Editorial Reviews. From Publishers Weekly. The authors—researchers and academics with the Center for Aging Studies at the Erickson School and with the .
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Several years ago, one of the floors of the most recent wing was a locked dementia floor and this floor continues to be negatively regarded. The floor appears to retain this negative cachet from the time it was a locked DCU, despite the fact that residents of varying cognitive abilities are mixed together on both the upper floors of the wing.
There seems to be residual stigma ascribed to this floor because of its past as a locked DCU. Stigma was attached to other areas in the medical care unit. Many residents preferred to sit near the central nurses' stations. Yet, we note that the built environment at Stonemont appears to lessen the power of stigma as it is attached to place. While the nature of stigma in this site built by accretion appears to be less focused on a particular place than in The Riverside, a purpose-built environment, socio-cultural factors may work to mitigate othering and must be considered in any discussion of stigma.
Stonemont is embedded within an affinity community where the culture of mutual support encourages relationships among the generations. Clearly, for purposes of anonymity, we cannot disclose the specific affinity group here. Residents who share affiliation with the affinity group share values and experiences passed along within families.
These values may also be shared with people who have been indirectly associated with the group through kinship with a member. Stonemont is adjacent to the headquarters of the affinity organization that, for nearly a century, has hosted events for affinity clubs from around the region.
Local clubs associated with the group regularly visit the home. Families attend these traditional events and volunteer their time with Bingo and other activities, even though they may not be related to residents. Many of the residents we met visited Stonemont throughout their lives. This association over the life course influences many of the people who choose to live in the home and may serve to mute any tendency to other co-residents. During interviews several residents mentioned that they came to the home as children or young adults to visit the elders living there.
James jumped right in to tell me how she and her husband had selected [Stonemont]. Her father was a [member of the group] and her sister had moved in about three years before they did. She knew the place well before she and her husband decided to move there. Residents who share a common culture and intergenerational contact with the home may have formed a bond that lessens or diffuses the stigma we have seen at more recently built sites that lack the longevity and cultural connectivity of Stonemont. But not all residents have a strong association with the affinity group.
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Because various kin of members are eligible, some residents are not themselves members of the affinity group and may be excluded and shunned. One of the administrators explained the social dynamic:. While it appears that stigma exists at Stonemont, we suggest it is stronger in the form of attachment to an individual, rather than to a specific space.
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In one case, a resident was shunned for his lack of membership in the affinity group. The director told us about Stanley, whose son was a high-ranking member, but who himself had never joined. Stanley was from a different part of the country and had a distinct regional accent. At Stonemont, Stanley became stigmatized by others. Several residents and staff commented on Stanley's differences from the other men.
It appears that Stanley has internalized this stigma, as evidenced by his apparent low self-esteem. He would not agree to a recorded interview. In fieldnotes, an ethnographer described one of her interactions with him:. Not only did Stanley not belong to the affinity group but he also did not follow its fixed gender roles and social norms. Instead of socializing primarily with men, Stanley flirted with women. The staff was aware of the situation. The Executive Director explained in her interview how his behavior is inappropriate:.
So there have been complaints because he is not [a member of the affinity group] he doesn't understand how he is supposed to behave…Many of them tie it back to being [a member]… they aren't going to include them because …you're not [a member] and you don't know what it's all about. They said they had nothing in common with him. Stanley's case shows how, in this affinity-based setting, individual differences can lead to stigmatizing behavior.
Although residents at Stonemont are grouped by care levels, the barriers to interaction between residents are not as evident as at The Riverside. Unlike the single link that connects the buildings at The Riverside, there are multiple intersections between care levels at Stonemont. These intersections reduce physical separations between residents of varying care levels.
We suggest that the presence of shared spaces, or social ecotones, may diffuse stigmatizing behavior.
Understanding Assisted Living | The Gerontologist | Oxford Academic
Whether driven by the way the spaces are designed or by social factors, for example corporate policy, Stonemont appears to be more socially integrated than The Riverside. The medical unit at Stonemont has its own activities calendar, but IL and AL, including AL in the terrace of the new wing, share a calendar. The stigma observed at Stonemont seemed more directed at individuals rather than a particular place.
There were social cliques and exclusionary behavior, as we have found in most of the settings we have studied, but these did not seem to have the focus on place that was observed in The Riverside Dobbs, et al. In Environment and Aging Theory , M. The external situation of increasing levels of care and dependence as manifested in the built environment is internalized in the anticipated loss of control that threatens the imagined future self. Fear and avoidance of that place and those people may become embedded in the culture of the setting.
There are many factors that can mitigate or aggravate stigma. Each setting we have studied has unique issues associated with collective living.
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Most residents expect to age-in place, that is, die in the setting. Many residents share cohort memories and values of past times. Why, then, is there a profound and disturbing distancing from housemates who exhibit signs of decline? When The Riverside was built, its founders envisioned a lovely setting where older adults could transition smoothly from one care level to the next. But in its second decade, the fear and avoidance of the AL building by IL residents negatively influences perceptions of residents who live in Al, and this fear prohibits social interactions.
Friends who move from IL to AL are often forgotten: The belief that the move into The Riverside's independent apartment would be the last move, from the perspective of the resident, has been proven false. Stonemont may not be as efficient as The Riverside, with its warren of hallways and mixed levels of care, however the interaction that is promoted by the prevalence of social ecotones in shared spaces and shared activities appears to diffuse the stigma that is associated with age-related decline.
Further study is needed to understand how social ecotones in the built environment may promote relationships between groups that would not otherwise interact and in turn, mitigate stigma. In all the sites in which we have conducted fieldwork for the larger study, we have observed instances when stigmatizing behavior appeared to negatively impact the health of residents. We have seen residents hide evidence of falls, and family members go to great lengths to delay a loved-one's move to higher care levels.
We have heard many voices in every site we've studied describe the hurtful effects of exclusion and shunning. This paper described the stigmatizing behavior we observed in two unique sites and how the culture of the places reflects the built environment; how meaning can be attached to physical space.
As we prepare for the increasing number of older adults over the coming years, it is important to consider what we have learned about purpose-built senior housing and how space frames culture and culture reflects space. Understanding how stigma manifests in various physical environments may lead to changes that improve the lives of current and future residents in collective living settings.
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Five of the co-authors on this paper contributed to the fieldwork: Their insights, and those of the other team members, shaped the discussion of stigma in the built environment and broader issues relating to senior housing. All sites and data discussed in this paper have been de-identified to protect anonymity. National Center for Biotechnology Information , U. Author manuscript; available in PMC Sep 9. See other articles in PMC that cite the published article. Abstract This paper focuses on stigma in collective living environments for older adults, specifically multi-level campuses.
Introduction Over the past two decades, the US has seen growth in the number and complexity of housing settings for the elderly. Stigma and the Built Enviroment Stigma may be defined as the assignment of negative worth and social distancing on the basis of group or individual characteristics.
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The Study upon which this Paper is Based This paper derives from ethnographic data collected over the course of a five-year study Stigma and the Cultural Context of Residential Settings. One ethnographer described the stigma she observed: An excerpt from an interview with an IL resident demonstrated the stigma attached to the loss of cognitive ability and aimed at AL: Again the phenomenon of othering and the desire to distance oneself from devalued housemates were documented by the ethnographers: Medical Nonfiction Details Publisher: Johns Hopkins University Press.
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If you're still having trouble, follow these steps to sign in. Add a library card to your account to borrow titles, place holds, and add titles to your wish list. Add it now to start borrowing from the collection. The library card you previously added can't be used to complete this action. Assisted living is the fastest-growing alternative to skilled nursing care for frail older persons in the United States. The expectations, settings, and missions of these residences are varied, making it difficult for prospective residents and their families to anticipate what it would be like to live in them.
This book is a unique portal into the real world of assisted living and the key issues facing consumers, providers, and policy makers.
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Drawing on in-depth interviews with residents, their family members, staffers, and administrators, Inside Assisted Living opens the window on day-to-day life in six different types of assisted living residence. Sidney at Laurel Ridge," the detailed profiles of individuals show the commonalities among the residences while highlighting the positive and negative aspects of each.
The voices of those living, visiting, and working in the homes clarify the important local social relations, staff dynamics, leadership and national funding, regulation, aging-in-place challenges presented by assisted living. Introductory and concluding chapters synthesize new findings that cross the six settings and reflect issues vital to all participants.
The book also features an appendix detailing the research process involved in creating the profiles.