The Erosion of Autonomy in Long-Term Care Book

1	The Meaning of Autonomy in Long-Term Care	3
	Different Concepts of Autonomy	7
	Autonomy, Privacy, and Liberty	16
	Conclusion	19
2	How Did We Get Here? A Brief History of the Nursing Home	22
	The Colonial Period	23
	The Rise of Institutions	25
	The Jacksonian Approach	26
	The Early Twentieth Century	29
	Social Security and the Advent of Proprietary Homes	29
	The Emerging Medical Model	31
	The Growth of Regulation	33
	The Regulatory Criteria at the Time of This Study	35
	Conclusion	37
3	The Research Setting and Strategies	40
	The Research Setting	40
	Research Strategy - The Use of Participant Observational
	Techniques	45
	Nonethnographic Data Collection	49
	Informed Consent	51
	Analysis	52
	Conclusion	54
4	The Value Basis of Long-Term Care	57
	Positive Staff Evaluations	58
	Negative Staff Evaluations	61
	Family Values	64
	Residence Staff Values	65
	Conclusion	68
5	Caring and Cared-for: Role Relationships in Long-Term Care	69
	The Role Relationships of Patient and Physician	70
	Role Relationships in Intermediate and Skilled Care	71
	Family Roles	79
	Role Relationships in the Residence	82
	Conclusion	86
6	Restrictions	87
	Preserving the Body	89
	Compliance with Fiscal Policies	100
	Maintenance of Institutional Routines	104
	Conclusion	111
7	Activities and Schedules: The Routine of Daily Life	112
	Temporal Autonomy	112
	Schedules of Care	113
	Scheduled Breaks in the Routine - Weekly Activities	118
	Residence Routines and Schedules	121
	Conclusion	123
8	Interaction Patterns and Autonomy	124
	Staff-Patient Interaction Patterns	125
	Staff-Resident Interactions	132
	Patient/Patient Interactions	133
	Conclusion	139
9	Privacy: Access to Space and Property	141
	Spatial Rights	142
	Privacy of Possessions	148
	Information Privacy	149
	Bodily Privacy	149
	Residential Units	151
	Conclusion	154
10	Physical Redirection and Restraint	155
	Physical Redirection	156
	Restraints	159
	Conclusion	166
11	Summary and Implications for Long-Term Care	168
	Life on the Nursing Side - A "Total Institution"?	168
	The Impact of Nursing Homes on Autonomy	172
	Autonomy and Demented Patients	175
	The OBRA Regulations: A Regulatory Solution?	177
	Applying the Lessons of Residential Area to the Nursing Home	179
	References	183
	Index	187