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An Ethnographic Study of Stigma and Ageism in Residential Care or Assisted Living

Correspondence: Address correspondence to Debra Dobbs, PhD, Assistant Professor, School of Aging Studies, University of South Florida, 4202 E. Fowler Ave., MHC #1325, Tampa, FL 33620. E-mail: ddobbs{at}cas.usf.edu

Purpose: This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC–AL) communities and what these settings have done to address stigma. Design and Methods: We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family and staff) from six RC–AL settings in Maryland. We entered the transcript data into Atlas.ti 5.0. We analyzed the data by using grounded theory techniques for emergent themes.  Results: Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Implications: Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff recognition of resident preferences and strengths, rather than their limitations.

Key Words: Dementia • Long-term-care environments • Residential care settings • Stigmatization