The purpose of this study is to examine how care in an assisted living facility (ALF) is provided to residents with dementia. A review of the literature revealed that ALF residents are more cognitively and physically impaired than previously presumed. However, ALFs are not required to employ registered nurses (RNs) or employees who have education in health care. Because so little is known about the care residents with dementia receive in ALFs, I conducted a 7-month long ethnographic study, during which time I collected data in one ALF using participant observation, formal and informal interviews, and focus groups.

Social constructionism was the theoretical framework used to examine the interactions between caregivers and residents with dementia and to ascertain if the interactions were person-centered. Social constructionism can be used to show the near difficulty, or incommensurability, that ALF caregivers encounter when caring for residents who are from a different culture and are cognitively impaired. Social constructionism can also be used to determine if Kitwood's (2004) "person-centered care" approach to persons with dementia is used in a facility.

Three major themes emerged from this study. Theme 1 reveals the conflict within this ALF administration between providing quality care and making a financial profit. Observations verified that the facility's claims of quality care and stated philosophy did not reflect the care actually delivered. Theme 2 describes how caregivers without formal education learned to care for residents with dementia and reveals that two types of caregivers worked in the facility, person-centered caregivers and me-centered caregivers. Theme 3 explains how health care was provided and identifies problems in the way the employees provided care, including how they monitored, assessed, and communicated the residents' health care needs. This study illuminates the role gerontological nurses could play if they were employed in an ALF. Nurses could show caregivers how to deliver person-centered care to residents, thus improving a facility's environment and, most importantly, the quality of life for its residents.