Reinventing Care

David Barton Smith

Description

TThe recent growth of "assisted living" facilities and programs has shaken the foundations of the system of long-term care for the elderly in the United States. Fueled by consumer frustrations with the available options, notably nursing homes, the assisted living model emerged during the 1990s to promise shelter, health care, control of one's own life, less government involvement, and a "real home." But how well have the advocates and developers of assisted living delivered on such promises? And what are the model's implications for public policy and the future of caregiving?

In Reinventing Care, David Barton Smith offers brilliant insights into those questions by examining the realities of assisted living in New York City. Encompassing the largest, most concentrated population of elderly in the United States, New York spends more per person caring for its seniors than any other urban center. Yet, while the size of the city's care system boggles the mind, it nevertheless contains the same elements that exist in other metropolitan areas and thus provides valuable lessons for the nation as a whole.

Smith's study draws on twenty-five years of research, including hundreds of interviews and visits to representative facilities. He provides a succinct overview of how care is presently organized for New York's aging population and traces the history of the system up to the present. Among the key issues he addresses are the role of market forces and government regulation, the impact of class differences on access to quality care, and the ways in which perceptions of community affect the creation and management of assisted living programs. At the heart of the book are ten fascinating case studies, half of them focused on private-pay facilities and the other half on public-pay institutions.

While finding that the actualities of assisted living rarely match the rhetoric of its proponents, Smith sees much to admire in its goals. He suggests tactics and strategies--such as promoting family- and community-based models of assisted living and adopting a standard of licensure for certain facilities--that could point the way to a better future.

Sujets

• Caregiving
• Allied Health Services
• Medical
• Médecine
• Caregiver
• Index of urban studies articles
• Health

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 01 avril 2003
• Nombre de lectures: 0
• EAN13: 9780826591708
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

ReinventingCare

AssIsTed LIVIng In New YORk CITy D A v i D B A r t o N S m i t h

Reinventing Care

© 2003 Vanderbilt University Press

All rights reserved

First Edition 2003

This book is printed on acid-free paper.

Manufactured in the United States of America

Library of Congress Cataloging-in-Publication Data

Smith, David Barton. Reinventing care : assisted living in New York City / David Barton Smith. 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 0-8265-1428-6 (cloth : alk. paper) ISBN 0-8265-1429-4 (paper : alk. paper) 1. AgedLong-term careNew York (State)New York. [DNLM: 1. Assisted Living FacilitiesAgedNew York City. 2. Long-Term CareAgedNew York City. 3. Health Services for the Agedorganization & administrationNew York City. WT 27 AN7 S645r 2003] I. Title. RA564.8.S63 2003

362.16097471dc21

2003002248

Reinventing Care

Assisted Living

in New York City

David Barton Smith

VA N D E R B I LT U N I V E R S I T Y P R E S S

N A S H V I L L E

To my parents, Nancy and Henry, to their struggle to maintain control over their lives, and to my siblings Barbara and Woollcott who have fought for them.

Contents

1 2 3

4 5 6

7

Preface

ix

Part I Inventing Care

Growing Old in a City 3 A Brief History of Care 28 Emergence of the Killer Application

Part II The Struggle for Control over Markets and Lives

58

Markets, Margin, and Mission 83 Market-Driven Private-Pay Assisted Living Publicly Supported Assisted Living 134

Part III Reinventing Care A Future for Care 165

Epilogue

Bibliography

Index

187

199

191

98

Preface

The long-term care system frustrates the frail elderly who want to control their lives. It also frustrates those who struggle to finance, regulate, and provide their care. This book attempts to make sense of the dramatic changes in such care. It raises troubling questions about where we are headed. The book focuses on the evolving system of care in urban America that serves more than three quarters of the nations elderly (Eberhardt et al. 2001, 9293). I use the New York metropolitan area to illustrate that system of care. New York City is an ideal laboratory for exploring the alternative futures of long-term care. There are an infinite variety of ways to care for the elderly in New York City. The city encompasses the largest, most concentrated population of elderly in the world. It spends more per person caring for its elderly than any other urban area. The almost one million elderly within its borders encompass the extremes of wealth and poverty. They include the residents enjoying the amenities of $10 million penthouses overlooking Central Park and those struggling just to survive in public housing units in the South Bronx. New York is the ideological capital of the worlds free market. Yet many of its residents are profoundly skeptical of the ability of the market to care for the citys own elderly residents. The city has created the largest public hospital and housing system in the country and the largest concentration of voluntary philanthropic endeavors and cooperative housing arrange- ments in the world. Extremes provide a way of clarifying issues about how to organize care. In New York City the extremes thrive side by side. It is the major battleground where individualistic market ideology now vies with communitarian instincts to reinvent care. Long-term care is indeed changing in the United States. The median age of nursing homes, which encompass more than 1.8 million beds, is over twenty years (Gabrel 2000, 2). Many can no longer accommodate

ix