Structure Matters: Living and Working with Dementia in Skilled Nursing Facilities

• In Event: 1483 - Open Refereed Roundtable Session
  In Refereed Roundtable 100min: Table 02. Social Contexts of Aging, Health, and Dying

Abstract

Alzheimer’s disease (AD) is one of the pressing and distressing medical issues facing society today. Yet biomedical hegemony continues to marginalize the social and political aspects of illness. Our research explored the relationships between residents with Alzheimer’s and staff members to understand the structural dynamics shaping quality of care and subjective experiences. Drawing on facility health inspection data and a survey with staff members (N= 56), data revealed several health-related consequences exacerbated by structural problems resulting from competing goals of business and social models of care. Staff reported that organizational obstacles such as low perceived staff appreciation, a perceived lack of fair wages, compassion fatigue, and a lack of support increased their stress levels and disengagement with residents. To triangulate, we also conducted over 300 hours of participant observation in a specialized care unit for people with Alzheimer’s. The observational data support findings from surveys and highlight new themes. Data suggest that the institutional logic of the facility, based in a business model of care, perpetuates unequal dynamics of power among staff members, may threaten the quality of care for people with AD themselves, and serves as a barrier to meaningful interactions between staff members and staff and residents alike. As much social progress as has been made in the improving skilled nursing facilities, the "Iron Cage" of bureaucracy creates a path dependency of paternalism that is especially persistent when it comes to dementia care.

Authors

• Brittney Pond, College of the Holy Cross

• Renee Lynn Beard, College of the Holy Cross