(June 2025) Moving into a nursing home is often met with hesitation — not just from older adults themselves, but also from their families. Yet new research suggests that the experience may be more positive than many expect.

In a study published in the American Journal of Epidemiology, researchers Anne Laferrère and Jérôme Schoenmaeckers from Université Paris Dauphine-PSL, HEC-Liège, and Université de Liège set out to investigate whether Europeans really do feel better at home than in a nursing home.

They used data from over 20,000 older adults across 15 European countries who participated at some point in Waves 4 to 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Everyone in the study was aged 65 or older and had at least one limitation in their ability to carry out everyday tasks like dressing, bathing or walking. Life satisfaction was measured on a scale from 0 (completely dissatisfied) to 10 (completely satisfied).

A misleading first glance

At first, the answer seemed obvious: those living in nursing homes indeed reported lower life satisfaction than those living in the community.

Once the researchers took into account economic situation, health and disability level, the negative association became non-significant. In fact, functional status – i.e. how well someone can get around and care for themselves – seemed to explain most of the difference in life satisfaction between nursing and private homes.

Taking selection into account

A major challenge in this kind of research is selection bias. People who move into nursing homes often differ from those who don’t - in both measurable and hard to measure ways.  For example, above a certain level of disability, it becomes difficult to stay at home. And maybe they have less family support. Maybe there were already less happy.

To dig deeper, the authors used more sophisticated methods to mimic a “fair comparison.” When they matched individuals with similar health, family situations, and finances — one in a nursing home and one at home — they found that nursing home residents were still slightly less satisfied with life overall.

Following individuals over time tells a different story

Using SHARE’s unique longitudinal design, where respondents are interviewed every two years, the authors were able to track the same people before and after they moved into a nursing home. This allowed them to compare each person with themselves over time.

Despite the emotional difficulty of leaving their homes, many of the older adults interviewed by SHARE actually felt better after the move. Why? Likely because nursing homes offer stability, access to care, and relief from the burdens of everyday living – particularly for those with declining health.

But not everyone is equally satisfied

Of course, not everyone benefits equally. The study found that:

• Women were more likely to report improved well-being in a nursing home than men. Women have higher life expectancy than men, and their extra years of life are for most accompanied by disability. Women also tend to marry men who are older than them. Hence men are more likely to benefit from their spouse’s care at home than women. Nursing homes may also offer them relief from domestic responsibilities and a renewed social life.
• Single people and those without children saw greater improvements — potentially because institutional care helped replace the informal support they lacked.

Don’t forget institutional quality

The study didn’t directly measure the quality of nursing homes themselves — but this factor is certain to play a role. Countries differ in how care is funded, regulated, staffed and delivered. In places where institutional care is more professionalised, well-resourced, and socially integrated, residents may fare better. This is an important area for future research.

What this means for policy

This research doesn’t suggest we should push people into nursing homes or rush to build more. But it does challenge the common narrative that nursing homes represent the least desirable option. For many people, life in a nursing home has the potential to increase well-being, especially when health and mobility decline.

As the population ages, policymakers face tough questions: Should we invest more in adapting private homes? Or expand access to well-designed nursing homes? According to the authors, the best answer is probably: both.

People deserve real choices as they age, and the support to make whichever choice best fits their needs.

Final thoughts

So, do Europeans really feel better at home than in a nursing home?

The answer is nuanced. It turns out that the best place to grow old might not always be the one we think we want, but the one that actually meets our needs.

Study by Anne Laferrère, Jérôme Schoenmaeckers, Do Europeans really feel better at home than in a nursing home?, American Journal of Epidemiology, 2025;, kwaf041, DOI: 10.1093/aje/kwaf041

URL: https://doi.org/10.1093/aje/kwaf041

Picture: © Adobe Stock / Halfpoint