Nursing Home Ethnography

Advanced Seminar

October 29–November 2, 1995

Nearly two million people in the United State—5 percent of the over-65 population—now live in nursing homes, and the “mom and pop” old-age homes of fifty years ago have evolved into a $40-billion industry. Ten scholars, all of whom have conducted ethnographic research in nursing homes, gathered at the School in the fall of 1995 to develop a cultural model of the nursing home institution. The advanced seminar was the first such gathering of anthropological scholars in this relatively new ethnographic territory.

The participants collectively generated a holistic cultural model of the nursing home. “We analyzed not only the cultural space but the social processes that undergird that space and provide meaning for the daily activities that take place there,” said chair Philip B. Stafford of Bloomington (Indiana) Hospital. Seminar papers described both small and large-scale anthropological projects that addressed such elements of the nursing home environment as nursing practices, care giving, family roles, food, personal possessions, and patient coping mechanisms. They ranged from a macro-level focus on the place of the nursing home within modern and postmodern culture to a micro-level focus on the body of the prospective “patient” as viewed by those who may place it within the institution.

Central to the week’s discussions was the question of whether the nursing home is a medical or a domestic environment: Is it hospital, or is it home? The model developed by seminar participants looks at the nursing home as a contested cultural domain in which the daily life of occupants and employees is pervaded by this ongoing “turf war.” An example is the conflict arising from differing interpretations of food, addressed in Joel Savishinsky’s paper. According to the hospital model, food is regarded as diet and nutrition. In the home model, food is expected to taste good and promote sociability. “Sensitizing people to these inherent ambiguities enables them to step back and reinterpret situations,” notes Stafford. “In addition, a third domain of meaning—the domain of money-making—overlaps the scheme and provides an interpretive framework for administrative and regulatory agents whose physical presence may be missing but who, nevertheless, wield power.”

“This was a rare opportunity for individual scholars to receive critical feedback and also to pursue a collective task: a more unified understanding of the institution of the nursing home,” Stafford said. “As anthropologists in urban settings, we are particularly conscious of the practical implications of our work and the need to address policy issues. The model we developed while at SAR sets the stage for the more important work to follow: that of employing anthropological understanding to effect change in the institution itself.”

Philip B. Stafford, Chair Senior Health Services, Bloomington, IN, Hospital Homebodies: Voices of Place in an American Community
Jaber Gubrium Department of Sociology, University of Florida The Nursing Home as a Discursive Anchor for the Body
Haim Hazam Department of Sociology and Anthropology, Tel Aviv University The Home over the Hill: Towards Modern Cosmology of Institutionalization
J. Neil Henderson Suncoast Gerontology Center, University of South Florida Dementia Specific Care Units and Soteria: A Cultural Analysis
Jeanie Kayser-Jones Department of Physiological Nursing and Medical Anthropology Program, University of California at San Francisco The Treatment of Acute Illness in Nursing Homes: The Cultural Context of Decision-making
Margaret A. Perkinson Polisher Research Institute, Philadelphia Geriatric Center Defining Family Roles within a Nursing Home Setting
Graham D. Rowles Sanders-Brown Center on Aging, University of Kentucky Family Involvement in Nursing Home Decision-making
Joel S. Savishinsky Department of Anthropology, Ithaca College 'Bread and Butter' Issues: Food, Conflict, and Control in a Nursing Home
Renee Rose Shield Brown University Wary Partners: Nursing Assistants and Family Members in Nursing Homes
Maria D. Vesperi Department of Anthropology, University of South Florida, New College Irony in Contemporary Ethnographic Narrative

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