June's troubled transition: adjustment to residential care for older adults with dementia

In research on dementia care and housing transitions, only rarely are residents themselves present as active informants. This is a costly omission, inasmuch as manifestations of dementia, perceptions of care settings, and residents' experience of such transitions are both complex and highly variable. In this article, drawn from a larger study of the social organization of care in residential care/assisted living (RC/AL), we develop a detailed, ethnographic narrative that combines first-person reflections by, and observational data on, a single resident--a focal case. The account suggests that for older adults with mild to moderate dementia, awareness of serious impairment among coresidents can be both distressing and stigmatizing. We further argue that assumptions about and attributions of dementia by staff members, compounded by immediate demands of caregiving, may create a self-fulfilling prophecy resulting in residents' resistance and withdrawal. The case also suggests that, to the extent this interactional dynamic is present, distinctive goals in RC/AL, such as enhanced self-determination among residents, are undermined.