considered a type of LTC institution. The CCRC intentionally provides a home-like atmosphere and a diverse range of supportive services (Kapp & Wilsond, 1995). It was developed for maintaining residents’ autonomy and independence (Sherwood, Rucklin, Sherwood, & Morris, 1997). Although residents enter the CCRC when they are functionally independent, many could lose their functional or cognitive independence and with time require higher levels of care (Shippee, 2009). As a result, many CCRCs offer residents the possibility to move to higher levels of care within the same setting (Roth, Eckert, & Morgan, 2016; Shippee, 2009).

Although the CCRC has received considerable popular press attention as a potentially valid option for older adults (Mirovsky, 2008), the majority of older Israelis live in the community. In 2012, there were 184 CCRCs in Israel, which provided 23,040 living units for older adults. This constitutes 31 units per 1,000 individuals over 65 or 64 units per 1,000 individuals over the age of 75 (Brodsky, Shnoor, & Be’ er, 2012).

Among individuals entering a CCRC in Israel, the move usually occurs after the loss of a lifelong marital spouse when the older person still functions independently physically and cognitively yet is aware of the possible future losses that are likely to occur due to old age (Ayalon, 2016; Bäumker et al., 2012; Brodsky et al., 2012). Moreover, despite the resemblance of the physical environment to high-quality hotels with a personal touch, CCRCs, like other institutions, possess semi-totalitarian characteristics, as noted by Goffman (1963) and Gamliel & Hazan (2006). These semi-totalitarian characteristics are manifested in the fact that people are cut off from the community at large and instead, live the rest of their lives within a single place where they sleep, eat, and attend social activities.

Past research has highlighted the structurally ageist features of LTC institutions (Dobbs et al., 2008; Zimmerman et al., 2016). These features restrict residents’ autonomy, especially when their functional abilities decline (Ryvicker, 2009; Shippee, 2009). For instance, a study on the role of social workers in old age homes for independent and frail older persons in Israel has found that social workers exhibited paternalistic attitudes that tend to restrict residents’ autonomy (Koren & Doron, 2005). A different study stressed the search for autonomy, which often drives older adults to seek out CCRC residency. However, many times, residents end up facing a decline in their autonomy once their condition deteriorates (Ayalon, 2016). Furthermore, in the absence of clear guidelines or a formalized policy regarding intimate relationships between residents, each institution determines its own approach toward sexuality and relational needs among older LTC residents (Bauer, Nay, & McAuliffe, 2009). Possibly, in the case of independent older adults, who tend to experience high levels of autonomy compared with dependent residents (Shippee, 2009), CCRC staff might have a lesser influence on older adults’ relational opportunities and choices, but this remains to be examined.

LAT: A form of late-life repartnering

LAT is defined as an exclusive intimate relationship between unmarried individuals who remain in their own separate homes, but at times live and spend time together (De Jong Gierveld, 2002). It ensures individuals a significant degree of autonomy (Karlsson & Borell, 2002) along with identifying themselves as committed to one another as long as the relationship lasts. However, it does not necessarily indicate the relationship would be permanent (Benson & Coleman, 2016a). LAT partners in the U.S. were reported to seek age appropriate terms for defining their relationship contrasting it with dating and marital relationships. They preferred not to use youthful terms such as girl/boyfriend yet often used such terms because of a lack of alternatives (Benson & Coleman, 2016b).

LAT is one of the three late-life repartnering forms. The other two are cohabitation and remarriage (De Jong Gierveld, 2004). Most of the literature addresses the broader phenomenon of late-life repartnering including all three forms rather than studying each form separately (e.g., Davidson, 2002; De Jong Gierveld, 2002; Koren, 2011, 2014).

Late-life repartnering is mainly practiced among older persons from middle to high socioeconomic status (Davidson, 2002). It is more common in modern western societies and is hardly recognized in eastern and traditional societies (Mehta, 2002). In societies such as Israel, which is located between tradition and modernity, late-life repartnering exists yet it is not accepted in all social circles (Koren & Eisikovits, 2011). Furthermore, records regarding prevalence and demographic features are unavailable. Despite the lack of official Israeli records, from various studies conducted in Israel (e.g., Koren, 2011; Koren & Simhi, 2016), we have learned that legal remarriages are the exception, whereas cohabitation and LAT are preferred. This could be explained by the fact that to marry and divorce in Israel, couples must obtain religious authorization (Gavriel-Fried & Shilo, 2017).

Widows and widowers were found to avoid remarriage or repartnering among other reasons due to spouse sanctification meaning idealization of deceased spouse and of the relationship with deceased spouse (Bennett, Arnott, & Soulsby, 2013; Van Den Hoonaard, 2002). However, their perspectives on LAT are yet to be studied. Most partners experience their repartnering relationship as essentially different from their lifelong marriage (Koren, 2011). The experience is influenced by the limited time left to live (Bildtgård & Öberg, 2015). It is perceived as a way to maintain a youthful self-image and is seen as a means for having fun rather than for raising a family (Koren, 2015). Previous research indicated that older women whether repartnered or not expressed greater value in companionship, cuddling, affection, and intimacy in their sexual relationship (Hurd-Clarke, 2006). Furthermore, regardless of practicing sexual intimacy in late-life repartnering, or not, it included partner exclusivity. Partners were found to be committed to each other by providing care out of willingness rather than obligation (Koren, 2011). Furthermore, LAT partners who were confronted with caregiving needs, provided care (De Jong Gierveld, 2015) indicating their togetherness despite living apart.

Heuristic theoretical framework

This study emphasizes LAT relationships in the context of the CCRC as a community rather than as a phenomenon experienced by older persons as individuals or dyads. Therefore, this study adds by stressing the role of the CCRC environment as constructing the meaning of LAT relationships. By doing so, the study contributes to the understanding of LAT in a unique socio-environmental context. In this study, community (Ramon, 2001), PIE (Akesson et al., 2017; Kondrat, 2002; Weiss-Gal, 2008), and P-E fit/misfit (Edwards et al., 2006) approaches are heuristically used for studying LAT in the CCRC. We refer to Ramon’s (2001) definition for a community with physical boundaries:

[It is] perceived as a large group of people located near each other physically, […] smaller than a whole society yet larger than a family unit […], provides a sense of belonging with a shared frame of reference and solidarity within a lived social framework. (Ramon, 2001, p. 29)

The present study

Given the fact that both CCRCs and LAT represent opportunities for new beginnings in old age, exploring the intersection between the two could provide new understandings on the features of the CCRC and on LAT relationships and provide ways to enhance residents’ well-being and quality of life. To examine these intersections, we specifically interviewed both men and women in LAT and not in LAT as well as CCRC staff. Respondents were queried in order to identify the unique characteristics of the CCRC and the potential role they play in LAT.

We used the following research question to guide our inquiry of the phenomenon: What is the meaning and experience of LAT in CCRCs? Specifically, in the light of the interdependence among the various stakeholders within the CCRC, we examined the meaning of LAT from three different perspectives of stakeholders who share the same environment: widowed LAT residents, widowed residents who are not in an LAT relationship, and CCRC staff. Important to note that meaning is different from definition. Hence, our focus was on the subjective perception of the construct LAT, rather than on an objective definition.

Sampling and sample

We used criterion sampling (Patton, 2002) including the following criteria: (1) institutions recognized as CCRCs, (2) LAT residents who have entered their relationship after moving to the CCRC, (3) residents not in an LAT relationship, and (4) CCRC staff working in the CCRC who have constant and direct contact with residents and could therefore provide their in-depth experiences with the LAT phenomenon in the CCRC.

The actual sample included 3 CCRCs and 30 participants, 10 for each data set; 10 widowed LAT residents (5 men age 79–96; 5 women age 76–88), in the relationship 1–6 years, residing in the CCRC 1–15 years, have 0–3 children and 0–12 grandchildren. Ten widowed residents not in an LAT relationship (2 men age 87–90; 8 women age 84–93), residing in the CCRC 2.5–13 years, have 1–3 children and 2–14 grandchildren. Subjective financial state of all participating residents was mid to high. Ten CCRC staff (4 social workers, 2 medical staff, 2 housemothers, 1 group instructor, and 1 operations manager) working in the CCRC 0.5–30 years. Although we chose CCRC staff from different professional backgrounds, they all had constant and direct contact with residents. We found essential similarities in their perceptions of LAT despite their diverse educational training and diverse perceptions on providing social and medical services.

Data collection

The first author contacted social workers of several CCRCs in the northern part of Israel. In the process of recruitment, we learned about the scarce number of LAT residents in CCRCs. Consent to participate was received from three CCRCs. After receiving permission from the director of each CCRC, the social worker approached residents and CCRC staff. Undergraduate students specializing in social work with the older population received training from the first author in qualitative interviewing. They conducted semi-structured in-depth interviews in Hebrew, audio recorded, and transcribed them verbatim. Data collection was determined by data saturation.

Interview guide

The interviewer and interviewee create data together during the interview (Charmaz, 2006). As such, along with the interview guide, the interviewer is one of the research tools (Patton, 2002). Interviews were based on a semi-structured interview guide that was adapted to each perspective. ¹

The opening grand-tour question ² (Spradley, 1979) asked all resident participants to tell their story of late-life LAT constructed in the CCRC. CCRC staff were asked to tell their experience with late-life LAT constructed in the CCRC. During recruitment and data collection, we learned about the sensitivity of relating to the phenomenon of LAT and repartnership. We subsequently addressed it as: “a special relationship.” Questions were asked to explore the following topics: Partnership, for example: “What makes you/them a couple?” The CCRC environment, for example: “In your opinion, how is life in the CCRC in comparison to the community?” Significant others, for example: “How do residents who are not in a LAT relationship relate to LAT residents?” Old age, for example: “what is being old/old age for you?” During the interview, probing questions were asked, for example: “When you say friendship, what do you mean?”

Data analysis

First, the unique experience of each of the three perspectives (data sets), based on interviews with 10 participants for each data set, was analyzed separately (Braun & Clarke, 2006) by the undergraduate students under the supervision of the first author. The first author, as the students’ supervisor, took part simultaneously in the analysis of all three data sets. Second, the triangulation of all three (data sets) of the entire sample (the data corpus), presented in this article, was performed (Braun & Clarke, 2006; Patton, 2002) by the first author and confirmed by the second author. The integration of multiple perspectives brought by different stakeholders allowed us to better explore the intersection between CCRC and LAT.

The first phase of analysis was conducted separately for each of the three perspectives (data sets). It included several steps not necessarily performed linearly to enable flexibility of going back and forth between steps. First, familiarizing with the data by reading and rereading each interview, noting down initial ideas by the students and first author for all the interviews and by the second author for selected interviews. Second, generating initial codes by coding the entire texts into smaller segments and providing a relevant title or titles for each segment (Braun & Clarke, 2006). Furthermore, comments for excerpts were written on descriptive, linguistic, and interpretive levels (Smith, Flower, & Larkin, 2009), when relevant. Descriptive level refers to analysis of content, whereas the linguistic level refers to analysis of grammar and metaphors used. Combining these two levels assists in deriving interpretations that are grounded in the data (illustrated on excerpts in the findings section). Third, analysis across interviews for each of the three perspectives (data sets) to identify themes was performed using a WORD table. The excerpts illustrating a code appearing within a single interview are “copy/pasted” in the relevant columns along with line numbers inserted in the verbatim transcribed interview document. This creates a list of titles/codes used and enables to perform constant comparisons ³ within and across interviews during the coding process of analysis.

The second phase, triangulation (Patton, 2002), included several steps that were also not necessarily performed linearly. The aim was to identify themes that emerged across the entire data corpus which included the three perspectives (data sets). This is similar to the stage of reviewing themes in thematic analysis (Braun & Clarke, 2006). We checked whether and how the themes came through across all three data sets. Constant comparisons were performed across perspectives (data sets) for identifying themes across all three perspectives (data sets; LAT residents, residents not in a LAT relationship, and CCRC staff).

The themes presented in this article were initially identified inductively during the analysis of the LAT residents’ perspective (data set). After each data set was analyzed separately, the authors continued the second phase of analysis by triangulating the three data sets. This was achieved by examining the themes that were identified as central in each data set against the other two data sets through the process of constant comparative methods (Charmaz, 2006) for triangulation (Patton, 2002) as described above. As such, the second phase was deductive. This process resulted in a richer and broader experience presented in the finding section of this article in which the selection of vivid compelling extract (quotes) examples and their final analysis (Braun & Clarke, 2006) of content, linguistic, and interpretative (Smith et al., 2009) are presented.

Trustworthiness

Trustworthiness was achieved in several ways. All stages of the study were conducted systematically and documented. Documentation included recording the interviews and transcribing them verbatim to make it accessible to the teams of each data set and to both authors, for coding and writing comments to ensure referential adequacy. Peer debriefing was conducted in both phases. In the first phase, students worked together discussing the codes and consulting with the first author until agreeing on themes. In the second phase, the second author read the interviews, went over the analysis with the first author, and confirmed the themes. Triangulation serves as another means of trustworthiness by allowing use of multiple and different sources to provide corroborating evidence (Patton, 2002).

Ethics

The ethics committee of the University of Haifa (approval #067/14) and the ethics committee of Bar-Ilan University (provided February 2014) approved the study. Each participant signed a letter describing the aim of the study and its requirements along with a declaration of consent. Confidentiality was achieved by omitting the location and names of the CCRCs and by omitting participants’ names and other identifying information from quotes.

Friendship rather than partnership

Most participants within all three data sets pointed out that they perceive LAT relationship in the CCRC as friendship rather than romantic partnership. In their responses, they illustrated how the way LAT in the CCRC is referred to and influences how it is perceived by self and others.

LAT residents illustrate the difference between partnership and friendship and characterize the LAT as friendship. Residents not in an LAT relationship add that the meaning of LAT as friendship shapes its legitimacy, as romantic partnership is seen as a deviation. CCRC staff add to the discussion by pointing to the fact that the way LAT is defined shapes the public opinion in the CCRC. The three data sets combined provide a broad and in-depth experience of how such relationships are most commonly perceived in the CCRC.

LAT residents describe their LAT relationship:

We somehow began to get friendly and since then we meet here and there. He comes to me, I go to him for a short while usually in the afternoon and sometimes we go for a walk when the weather is good, and it’s going on so far, I think for a year or so. I said that it cannot be called partnership because partnership is a heavy concept, it’s something more committed. What we have is friendship. You could say we are friends. It cannot be called partnership, that’s what I think. […] I don’t define him as a partner but as a friend, I don’t think it’s the same. […] There are no such cases in the CCRC of actually living together, there is no such thing. Partnership is something more intimate, closer, and stronger. I think, according to my definition, that partner and friend are not the same, that’s what I think. It’s a friend an acquaintance, a friend. (Woman, LATR2, 1-year LAT, age 87)

Another LAT resident adds the issue of intimacy:

[…] There’s a difference, I differentiate between a friend and a partner, I’m more of a friend than a partner, because a partner is more, that’s how I define it. […] A partner is more intimate perhaps than a friend, I’m a good friend but not that intimate. (Woman, LATR1, 4 years LAT, age 88)

The following quote of a resident not in an LAT relationship illustrates how the meaning of LAT as friendship shapes its legitimacy:

There is one couple here, they don’t live together, they are a lot together outside, the way I see it, they go on trips together, they travel together and so on, but they don’t live together, it’s really close to friendship, could be, but if they go to bed together then its more than friendship. […] it’s inappropriate. Look, it doesn’t mean for instance, if someone is widowed at a young age and there is no choice, he can’t function because he has small children, works at a job which does not enable him to perform household chores in addition, but he’s a young man, yes. I don’t understand these attempts to get involved with someone [in the CCRC]. (Man, NLATR4, age 87)

The next quote by a CCRC staff member illustrates the friendship characteristics of LAT relationships in the CCRC:

This quote confirms that LAT relationships in the CCRC happen after widowhood. It also emphasizes that it is friendship rather than partnership despite the intimate aspect of the relationship. The intimate aspect is apparent by gestures such as the man opening the door for the woman, indicating exclusivity of the friendship but not partnership which indicates a romantic relationship.

The next quote by a CCRC staff member illustrates LAT residents’ concern of the public opinion related to widowhood, thus providing a reason for insisting on referring to the relationship as friendship rather than partnership:

Widowhood influences the ambivalence towards repartnering and the need to emphasize that it is not partnership: “we’re only friends” even towards the other residents. They are concerned of what they [other residents] will think of them. (STAFF3, age 53)

The following quote illustrates experiences of men and women LAT residents who would like their LAT relationship to be more than friendship, but their LAT friend is not interested. As such their LAT friend’s wishes coincide with the previous experiences presented above whereas theirs’ illustrate the opposite:

This friendship within a day could turn into a partnership, it [partnership] doesn’t bother me it bothers her. We maintain a beautiful friendship but not partnership, there is no kiss, no hug, there is a smile. (Man, LATR10, 6 years LAT, age 94)

Not living together yet being all the time together

The following theme illustrates how residents and CCRC staff emphasize that although LAT relationships do not include living together, the members of the relationship are perceived as being all the time together, indicating that it is what makes them a couple.

The following quotes illustrate the perspectives of CCRC staff:

It’s each one living apart. He’s in his apartment, she’s in her apartment and they come down together, they have activities together, at performances, everything together […]. They go out shopping together, I see, they come to all kinds of activities together, […] they sit together, serve each other snacks […]. They go out together to have coffee outside of the place here. You see that they are the entire time together. (STAFF2, age 38)

The following quote of a CCRC staff adds the difference between behaviors of LAT residents in the CCRC in comparison with when they are outside the CCRC:

The ones that met after [moving to the CCRC] each one chose to stay in his apartment. They spend most of the day together, outings, run errands, medical check-ups. During the day, they are together but at the end of the evening, each goes to his own home. They do not agree to be together in one apartment. I recommended it to some, but they did not agree. They order rooms at hotels, they go to hotels to spend time together but here [in the CCRC] they do not agree [to live together]. (STAFF5, age 38)

The next quote of another CCRC staff member adds the following:

Each has his own unit here, but they are together a lot, many hours together. The younger ones also travel abroad. There are those not in a state to travel anymore, but they go to the theatre together, she prepares a sandwich for him and she pays attention he eats well. I hear the neighbour say: “since she is with him I don’t feel comfortable to put the food I cook in his freezer, I don’t have room in my freezer.” She is someone else not in a LAT relationship. She [his LAT friend] pays attention to what happens, what he eats, in terms of a LAT relationship, there is someone who pays attention to him, that cares, that doesn’t allow foreign forces to invade their space as a couple. (STAFF4, age 61)

The following illustrates how residents who are not in an LAT relationship perceive it:

There are several such couples here, I don’t know if they live together but I see them in the dining room together, at performances together, I wish them health, I am not willing [to get into such a relationship] […]. As far as I know there are no couples who moved in together. He has his apartment and perhaps he stays over for a night, I don’t investigate into that, I don’t know, and it also does not interest me but in principle they did not move in to live together. Could be that not, I don’t really know the reason, I didn’t get interested, at my age it isn’t appropriate anymore, no. (Woman, NLATR8, age 88)

The following quote illustrates the perspective of an LAT resident:

I live here alone, he lives alone, we don’t live together but we meet in the evening at around six o’clock there is a program of lectures that is over at seven. At seven we sit a bit in the cafeteria, talk a bit with people. There are many nice people here, drink coffee and later at eight everyone goes home to listen to the news or watch television, everyone goes his own way and so do I with him and if we’re hungry we eat something together, sit a bit more and then he goes home. (Woman, LATR6, 2.5 years LAT, age 88)

Friendship rather than partnership: The social environment of CCRCs as semi-totalitarian institutions

Late-life repartnering relationships in the CCRCs that participated in this study are solely LAT relationships. Along with not living together in the same apartment, LAT residents insisted it was not a partnership while emphasizing its friendship nature. Furthermore, if the relationship included a physical-sexual component, it was usually kept vague. Although some of these characteristics are also apparent in LAT relationships in communities outside CCRC environments (Benson & Coleman, 2016a, 2016b; De Jong Gierveld, 2002), it seems that LAT CCRC residents make a special effort to emphasize them. A possible explanation could be related to features of the CCRCs’ social environments as semi-totalitarian institutions (Gamliel & Hazan, 2006). Residents who were not in an LAT relationship expressed attitudes such as late-life repartnering not being age appropriate in general and spouse sanctification after widowhood (Bennett et al., 2013; Van Den Hoonaard, 2002) in particular. Furthermore, ageist attitudes against late-life repartnering as age inappropriate reflect the mainstream attitudes in Israel toward the phenomenon (Koren & Eisikovits, 2011). In institutions such as CCRCs, in which residents share their social environment (Gamliel & Hazan, 2006), exposure to such attitudes is harder to avoid than in the larger more open society outside the CCRC and could account for insisting that an LAT relationship is not a partnership, but rather a friendship. These examples potentially suggest a misfit between the person and the environment, as the environment limits the relational opportunities of CCRC residents.

Past research (Ayalon & Green, 2013) has shown that CCRC residents tend to classify their social relations according to three main bases. One of these bases is a spatial dimension that distinguishes between the private and the public space in the CCRC. According to residents, only the most intimate relationships are allowed to invade the living space, whereas most other relationships occur in the public setting of the lobby. The present study shows that the legitimacy to repartner is given under certain conditions such as LAT. LAT couples are discouraged from making their relationships too private. As long as things are out in the open and everyone sees, the relationships are not threatening. But, if they occur in the private setting of the room, the relationship gains a different status, which distinguishes it from all other relationships in the CCRC.

Constructing LAT as an exclusive friendship

Although LAT CCRC relationships are not perceived as partnerships but as friendships, there are several identifiers which construct them as exclusive friendships. This is achieved by establishing a boundary between the partners as a unit and the rest of the environment (Gamliel & Hazan, 2006). One identifier is openly demonstrating going upstairs together after the evening activities. Residents who do not have an exclusive friendship go upstairs alone as individuals, whereas LAT residents go upstairs as a pair. Another identifier is serving snacks to each other or making a sandwich for the LAT friend and making this known among others in the CCRC environment. Once two residents are established as a couple, other residents refrain from violating their boundaries by not entering their space. Other identifiers are walking hand in hand or a smile. These are identifiers that substitute hugs, kisses, and caresses and indicate the relationship as exclusive friendship rather than partnership. Such a behavior coincides with the principle of relationship between micro and macro realities in the PIE approach (Weiss-Gal, 2008). This principle relates to ways the CCRC environment and its structure shape residents’ behaviors which in turn are constituted by the same action they shape and condition (Kondrat, 2002).

Not living together yet being all the time together: Limited autonomy

Although LAT CCRC residents do not live together, they are perceived as being all the time together. This is different from LAT relationships practiced in communities outside CCRCs. LAT in the general community outside the CCRC emphasizes the advantage of enabling a great deal of autonomy and independence along with intimacy and companionship (Karlsson & Borell, 2002). What accounts for differences between LAT in communities outside the CCRC and inside the CCRC might be the interactive effect the environment (Weiss-Gal, 2008) of the CCRC has on the person in an LAT relationship. Perhaps LAT residents feel they have to be together because they are perceived as being in an exclusive friendship. Because they do not reside in the same apartment, the only thing that indicates their relationship as exclusive is spending the majority of their time together. Therefore, they feel the need to constantly demonstrate their relationship. LAT partners in the community outside the CCRC do not have to give an account to an institutional social environment, and thus their lives remain more private than in the CCRC. As such, one of the disadvantages of an LAT relationship within an institutional environment is limited autonomy within the LAT relationship. As a result, being together all the time might become a burden rather than an asset because it restricts human freedom (Kondrat, 2002). However, perhaps LAT residents choose such a sacrifice to maintain a sense of belonging with a shared frame of reference and solidarity within the lived social framework (Ramon, 2001) of the CCRC as a community.

Limitations and implications for practice and research

A PIE approach views reciprocity between LAT residents, residents not in an LAT relationship, and CCRC staff as persons interacting with the CCRC (Weiss-Gal, 2008) as a social environment (Gamliel & Hazan, 2006), and how the two (P-E) co-constitute each other (Kondrat, 2002). Although findings are based on three different perspectives within the environment of the CCRC, we were unable to capture possible differences between CCRCs. A larger study including more CCRCs as units of study could enable such comparisons. We also did not gain the perspective of the children of LAT CCRC residents, although their perspective might be quite influential as well (Koren & Simhi, 2016).

Yet our findings provide CCRC staff within the CCRC with a deeper understanding of what it means for LAT residents to practice their relationship within a CCRC environment. Such an environment believes in spouse sanctification due to widowhood (Bennett et al., 2013; Van Den Hoonaard, 2002) and views repartnering as inappropriate in old age. CCRC staff could intervene at the micro, mezzo, and macro levels. At the micro level, they could assist LAT residents in face-to-face intervention sessions to balance intimacy and autonomy (Karlsson & Borell, 2002). At the mezzo level, group interventions with residents could aim to openly address these common attitudes toward LAT relationships. At the macro level, collective activities within the CCRC such as exposure to movies and lectures on late-life partnerships could promote greater tolerance toward the phenomenon. Theoretically, our findings stress the importance of considering the P-E intersections, by demonstrating the unique features of late-life LAT in the CCRC. Practically, the findings inform both CCRC directors and CCRC staff regarding the unique characteristics of such relationships and point to potential areas of tension due to potential P-E misfit.