Expert vs. Consumer Viewpoints: An Organizational Analysis of the Contrasts in Descriptions of Homes for the Aged by Administrators and Indigenous Residents
Creators: Silverstone, Barbara M.
Publisher: name: Columbia University
Year: 1973
Subjects: Social service
Aging
Older people--Institutional care
Old age homes--Administration

description: The primary focus of this organizational study of thirty two homes for the aged was to explore the degree of difference between administrator (expert) and resident (consumer) judgments of the psycho-social environment of their homes and to detect organizational variables which might account for these differences. It was hypothesized that adequate communication linkages to the homes would be negatively correlated with resident-administrator differences in viewpoints of the psychosocial environment. Adequate communication linkages were defined as those which approximated a model of linkage adequacy derived from the ''balance theory of coordination" postulated by Eugene Litwak. Based on a multimodel theory of organizational structure it calls for mechanisms of coordination between antithetical organizational substructures to insure sufficient closeness for communication but sufficient distance to prevent conflict. A secondary focus of this study was the substantive findings regarding resident viewpoints of the psychosocial environment irrespective of their differences from administrators. The concept of "psychosocial environment" was defined and operationalized by Allen Pincus who developed an instrument (HDQ) for measuring the degree of privacy, freedom, social resources, and integration into the larger community provided by the psychosocial environment of homes for the aged.

The study hypothesis was not supported by correlational findings; however, linkage adequacy ratings did account for seven percent of the variation in administrator-resident differences when entered into a regression analysis with variables measuring contacts between administrator and residents and residential participation in group activities. Of significance at the .05 level was the age of the administrators with the younger ones tending to have fewer differences from the residents; administrators' ranking of professional staff meetings and communications with the housekeeping staff as useful sources of information about their residents; and higher mean resident HDQ Dimension II (freedom) scores. A multiple regression analysis of these variables plus the mean home ratings of resident friendliness to staff accounted for 55% of the variation in resident-administrator differences.

These findings support the balance theory of coordination in that they reflect both distancing mechanisms (indirect linkages; i.e., administrator-staff contacts) and conditions which promote closeness (resident friendliness to staff). The age of the administrator, positively correlated with resident-administrator differences, reflected greater reliance by the younger administrators on their staffs and less control by their boards. Neither resident age, health, size of home, socio-cultural similarity between resident and administrator, nor the degree of informal administrator contact with residents were associated with resident-administrator differences.

Resident scores on the HDQ suggest the psychosocial environments of the homes providing a great deal more privacy than a lack of privacy, more integration into the larger community than isolation, slightly more social resources rather than a lack of social resources, and as much freedom as structure. Those variables negatively associated with the dimension scores on a home by home basis included poorer ratings on resident mental health, mobility, and physical isolation. Homes with a greater degree of board control less participating activities and where residents tended to take their complaints to the administrator tended to have less freedom. Homes located in the country, with a resident council and social worker and with frequent administrator-resident contacts tended to score higher on the resource dimension.

Implications for social planning include greater confidence in the older consumer as a source of informational feedback and increased scrutiny of administrator viewpoints especially as they relate to utilization of staff. The study suggests that planning must be geared to providing for the needs for the immobile, mentally impaired, isolated resident as well as stimulating administrative and structural changes which allow for a greater degree of freedom and social resources.