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In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy.
This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer a detailed description of the organizational patterns that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in these settings. The book concludes with concrete suggestions on methods to increase the autonomy of elderly individuals in long-term care institutions.
1. The Meaning of Autonomy in Long-Term Care
2. How Did We Get There? A Brief History of the Nursing Home
3. The Setting and Research Strategies
4. The Value Basis of Long-Term Care
5. Caring and Cared For: Role Relationships in Long-Term Care
7. Activities and Schedules: The Routine of Daily Life
8. Interaction Patterns and Autonomy
9. Privacy: Access to Space and Property
10. Physical Redirection and Restraint
11. Summary and Implications for Long-Term Care