The social world of assisted living |
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| Affiliation: | 1. Population Research Unit, Department of Social Research, University of Helsinki, Finland;2. National Institute for Health and Welfare, Helsinki, Finland;3. Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Sweden;4. Max Planck Institute for Demographic Research, Germany;5. Department of Sociology, Stockholm University, Sweden;1. Department of Medicine, Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQUEST), Michael E. DeBakey VA Medical Center, Houston, Texas;2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas;3. Department of Medicine, Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington;4. Department of Medicine, University of Washington School of Medicine, Seattle, Washington;5. Department of Medicine, Center for Translational Research on Inflammatory Diseases, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas;6. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida;1. SOIE, Institut Supérieur de Gestion de Tunis, Université de Tunis, Tunisia;2. LASPI, L''Institut Universitaire de Technologie de Saint-Etienne, Université Jean-Monnet, France |
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| Abstract: | This study defines assisted living as a unique social world and is based on a 22-month ethnography in three facilities and completion of the program required of certified assisted living facility (ALF) managers in Oregon. The focus was on how daily operations are affected by central values (i.e., independence, choice, privacy) defined by Oregon Administrative Rules (OAR). In their efforts to legitimize this newly constructed social world, proponents and providers have developed a package consisting of a unique vocabulary and two organizational practices, the Negotiated Service Agreement (NSA) and Managed Risk Agreement (MRA). This package is integral to the maintenance of this social world, providing the means for defining and defending assisted living. These organizational tools offer a contemporary perspective on the rights of chronically ill and disabled seniors to make choices about their health care, even choices that might be defined as risky by medical professionals. |
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