Autonomy in assisted living: Employees\u27 perspectives

This focused ethnography explores how the employees of assisted living give meaning to the term autonomy. Assisted living is a housing option for senior citizens who require some help with personal care activities, but do not require the level of care provided in nursing homes. The philosophy of assisted living is based on the principles of autonomy, independence, and dignity. Autonomy is a complex concept that involves an interaction between two people: one making a choice and another respecting that choice. Because autonomy is relational, the employees who interact with the residents are in a position to enhance or thwart residents\u27 autonomy. There is little research on the employees of assisted living, particularly related to how they understand the concept of autonomy and how they respect residents\u27 autonomy. The purpose of this study is to understand how the employees of assisted living interpret the concept of autonomy. The following data collection methods were used: interviews with 27 staff members at two assisted living settings, observations in public places in the assisted living communities, and interviews with 11 residents at both settings. Five themes emerged: (1) Staff members\u27 perceptions that the mission of assisted living is to maximize physical independence; (2) Staff members\u27 perceptions that their role is to intervene in the residents best interests; (3) Staff members\u27 perceptions of the residents as childlike and their adult children as primary decision-makers; (4) Staff members\u27 perception that they are responsible for ensuring the safety of the residents; and (5) The nature of congregate living arrangements. The analysis of the data suggests that the social structure of assisted living produces tensions that influence the staff\u27s ability to enhance autonomy. Recommendations for ways to address these issues are included, along with suggestions for future research.