SMOKING AND ADULTHOOD - RISKY BUSINESS IN A NURSING-HOME

Smoking is a ubiquitous yet rarely examined behavior in nursing homes. Data derived from observations, document reviews, and formal intervie ws, are used to explore the concept of autonomy underlying staff's man agement of smoking by elderly residents. Central themes in staff's dis cussion of management issues are: safety, health, autonomy, and qualit y of life. Management practices vary widely and may abrogate, uphold o r enhance the autonomy of residents. When various polarities of autono my are examined (i.e., decisional vs. executional, direct vs. delegate d, competent vs. incapacitated, authentic vs. inauthentic, immediate v s. long range, and positive vs. negative), then staff's concept of aut onomy is revealed as unidimensional, overly simplified, and taken-for- granted. Re-conceptualizing autonomy not only broadens the debate but calls into question some basic assumptions and practices on which long -term care depends. The issue is larger than smoking. A fundamental re -thinking of the concept of custodial care is required.