This book reports on a research project that aimed to explore what people mean when they talk about quality in Assisted Living (AL). The authors are all members of a multi-disciplinary research team that carried out a four-year study of seven AL facilities in Maryland in the United States of America (USA). The book is based on the premise that quality of life and quality of care are not fixed concepts but mean different things to different people and often change over time. It explores a diversity of views through interviews with residents, families and staff, and includes a useful discussion of the role of compassion and dignity in care settings. It is organised across eight chapters. The first seven of these focus on residents’ views of quality; institutional life in AL; cultures of caring, food and dining; autonomy; regulations, rules and financial realities; and changes in quality over time. The final chapter summarises the main themes and there is an appendix that describes the research methods used in the study.
Through an extensive use of quotes and narratives, the book paints an interesting picture of life in AL from residents’ perspectives and provides a detailed description of how AL functions as an institutional setting. In particular, it demonstrates how a delicate balance is achieved between individual choice and routine, control and rules/regulations. This is nicely augmented by a discussion of ageism and attitudes to risk, autonomy and freedom of movement, particularly for residents with a dementia. The authors also provide an overview of the range of roles that staff often take on in AL settings – medical, social and caring. In this respect, staff wellbeing is described as being crucial to quality care. Many of the findings described in the book correspond with those from UK literature. For example, food, social interaction and family ties are all shown to be key components of quality of life for most residents. In discussing these and other concepts, the book makes some references to theory, including Groffman's model of resistance and Maslow's hierarchy of need.
The final chapter provides a useful summary of the lessons that can be drawn from the study and describes strategies that can be used in order to achieve a quality balance in AL settings. For example, it is suggested that perceptions of quality should be explored with potential residents and their families before they move into an AL facility.
The book is unusual in that it is fundamentally an extended research report. It is well written and achieves its aim of exploring the meaning of quality from a range of perspectives. It has a welcome focus on the views of residents, and the authors are to be congratulated for the efforts they have made to capture these views: this approach provides an effective way of portraying the day-to-day life of residents. For example, a female resident describes the issue of choice in seating arrangements at meal times as follows:
Once you sit at a table it seems like those that are there expect you to be there. And it's very rare that you don't sit at the same table. You might not sit in this seat, you might sit in this seat (pointing) … but usually you sit at the same table. (p. 109)
The book does present some challenges for readers from outside the USA. In particular, it would benefit from an introduction to AL for those not familiar with the model, along with some international context. For example, how does this model compare with other residential settings such as care homes and serviced apartments in European countries? Referencing is relatively sparse for an academic book, with on average fewer than ten references per chapter. This book will be of interest to a broad audience in relation to AL and other residential care settings, including managers, commissioners, care staff, researchers, students and also the wider public.
