THE SOCIAL DYNAMICS OF ELDER CARE: RITUALS OF BUREAUCRACY AND PHYSICAL NEGLECT IN NURSING HOMES

Abstract

This research concerns nursing home rituals involving bureaucracy and physical neglect. It uses 40 ethnographies, biographies, and autobiographies to explore various symbolic themes expressed through everyday interaction in nursing homes. The themes involve bureaucratic concepts such as staff separation, rules, documentation, and efficiency. They also involve ideas of physical neglect, such as medical dereliction, personal negligence, environmental negligence, and bodily harm. Relying on structural ritualization theory, this work argues ritualized symbolic practices of bureaucracy unintentionally manufacture attitudes and acts of mercilessness for workers in both for-profit and nonprofit nursing homes. This aids in the development of rituals facilitating the physical maltreatment of residents.

Notes

¹The goal of this research was not to focus on quantitative measures of facility size and location. Regardless, when analyzing our literary sources, we noticed some discussed these variables, while others did not. Many of the authors for our sources used qualitative methodologies that sought to achieve anonymity for people involved with the nursing homes they studied. However, we believe many decided not to disclose information on facility size and location to ensure anonymity for the institutions as well. Other studies exist focusing on variables of facility size, location, and quality of care (see Holmberg and Anderson 1968; Winn 1974; Gottesman 1974; Hawes and Phillips 1986).

²This includes the development of aggression in ancient civilizations (Knottnerus and Berry 2002), hierarchal distinctions on plantations (Knottnerus 1999), social identity for immigrants (Guan and Knottnerus 1999; Knottnerus and LoConto 2003; Guan and Knottnerus 2006), and educational issues (Knottnerus and Van de Poel-Knottnerus 1999; Van de Poel-Knottnerus and Knottnerus 2002; Wu and Knottnerus 2005). Other social issues SRT examines include corporate crime (Ulsperger and Knottnerus 2006; Knottnerus, Ulsperger, Cummins, and Osteen 2006), social inequality (Varner and Knottnerus 2002; Mitra and Knottnerus 2004), and natural disaster responses (Thornburg, Knottnerus, and Webb 2007). It also explores interaction in experimental task groups and deritualization (Sell, Knottnerus, Ellison, and Mundt 2000; Knottnerus 2002, 2005).

³It is coincidence that the 40 sources ended up divided evenly based on ownership.

⁴In this study, the comparison of numbers in for-profit and nonprofit categories is purely for qualitative, descriptive purposes. With literary sources being of different length in each ownership category, frequencies used in this research do not warrant quantitative analysis with inferential statistics. Moreover, we do not intend this work to be generalizable to all nursing homes. We see it only as a reflection of the facilities analyzed in the sources used (for more on this issue see Berg 2007).