Dissonance in the Dining Room: A Study of Social Interaction in a Special Care Unit

Abstract

This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed through the process of negotiation occurring in social interaction. The study adopts an environment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Quality of Life with the cognitively impaired.

A home away from home: The meaning of home according to families of residents with dementia

“…It has been recognized that supportive caregiving practices are critical to maximizing the therapeutic potential of the home-like environment (Day et al, 2000;Moore, 1999). From the family perspective, it is clear that how we do what we do is as important as what we do.…”

The Therapeutic Design of Environments for People With Dementia

“…In contrast, people with dementia residing in smaller units experience less anxiety and depression and more mobility (Annerstedt, 1997;Skea & Lindesay, 1996). Small group sizes are also positively associated with increased supervision and interaction between staff and residents (McCracken & Fitzwater, 1989) and with social interaction and friendship formation among residents (McAllister & Silverman, 1999;Moore, 1999;Netten, 1993). No consistent numbers are offered for what constitutes a "large" or a "small" unit.…”

“…Further, noninstitutional design requires supportive caregiving to be effective. In an ethnographic study of one facility, "institutional" caregiving practices (characterized as inflexible and formal) were described as undermining the therapeutic potential of the homelike environment (Moore, 1999).…”

“…Noninstitutional dining-in which residents dined "family style" at small dining tables in a coffee room, instead of from trays while seated in chairs in the corridorwas linked to increased social interaction and communication during dining and to improved eating behavior among residents (Götestam & Melin, 1987;Melin & Götestam, 1981). Institutional staff practices (e.g., assigned seating, institutional food service) provoked disruption and agitation in dining rooms with homelike design features (Moore, 1999).…”

Establishing Continuity of Self-Memory Boxes in Dementia Facilities for Older Adults: Their Use and Usefulness

“…However, a person-centered design approach can be incomplete and ineffective without staffing adequacies and a matching caregiving philosophy (Moore, 1999;Schwarz, Chaudhury, & Tofle, 2004).…”