This 1966 paperback edition of a publication which first appeared in 1963 has by now been widely reviewed as a worthy contribution to the sociological study of deviant behavior. Its current appearance as a paperback is a testimonial both to the quality of the work and to the prominence of deviant behavior in this generation. In general the author places deviance in perspective, identifies types of deviant behavior, considers the role of rule makers and enforcers, and some of the problems in studying deviance. In addition, he develops a sequential model of deviance relying on the concept of career, a concept originally developed in studies of occupations. In his study of a particular kind of deviance, the use of marihuana, the author posits and tests systematically an hypothesis about the genesis of marihuana use for pleasure. The hypothesis traces the sequence of changes in individual attitude

Outsiders Studies in the Sociology of Deviance.

Evaluating the quality of medical care.

Editor – I am moved by Professor Allan's elegy to bygone NHS virtues of ‘calm caring and gentle pace of clinical life… and all the time in the world to deliver compassionate care' ( Clin Med October 2009 p 407). One's immediate instinct would be to say ‘Ah, but times have changed' – only

Quality of care.

Not Your Mother’s Old Age: Baby Boomers at Age 65

Purpose of the study Little is known about adults' future planning for long-term supports and services (LTSS), and no studies have examined how LTSS planning compares between Baby Boomers and their parents' generation. The primary aim of this study is to examine the potential influences of birth cohort and gender on LTSS planning. Drawing on Andersen's Behavioral Model of Health Services Use, birth cohort and gender are viewed as predisposing characteristics, and several additional predisposing, enabling, and need characteristics are included as independent variables. Design and methods Cross-sectional design; data obtained from a statewide survey of 2,522 randomly selected Baby Boomers (born between 1946 and 1964) and older adults (born before 1946). Results Two thirds of respondents expected to need LTSS, but few reported saving for such services. Controlling for other independent variables, compared with older adults, Baby Boomers were significantly more likely to plan to move to an apartment, live in a retirement community or assisted living, and live with an adult child. Conversely, women were more likely than men to report planning to use specific LTSS such as homecare, but specific LTSS plans did not vary by birth cohort. Implications Policymakers and providers should prepare for a shift in community planning to accommodate the changing plans and expectations of Baby Boomers, large numbers of whom plan to age in existing homes and retirement communities, or live with adult children, with increasing demand for informal family support. The LTSS industry should also adapt to meet the need for formal services, which will likely continue to grow.

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Long-Term Supports and Services Planning for the Future: Implications From a Statewide Survey of Baby Boomers and Older Adults

Purpose of the Study: T o determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes. Design and Methods: Ethnographic in-depth interviews were conducted in 5 multilevel set tings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma. Results: F our themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma. Implications: In no instance were examples or themes identified that suggested the staf f intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals’ likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma.

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Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes

Over the last five decades, the number of U.S. households in age-restricted housing, including active adult retirement communities (AARCs), has increased steadily to nearly 2.7 million households headed by individuals 55 and older. Recent projections anticipate 54,000 new 55+ housing starts in 2011 and 79,000 in 2012 (MetLife, 2011). This growth is due, in part, to the Baby Boomers (hereafter Boomers) who in 2001 began turning 55, the minimum age for entry into most AARCs by the 1998 Fair Housing Act Amendments (42 U.S.C. §§ 3,601–3,619). Because of their numbers, Boomers will likely influence AARCs whether Boomers embrace age-restricted senior housing or not.

Based upon ethnographic research, this article examines the underpinnings of age-based social dynamics, as older, established residents in an AARC encounter newly arrived Boomers. In a community where an active lifestyle is presumably shared, this paper explores the social construction of group identity and ageism. Comity, the harmony and camaraderie that develops among people who share experiences and activities, emerged as a strong theme within the social life of this particular community. We begin with a poignant incident that disrupts this community’s sense of comity and, more importantly, speaks to larger sociocultural understandings of aging and the power and prevalence of ageism, even in an environment where “everyone is old” (Kastenbaum, 1993). The incident reflects assertion by Gilleard and Higgs (2000, p. 8) that “age is more a site of contradiction than of community.” The conflicts between these “competing cultures of aging” indicate that Third Agers, those in an “era of personal fulfillment” according to Laslett (1989, p. 4), share a common disdain and dread of the Fourth Age, a period of “final dependence, decrepitude, and death” (4; for more information about the First and Second Ages, cf. Laslett, 1989).

In 2009, we began fieldwork in Woodhaven (all place and people names are pseudonyms), an AARC of several thousand people located on the east coast. Laid out in suburban-style cul-de-sacs, Woodhaven includes some rentals but is primarily privately owned housing including condos, town houses, and single-family homes. The ongoing need to attract new and most likely younger buyers prompted the community leadership to authorize a major renovation of the decades-old clubhouse that housed outdated fitness equipment and an inadequate pool. A number of established residents told us they looked forward to what some were calling “new blood,” anxious to hand over some leadership roles, and welcome the widely touted Boomer generation into the vibrant social life they had developed in the years they had lived there. In those first weeks of fieldwork, stories began to emerge indicating that the Boomers did not necessarily feel the same way. A key story, told primarily from the perspective of Woodhaven’s established residents, continued to engender feelings of resentment 2 years after the event: “The only problem we’ve had,” said Rita Hurley (age 79; Boomers during the time of our fieldwork would have ranged from 45 to 63 years of age), “is with the Boomers; they’ve been kind of rude.”


Rita was in the middle of a Drama Club rehearsal when she discovered the newly formed Boomer Club was meeting nearby. She thought it an ideal opportunity to welcome them. “Of course, good old charming me, I go in and said, ‘Would you mind if I just speak a few minutes to invite people to come and join [in the activities here]?’” She began her short, enthusiastic speech by telling the 10 people in attendance, “We’re so thrilled to have you. We’ve been waiting for you to come. We need you and your fresh ideas.” She was met with a silent and cold reception. “There was not a smile in the crowd.” She continued:

… this woman finally raised her hand and she said, “I just wanted to say, we’re not really interested in joining the old people. You can just save your breath. We didn’t come here to hang out with people old enough to be our parents.” I felt like I had been slapped. That was so rude and nobody spoke up to say anything different.


Rita left, stunned. After returning to rehearsal, she related the story to the Drama Club members who were shocked. “They were all just, ‘I can’t believe that! I can’t believe they said such a thing!’ I said, ‘I couldn’t either.’”


Despite the relatively small group of people involved, the story of the Boomer reaction spread “like wildfire,” as Rita described it. Early in our research, the effects of the Boomers’ comments remained palpable. Many older informants referred to this exchange and their consequent low regard for the Boomers as a group. Rita reflected on this incident in her interview:

It was terrible. We got off on such a bad footing with these people. Nobody wanted to have anything to do with the Boomers. Boomers didn’t want to have anything to do with us.


Complicated power and identity dynamics are evident in this exchange. The incident crystallizes ageist sentiments held by both Boomers as well as the established community members. Some older residents may have been guilty of overvalorizing the youth of the Boomers, desiring both to be seen as still active and “not old” or sick and hoping to be accepted by the younger residents. Not every Boomer held these ageist sentiments or belonged to the Boomer Club, and in some cases, significant friendships and bonds arose across these age groups. Nevertheless, the story confirmed deep-seated sociocultural attitudes about age and illness. It made a lasting impression and had become more than a story; it had become legend (Mullen, 1972). Legends, writes folklorist Tangherlini (1990, p. 380), gain power “by tapping already established beliefs and values” and “by constructing a symbolic reality which encompasses these values and beliefs.”

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Baby Boomers in an Active Adult Retirement Community: Comity Interrupted

Objectives. The study sought to identify the v aried types of change arising from internal and external influences in assisted living (AL) settings, expanding upon the literature’s limited focus on resident decline and staff turnover and clarifying the importance of changes to life and work there. Method. This analysis emplo yed qualitative interviews and observations from 4 studies involving 17 ALs to identify elements of change largely absent from the literature. Case material identified by the research team members relating to persons, groups, and settings exemplifying typical changes, as well as variations across settings, are presented. Results. Multiple domains of AL change were identified, to include those in: (a) the external economic or competitive environments; (b) ownership, management, or key personnel; and (c) physical health or cognition of the aggregate resident population. In many cases, the changes influenced residents’ satisfaction and perceived fit with the AL environment. Discussion. Change of man y types is a regular feature of AL; many changes alter routines or daily life; raise concerns of staff, residents, or families; or modify perceptions of residential normalcy. Environmental gerontology should more often extend the environment to include the social and interpersonal characteristics of collective living sites for elders.

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The Facade of Stability in Assisted Living

This paper focuses on stigma in collective living environments for older adults. We contrast two design profiles, a purpose-built campus which opened in 1997, and an older setting that grew by accretion over decades. The separation by care levels in both sites is reflected in their cultures as residents and staff relate to levels of care through a vocabulary of fear. Residents of the independent living building on the purpose-built campus refer to the assisted living building as “the dark side.” In this setting we observe stigma assigned to a place in the built environment. By contrast, the older setting features a less-structured clustering of independent living and assisted living. We have observed less stigma associated with levels of care in this older building. Grounding our analysis in data drawn from ongoing ethnographic research, we focus on the built environment as it relates to stigma in the social environment.

Amanda D. Peeples

Papers

Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes

Baby Boomers in an Active Adult Retirement Community: Comity Interrupted

The Facade of Stability in Assisted Living

The Dark Side: Stigma in Purpose-Built Senior Environments

"It's a lot!" the universal worker model and dementia care in assisted living.