Exchange and power in special settings for the aged

Goffman's model of institutional totality was examined within a social-exchange framework in the boarding and nursing units of two homes for the aged. The power-dependence relationships appeared to be determined by the residents' social resources -- all the assets that enabled them to reward a favor, extort a concession, or do without -- and by the conditions of patienthood that limited their use. Boarders were equally responsive to peer and staff expectations while patients, lacking a cohesive peer group, were more confirming to the demands of staff members, who controlled most of the system's rewards in the nursing units. Efforts to humanize these late-life settings seem unlikely to succeed unless they take into account staff's ability to structure the conditions of negotiation as a base of its power.