Aging with Dignity: Rethinking Mental Health Support in Assisted Living Facilities

Abstract

This dissertation examines how cultural fears of death shape the care provided to older adults in Assisted Living Facilities (ALFs) across the United States. Grounded in Interpretative Phenomenological Analysis (IPA), the study draws on in-depth interviews with seven caregivers working in diverse ALF settings. The study examined how existential anxieties and societal avoidance of mortality subtly shape decisions that privilege safety over mental health and quality of life. The findings revealed five interconnected themes: the invisibility of older adults in daily and medical encounters, cultural and institutional avoidance around death, the tension between autonomy and safety at the end of life, the marginalization of psychological and emotional support, and the impact of systemic pressures and organizational culture on caregiving practices. Together, these themes highlight how unspoken cultural anxieties manifest in policies and daily routines, often limiting opportunities for dignity, meaning, and relational care. The study advances clinical psychology by applying depth psychology concepts, especially Jung and Freud’s insights into unconscious processes, to the lived experiences of caregivers. It highlights the need to address physical safety as well as emotional wellbeing, dignity, and opportunities for meaning in later life. The findings point toward integrative and person centered models of care that recognize mortality without suppressing it and offer a more humane and balanced approach to mental health support in ALFs.