Purpose This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC–AL) communities and what these settings have done to address stigma. Design and recognition of resident preferences and strengths, rather than their limitations. Methods We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family and staff) from six RC–AL settings in Maryland. We entered the transcript data into Atlas.ti 5.0. We analyzed the data by using grounded theory techniques for emergent themes. Results Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Implications: Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff

The assisted living industry provides residential, medical, nutritional, functional, and social services for approximately 1 million older adults in the United States. Despite their holistic approach to person-centered care and their emphasis on a consumer-empowered, social environment, assisted living providers pay scant attention to clients’ sexual needs. In this article, the authors discuss the realities of sex and intimacy in assisted living from the perspectives of residents, families, managers, and staff, exploring the discourse of sexuality, the impact of institutional structure and the role of oversight on sexual attitudes and behaviors, and the relationship of assisted living industry values to residents’ sexual expression. Also presented are practical recommendations and policy implications for addressing the sexual and intimacy needs of current and future cohorts of assisted living residents. Data for this article were drawn from 3 National Institute on Aging–funded ethnographic studies conducted in 13 assisted living settings over 9 years.

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Our data underscore the importance of resident autonomy and quality of care in relation to visitors and visiting, especially how this relationship is affected by inconsistent and confusing formal and informal visiting policies in AL.

Change of many 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.