This article is concerned with the issues of motivation and control of nursing home personnel to increase their responsiveness to the needs of the elderly. The perspective taken is one of organizational analysis and, specifically, a consideration of the functions and dysfunctions of particular reward structures. The reward structures analyzed are (1) reimbursement schemes for homes in relation to the performance of home administrators and (2) supervisory arrangements for personal care workers in regard to the delivery of nonroutine services to patients. We point out some of the difficulties inherent in existing organizational structures and suggest modifications to increase the influence of patients and their relatives.
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