Residential Care: Conceptual Development
Residential care, in its development as a form of housing and/or service provision for elderly persons, has been caught in a peculiar bind. On the one hand, the framers of policy have tried to retain the noninstitutional character of such residential alternatives. On the other, evidence of abuse (for example, lack of necessary medical care, exploitation, physical abuse) in these facilities and the level of frailty of many residents require that regulations be implemented to assure the quality of care provided. Trying to accomplish these often contradictory goals has left a confusing state, within which the potential for inadequate care is great.
Contributing to this bind is the lack of a clear definition of the role of residential care or other forms of assisted living. The purpose of assisted living may be viewed as twofold. It may provide housing for individuals needing a supervised living situation, in which minimal assistance is provided. Alternatively, sheltered or assisted housing may be a form of care provision itself, in which more extensive medical and personal care assistance is available. Assisted living brings into focus the sometimes conflicting priorities of the social services, housing experts, and health care providers whose emphases in residential care may vary.
In long-term care for the elderly, the roots of the dichotomy between housing and care are similar to the conflicts between the medical and social models of care. The biological and biomedical models of aging have contributed to the perception of old age as an individual problem (physiological decline with chronological age). Aging is thus seen as independent of social structure and as largely a medical problem. This view does not, however, take into account social