The McDonaldization of Long-Term Care

Abstract

The organization of long-term care homes has changed significantly over the past decades. Local mom and pop nursing homes (NH) of the past have long since given way to large bureaucratic NH chains, creating an industry whose business is the production of “care”. This paper explores how Ritzer’s theory of “McDonaldization” can be used to strategically analyse the impact of these structural changes in American NH and assisted living homes in the care of elders. This analysis applies Ritzer’s four central concepts of McDonaldization to NH's in America: (1) efficiency, the best method to achieve the two key goals of passing inspections and filling beds that transcend the goal of optimum care; (2) calculability, the assumption that quantity equals quality, such as staff to resident ratios; (3) predictability, extremely repetitive, highly structured activities of daily living (ADLs); and (4) control, taking skills away from people and incorporating them into technology, such as electronic medical charts, medication monitoring software, and “call lights”. As with other McDonaldized industries, this creates an “irrationality of rationality”, resulting in dehumanizing conditions for care partners. These strategies would rationally seem to reduce financial costs by decreasing the number of workers. However, these strategies create greater human costs and often more financial issues in the long run from staff burnout, high turnover, poor quality of care and decline in the residents over all well-being.