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

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.”