title: Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes.
abstract: To 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.
  
  
  
  Ethnographic in-depth interviews were conducted in 5 multilevel settings 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.
  
  
  
  Four 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.
  
  
  
  In no instance were examples or themes identified that suggested the staff 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.
authors.affiliation: Cecil G. Sheps Center for Health Services Research and the School of Social Work, The University of North Carolina at Chapel Hill, Sheryl_Zimmerman@unc.edu.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: School of Aging Studies, University of South Florida, Tampa.
authors.forename: Debra
authors.initials: D
authors.lastname: Dobbs
authors.affiliation: Center for Aging Studies, University of Maryland Baltimore County.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Roth
authors.affiliation: Center for Aging Studies, University of Maryland Baltimore County.
authors.forename: Susan
authors.initials: S
authors.lastname: Goldman
authors.affiliation: Center for Aging Studies, University of Maryland Baltimore County.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Peeples
authors.affiliation: Center for Aging Studies, University of Maryland Baltimore County.
authors.forename: Brandy
authors.initials: B
authors.lastname: Wallace
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000884:Anthropology, Cultural; D040561:Assisted Living Facilities; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011287:Prejudice; D057545:Social Stigma
keywords: Continuing care retirement community; Multilevel settings; Outcomes; Processes; Structures