Assisted living (AL) has become one of the most sought after residential settings for the elderly. The question of how autonomy, a core American cultural value, is defined, experienced, produced, maintained or thwarted in assisted living is a critical one. We seek to determine the forces that create, insure, or deprive residents of autonomy, both in the AL setting as a whole and at the level of the individual. The meaning of autonomy to individuals and how this might be gradually relinquished or alternatively claimed are important elements we hope to explore. Thus the general goal of this 4-year proposed study is to examine the cultural construction, meanings, and situational contexts of autonomy in residential care for the aged. Further, we see autonomy itself as a culturally situated construct, supporting distinctive manifestations as """"""""independence,"""""""" """"""""choice,"""""""" """"""""control,"""""""" and """"""""say-so."""""""" Specifically, and based on prior work, we view """"""""autonomy"""""""" as a practice negotiated between facility factors and individual biographies, with profound implications for quality of life and health in long-term care settings. We view autonomy as a personal characteristic, something that is defined and determined by each individual, but is certainly influenced by other factors, such as family relationships and facility culture and rules. In addition, a key aspect of the proposed research will be to examine distinctive constructions of autonomy among AL settings. The proposed research has three specific aims: 1) To examine the meaning and context for autonomy as these are worked out in six distinctive assisted living settings;2) To better understand the on-the-ground process of negotiating autonomy in these settings;3) To examine in detail, and based on prior research, resident autonomy in relation to the six emergent themes of autonomy that provide the conceptual framework for this research. The proposed research will ethnographically examine in six settings, the meaning and context, and the negotiation of autonomy, through periods of sequential field work combining participant observation and key informant interviewing.

Public Health Relevance

Researchers have demonstrated that older adults'sense of autonomy - expressed as independence, choice or control - is integral to their health and well-being. This study examines how autonomy, a core American value, is defined, experienced, produced, maintained or thwarted in assisted living (AL), one of the most sought after residential settings for older adults. The proposed research will help inform policy and practice on how AL can provide an environment resulting in a better quality of life for the increasing number of adults living longer and moving into long-term care.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Community Influences on Health Behavior (CIHB)
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Nielsen, Lisbeth
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University of Maryland Balt CO Campus
Social Sciences
Schools of Arts and Sciences
United States
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Bennett, Colleen R; Frankowski, Ann Christine; Rubinstein, Robert L et al. (2017) Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living. Gerontologist 57:252-260
Morgan, Leslie A; Perez, Rosa; Frankowski, Ann Christine et al. (2016) Mental Illness in Assisted Living: Challenges for Quality of Life and Care. J Hous Elderly 30:185-198
Morgan, Leslie A; Rubinstein, Robert L; Frankowski, Ann Christine et al. (2014) The facade of stability in assisted living. J Gerontol B Psychol Sci Soc Sci 69:431-41