Self-perceived health of elderly institutionalized people.

Self-health ratings and salient themes of conversations with sixty-nine elderly residents of a long-term care facility in the United States are reported. Discussion draws on the fit of expressed ideas about health with descriptions of daily life experiences. Viewing the institution as a sickness setting contributed either to residents' redefinition of themselves as patients needing care or to their reformulation of a conception of health that was enabling. The latter involved identifying ways in which they were better than other residents, seeking assurance that they were doing well in spite of difficulties, and signaling desire for self-determination. It is argued that institutional structure limits ways in which residents may act to retain some image of health. This causes the system to benefit some more than others. System change would entail reorientation of values toward more flexible service patterns that take individual differences into consideration and tolerate experimentation around the limits of personal autonomy.