In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy. This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer a detailed description of the organizational patterns that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in these settings. The book concludes with concrete suggestions on methods to increase the autonomy of elderly individuals in long-term care institutions.

"This is an inspirational, even uplifting, book. Lidz, Fischer and Arnold do solid work in distinguishing among the various kinds of autonomy. They are careful to inform policy makers, nursing-home staffs, and the gerontology community generally of what moves are most likely to bring about the minor revolution they aim for." --Clinical Gerontologist "Fascinating....A useful compendium on one of society's persistent and pervasive ills....A book for departmental libraries, though to be read by all..." --Tom Aire, Psychiatrist, Nottingham, International Journal of Epidemiology "Richly illustrates the difficulties of supporting a patient's everyday or actual autonomy....Intellectually important, revelatory...offers insights that must be the basis on which real reform is crafted..." --Martha Holstein, Medical Humanities Review "The authors present a clear conceptual and historical framework which sets the context for the study's rationale and findings."--Disabilities Studies Quarterly