Determinants of resident autonomy in assisted living facilities: a review of the literature.

Assisted living (AL) stresses the importance of resident autonomy in the provision of good quality care. Resident autonomy has been linked to better resident well-being, less reliance on supportive services, and greater participation in social activities. Little is known, however, about factors that foster resident autonomy in AL. This article reviews what is currently known about organizational determinants of resident autonomy in AL. The open-natural systems approach to organizational effectiveness, which views organizations in relation to their environment, provides a broad conceptual framework for this analysis. Factors that influence resident autonomy in AL are classified into two categories: (a) external environmental conditions (e.g., ownership status, chain membership, regulatory environment) and (b) internal organizational structures and processes (e.g., facility size, residents' functional ability, resident social resources, and staff work environment). Environmental conditions represent the most antecedent set of factors that influence resident autonomy, indirectly through their effects on internal organizational structures and processes. Internal organizational factors influence resident autonomy through their impact on policies that enable resident choice and control in the facility. More research is needed to better understand the complex mechanism(s) through which organizational factors influence resident autonomy.