The Value of Independence in Old Age

Why is independence a central theme for proponents of assisted living facilities? How do assisted living providers respond to this theme? These questions are pursued in an ethnographic study centered on Oregon's assisted living program. Assisted living facilities (ALF), defined and monitored by Oregon's Senior and Disabled Services Division (SDSD), are a type of housing for disabled, primarily elderly, persons. Oregon Administrative Rules (OAR-411-56) define independence, requiring ALF providers to support resident independence. Using social worlds theory as a sensitizing concept, assisted living is treated as a distinct social world. The activities of key groups, including SDSD staff, an ALF professional group, and assisted living managers, are described. These members commit to a “social model” approach to long-term care for which independence is the unifying construct. This approach offers a value-practice “package” that explains how to implement the value of independence (Fujimura, 1997). Three arenas where this package is apparent are described: marketing, manager training, and daily operations. Content analysis of marketing brochures from 63 assisted living facilities shows that independence is a dominant theme, promoted like any other product. These materials indicate that assisted living operators promote resident independence by providing a barrier-free environment, helping residents with daily tasks, and allowing residents control over their decisions. Manager training programs are another arena where the policy value of independence is evident. Here, new managers learn “who we are” and “what we do” in this social world. They learn a new vocabulary and are introduced to tools for daily practice. They learn the boundaries of this social world, and above all, how to behave differently from nursing facilities that they associate with the “medical model.” In daily practice, managers use institutional conventions, including the “negotiated service agreement” and "managed risk agreement." These tools are designed to respond to the tension between supporting independence and providing care to chronically ill, disabled individuals. Observations of marketing, management training, and resident assessments indicate that the social world of assisted living is in a formative stage, as members attempt to define and legitimate who they are and what they do.