The 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.
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