Residential Care for the Elderly: Critical Issues in Public Policy

By Sharon A. Baggette | Go to book overview

any facility, operated for profit or otherwise, which accommodates or is designed to accommodate two or more adults unrelated to the owner or operator and which provides room and board on a 24-hour basis to primarily non-transient aged . . . persons who require some personal care, supervision, or assistance in daily activities such as bathing, dressing, or the taking of medicine prescribed for self-administration. ( Temple University, 1977, p. 3)

Unless otherwise specified in the following analysis (as in chapters 5 and 6), the term residential care is used generically to cover the range of options described above and will be used interchangeably with the term sheltered (or extrasheltered) housing, which is the term most often used in the literature of Western Europe.


RESEARCH FOCUS

Residential care is growing rapidly as a form of housing and service provision for older adults. The research reported here takes as its premise that RCFs have developed and now deliver a wide array of services in a policy environment of confusion and conflicting directions. The initial chapter describes several policy positions, summarizes the research approaches utilized, and reviews the belief systems that form the background for research in housing and care for older people. The regulatory context in which RCFs operate and the changes in the long-term care system as a whole have contributed to confusion about the appropriate design and use of RCFs. Since RCFs lack a clear role as housing and/ or care, a state of indefiniteness exists, in which policy develops without a distinct aim. Residential care policy is thus defined by historical and cultural influences in social policy development and in the regulation of long-term care, specifically for nursing homes. These influences have played a large role in the growing regulatory environment for residential care. Both the realities of the industry and the residents it serves, however, may call for a more creative response -- one based on current knowledge and experience rather than on preestablished routines for regulation in housing and health care for the elderly.

In particular, this book examines the characteristics of elderly RCF residents and reviews these through the lens of current state and federal regulations concerning the type of care provided in these facilities. The hypothesis is that the lack of knowledge regarding the characteristics of older persons who choose RCF care promotes facility design and regulations for living environments in which inappropriate care and oversight may be given. That is, there may be a mismatch between the stated purpose of facilities and regulations, on the one hand, and the clients who must be served, on the other.

Within this framework, the policy analysis of residential care consists of two distinct research tasks. The first includes an analysis of both the factors that contribute to the growth of residential care and also the current federal and state policies that define the character of residential alternatives. This review provides

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