Writing this book has taken me full circle. Almost twenty years ago I was a young social work student working in a state school for the mentally retarded. The facility itself was seen as a model institution, attracting many bright graduate students, innovative psychologists, and community volunteers. One unit, however, was left untouched by the otherwise creative staff. That unit housed the oldest residents. The lack of attention given to these residents and to many of the older mentally retarded adults whom I trained for "community living" sent me to graduate school to specialize in the new field of gerontology. The years since have provided me the opportunity to work with older adults in nursing homes, residential settings, and senior centers and as case-management clients.
My early experiences with deinstitutionalization of the mentally impaired -- lack of funding for staff training, inadequate follow-up, and visits to fearful residents in community placements -- have been well documented in recent years. The current trends in community alternatives for the elderly -- a deinstitutionalization from nursing homes -- have yet to attract the same attention. Yet, the potential for less than adequate care seems just as great in these settings, which often house both the mentally impaired and the aged. Alas, I find myself, years later, asking many of the same questions that came to me as a young student.
This book has thus grown from a long interest in the public choices made about the care of those individuals who depend on others for the basic needs of daily life. Along the way, a few individuals have been beacons of light-- illuminating the search for answers, challenging me with even harder questions, and setting standards for research that I still strive to attain. First and foremost, I want to thank Cora Martin, who encouraged me to pursue my academic interests and fostered my curiosity in the subject of aging. She, along with Hiram Friedsam and Marvin Ernst, through their fine scholarship and teaching, provided inval-