Encyclopedia of SociologyVol._3

Griswold’s impact on the sociology of literature has been powerful because she has systematically developed a methodological approach to studying literature and other cultural products and because her substantive research integrates a concern for meaning and the unique properties inherent in literary texts with an equal interest in social context, in the actors, institutions, and social behaviors surrounding texts.

Griswold’s concern for the integration of literary content with social context is shared by many. Janet Wolff, although she works primarily in visual arts rather than literature, has repeatedly challenged sociological students of culture to take content and aesthetics seriously, allying these concerns with their traditional specialty in social context and history (e.g., 1992; see also Becker in Candido 1995, p. xi). Priscilla Parkhurst Clark/ Ferguson (e.g., 1987) has written extensively on the literary culture of France, combining a study of specific works and authors with detailed analyses of literary institutions and social processes, in addition to her normative writings on improving the sociology of literature (1982). Corse (1995, 1997) combines a detailed reading of three types of American and Canadian novels with a historical consideration of the two nations’ canon development and a survey of the respective publishing industries to create a full picture of cross-national literary patterns and the explanation thereof. These works draw upon several important new approaches developed in the last twenty years.

The Production of Culture. The production of culture approach was the earliest of the new paradigms reinvigorating the study of culture in sociology. It stemmed from the growing interest of several prominent organizational sociologists in the sociology of culture (e.g., Hirsch 1972; Peterson 1976). These scholars made the now obvious insight that cultural objects are produced and distributed within a particular set of organizational and institutional arrangements, and that these arrangements mediate between author and audience and influence both the range of cultural products available and their content. Such arguments stand in stark contrast to earlier nonsociological conceptions of artistic production that featured artists as romantic loners and inspired geniuses with few ties to the social world. Art, in this view, is the product of a single artist and the content of

artistic works and the range of works available are explained by individual artistic vision. Becker’s influential Art Worlds (1982) effectively refuted such individualistic conceptions of cultural producers, at least in sociological research. Researchers in the production of culture tradition have showed conclusively that even the most antisocial artistic hermits work within an art world that provides the artistic conventions that allow readers to decode the work. Artists are free to modify or even reject these conventions, but the conventions are a crucial component of the work’s context. Art worlds also provide the materials, support personnel, and payment systems artists rely upon to create their works.

The social organization of the literary world and the publishing industry became obvious focuses for sociological investigations, from the produc- tion-of-culture approach. Walter W. Powell initiated a major research project with his dissertation, which was followed by his work on Books: The Culture and Commerce of Publishing (Coser et al. 1982) and Getting into Print (Powell 1985). This stream of research demonstrates how production variables, such as the degree of competition in the publishing industry, the web of social interactions underlying decisions about publication, and the fundamental embeddedness of publishing in particular historical and social circumstances, affect the diversity of books available to the public.

Peterson (1985) outlines six production factors constraining the publishing industry. Berezin (1991) demonstrates how the Italian facist regime under Mussolini shaped the theatre through bureaucratic production. Long (1986) situates the concern with economic concentration in the publishing industry in a historical perspective, and argues that a simple relationship between concentration and ‘‘massification’’ is insufficient for understanding contemporary publishing. Similarly, although as part of larger projects, Radway (1984), Long (1985), and Corse (1997) analyze the publishing industry and its changes as a backdrop for an understanding of particular literary characteristics. Radway traces the rise of mass-market paperbacks and the marketing of formulaic fiction to help explain the success of the romance genre (1984; chapter 1). Long (1985; chapter 2) acknowledges the importance of post World War II changes in the publishing houses and authorial demographics

in her analysis of the changing visions of success enshrined in best-selling novels, although she grants primary explanatory power to changes in the broader social context. Corse (1997, chapter 6) provides a cross-national study of Canada and the United States, arguing that the publishing industry in the latter dominates the former because of market size and population density. Canada’s publishing industry has become largely a distributive arm of the American publishing industry, despite governmental subsidies and other attempts to bolster Canadian publishing. The result is that American novels dominate the Canadian market (Corse 1997, pp. 145–154).

One important focus of production approaches is gender. Tuchman (1989) analyzes the movement of male authors into the previously femaledominated field of British novel publishing during the late 1800s as the field became increasingly remunerative. Rogers (1991), in her ambitious attempt at establishing a phenomenology of literary sociology, notes the gendered construction of both writers and readers. Rosengren’s (1983) network analysis of authorial references in book reviewing demonstrates, among other suggestive findings, the persistence of the literary system’s underrepresentation of female authors.

Reception Theory and the Focus on Audience. A second fundamental shift in the sociology of literature occurred as sociologists became familiar with the work of German reception theorists. Reception theory, and several other strains of similar work, shifted scholarly attention to the interaction of text and reader. The central figures in Germany in the late 1960s and 1970s were Hans Robert Jauss and Wolfgang Iser. In Toward an Aesthetic of Reception (1982) Jauss presents his main argument: that literature can be understood only as a dialectical process of production and reception in which equal weight is given to the text and the reader. Iser’s (1978) central focus is the act of reading itself.

Janice Radway’s (1984) seminal Reading the Romance introduced reception theory with its central interest in audience interpretation to many American sociologists, as well as to many scholars in related fields. To those already familiar with the work of reception theorists, Radway’s work powerfully demonstrated the potential of reception approaches for the sociology of literature. Radway’s

interviews with ‘‘ordinary’’ readers of genre romance novels (1984) uncovered multiple interpretations, instances of resistance, and fundamental insights into literary use and gender in a genre previously scorned as unworthy of serious scholarly attention.

Reception theory has generated a fruitful line of research in the sociology of literature. Long (1987) has examined women’s reading groups and their acceptance or rejection of traditional cultural authority in the selection and interpretation of book choices. Howard and Allen (1990) compare the interpretations made by male and female readers of two short stories in an attempt to understand how gender affects reception. Although they find few interpretive differences based solely on gender, they find numerous differences based on ‘‘life experience’’ and argue that gender affects interpretation indirectly through the ‘‘pervasive gender-markings of social context’’ (1990, p. 549). DeVault (1990) compares professional readings to her own reading of a Nadine Gordimer novel to demonstrate both the collective and the gendered nature of reception. Lichterman (1992) interviewed readers of self-help books to understand how such books are used as what he describes as a ‘‘thin culture’’ that helps readers with their personal lives without requiring any deep personal commitment to the book’s advice.

Griswold (1987) innovatively applied the reception perspective to a study of the cross-national range of published reviews of a single author, generating another fruitful line of research. Bayma and Fine (1996) analyze 1950s reviews of Vladimir Nabokav’s Lolita to demonstrate how cultural stereotypes of the time constructed reviewers’ understandings of the novel’s protagonist. Corse and Griffin (1997) analyze the history of reception of Zora Neale Hurston’s Their Eyes Were Watching God, analyzing the different positionings of the novel over time and detailing how various ‘‘interpretive strategies’’ available to critics construct the novel as more or less powerful.

Stratification. One final area of growth centers on the relationship between cultural products and stratification systems. Perhaps the central figure is Pierre Bourdieu (1984, 1993), whose analyses of class-based differences in taste, concepts of cultural capital and habitus, and examination of

the distinction between the fields of ‘‘restricted’’ and ‘‘large-scale’’ production have profoundly affected sociological thinking. Bourdieu (1984) has demonstrated how constructed differences in capacities for aesthetic judgment help reproduce the class structure. This fundamentally affects the conditions under which types of culture are produced, interpreted, and evaluated (1993). Bourdieu’s theoretical insights have inspired many researchers, although few work in literary sociology directly. For example, Corse (1997) examined the use of high-culture literature in elite programs of nation building, Halle (1992) investigated class variations in the display of artistic genres in the home, and DiMaggio and Mohr (1985) correlated cultural capital and marital selection. Cultural consumption and use are also stratified across categories other than class, for example, gender, race, and ethnicity. These categories have received even less attention than class in the sociology of literature, although some work has been done in gender (e.g., Simonds and Rothman 1992; Wolff 1990; Radway 1984).

Bourdieu, among others, has also highlighted the need for sociological understanding of aesthetic evaluation as a social process and for a recognition of the contested nature of the cultural authority manifested in aesthetic judgments (e.g., DiMaggio 1991). Although this is not a new point (e.g., Noble 1976), sociology is finally coming to terms with literary evaluations and the codified hierarchy of value as objects of sociological attention (Lamont 1987; Corse and Griffin 1997; Corse 1997).

International Approaches. Obviously much of the material discussed so far is international, primarily European, in origin. European social theory has always been part of American sociolo- gy—the ‘‘fathers’’ of sociology are, after all, Euro- pean—but there are cycles of more and less crossfertilization. Historically, European sociologists certainly evinced greater interest in the sociology of literature than did their American counterparts; an example is the ongoing series of articles in The British Journal of Sociology debating the state of literary sociology (e.g., Noble 1976). The reasons for European sociology’s greater interest in the sociology of literature are several: the relatively greater influence of Marxist and neo-Marxist traditions; methodological differences that legitimate

qualitative and hermeneutic traditions; and the tighter link between sociology and the humanities compared to the ‘‘science-envy’’ and concomitant embrace of positivism characterizing much of American sociology.

These historical differences have at least residual remains. Marxist and hermeneutic approaches and methods more reminiscent of the humanities are still more prevalent in Europe. For example, there is greater acceptance of work looking at a single novel, an approach rarely seen in American sociology (e.g., Wahlforss’s 1989 discussion of the success of a best-selling Finnish love story). Differences have decreased, however, primarily from the American embrace of European theories and methods rather than from the opposite movement.

One important group in the sociology of literature also proves a major exception to the historic differences in method between American and European sociologies of literature. The Marketing and Sociology of Books Group at Tilburg University in the Netherlands specializes in an institutional approach to understanding ‘‘the functioning of literary and cultural institutions . . . [and] the various aspects of consumer behavior towards books and literary magazines’’ (Verdaasdonk and van Rees 1991, p. 421; see also, for example, Janssen 1997). The group includes Cees van Rees, editor of the journal Poetics, which lives up to its subtitle—

Journal of Empirical Research on Literature, the Media and the Arts. The International Association for the Empirical Study of Literature (IGEL) sponsors an annual conference concentrating on such work (see Ibsch et al. 1995).

BROADER IMPLICATIONS

The sociology of literature has implications for wider social issues. In the debate over the opening of the canon—the question of what should be considered ‘‘great literature’’ and therefore required in school—people on both sides assume that reading X is different in some important way than reading Y. If not, it wouldn’t matter what was taught. Sociology of literature illuminates the process of canon formation helping to explain why certain books are canonized rather than others (Corse 1997; Corse and Griffin 1997); it sheds analytic light on processes of cultural authority

detailing who gets cultural power and how (DiMaggio 1991); and it elucidates the meaning-making activities of readers, showing what different audiences draw from particular texts (Griswold 1987). Sociological studies can help explain why people read, what they make of their reading, and how reading affects their lives. The relevance of literary sociology to the canon debates and its foundational arguments regarding the importance of extraliterary processes and structures can be seen in the increasing interest scholars outside sociology are showing in sociological variables and studies of literature (e.g., Tompkins 1985; Lauter 1991).

Similarly, many of the same questions of interest to sociologists of literature inform debates on media effects, debates such as whether watching cartoon violence causes children to act violently. This debate—and similar ones about the danger of rap music lyrics or the value of reading William Bennett’s Book of Virtues rather than cyberpunk or social fears about Internet chat rooms—centers on the core question of what effect art and culture have on their audiences. Radway (1984), for example, asks whether reading romance novels teaches women to expect fulfillment only through patriachal marriage—and demonstrates that the answer is a qualified yes. Corse (1997) argues that reading canonical novels is used to help construct national identities and feelings of solidarity among disparate readers. Griswold (1992) shows how the ‘‘village novel’’ establishes a powerful yet historically suspect sense of Nigerian identity. The question of the effect of reading—and the related question of literary use—is central to a complete sociology of literature. Although recent developments have moved us closer to answers, these are the key questions the sociology of literature needs to answer in the future.

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SARAH M. CORSE

LONG-TERM CARE

Long-term care (LTC) includes the full range of health, personal care, and social services provided at home and in the community for a continuing period to adults who lack or have lost the capacity to care fully for themselves and remain independent (Dearborn Financial Publishing 1997). A narrower but fairly common view is that LTC encompasses principally residential and institutional accommodation for older persons with special care needs. However, ‘‘long-term care’’ is a broad term, variously defined and interpreted in different countries and even within individual health and social care systems. As distinct from acute

care, LTC is not primarily curative but aims to maintain people either in the community or in residential (institutional) settings of various sorts.

Much discussion of LTC has focused, for demographic reasons, on care for elderly people. They are the main user groups in LTC, although longterm care users also include adults with special needs because of physical disability and mental illness or handicap. There are policy, finance, and practice issues inevitably raised by the mixed clientele of LTC (Binstock et al. 1996). A popular image is that LTC comprises mainly formal facilities and qualified personnel or trained volunteers delivering services in institutions and the community. However, probably the most common form of LTC worldwide and especially in developing countries is that provided by informal caregivers, particularly the families of those needing care. This can be a source of both pride and frustration for many families. There is increasing recognition of the burden and strain on informal family caregivers. In many cultures, the tradition of family care is ensconced in the notion of filial piety. While this is a particularly Chinese and East Asian concept of (reciprocal) duty of care between parents and their children, the realities of family responsibility and interactions in care are readily recognizable in all cultures.

The numbers and proportions of people, elderly persons in particular, living in formal LTC institutions vary considerably from one country to another. The size of the population group in question is not generally a very good indicator of the need for LTC, or its likely provision, in any given country. More important are the evolution and philosophy of health and welfare of provision. Epidemiologically and demographically, the gender balance in any given population is also important, as patterns of disability and service use tend to differ considerably between males and females. However, data on LTC are notoriously difficult to compare internationally. There are considerable differences in both definition and provision of the various types of residential facilities, nursing homes, and hostels, as well as of duration of stay. In Europe, for example, the percentages of people aged 65 and over living in an institution in the early 1990s ranged from 1.8 percent in Greece, 2.4 percent in Spain, 5.1 percent in France and the United Kingdom, and 5.4 percent in Denmark and

Germany to 9.1 percent in the Netherlands. The percentages of those living with their children showed an even greater range, from 7 percent in Denmark, and 18 percent in Britain and France to 35 percent in Greece and 48 percent in Spain. In the United States, on any one day, it has been estimated that 5 percent of the older population lives in a nursing home. However, between 25 percent and 43 percent of 65-year-olds (depending on estimates) can expect to use a nursing home at some time in their lives. Indeed, the older the person, the greater the chance of living in a nursing home. A person aged 85 or over in the United States in 1985 had almost a twenty times greater chance than someone aged 65–74 of living in a nursing home (Novak 1997).

ASSESSING NEED FOR LTC

An individual adult’s need for LTC typically arises when physical or cognitive abilities impair the ability at any age to perform basic activities of daily living (ADL) such as bathing, dressing and toileting and, increasingly, the ability to conduct instrumental ADL such as shopping and house cleaning. To help assess need for and provision of LTC, various forms of ADL scales have been developed. Two of the best known are by Katz et al. (1963) and Mahoney and Barthel (1965). Other important instruments include the Functional Independence Measure (FIM); the principal component of the Uniform Data Set (UDS); and the Minimum Data Set (MDS), a component of the Residential Assessment Instrument (RAI). The nursing home RAI includes a set of core assessment items (the MDS) for assessment and care screening for nursing home residents on, say, admission and periodically thereafter. This enables the identification of any significant change in status and the development of individualized restorative plans of care and it has been successfully applied in the United States and many other countries, for a range of specific purposes in LTC. Another relevant scale is the SF36 for health-related quality of life, although it is not primarily designed for use in LTC settings.

Aggregate need for LTC is influenced by a wide range of factors. Aging of populations is an important factor, but the health status of populations is perhaps even more important. Expectation of life at birth is increasing almost everywhere, and, more important, expectation of life at

age 60 and over is also increasing. The significance for LTC can be in at least two directions, depending on whether the expansion of morbidity or compression of morbidity hypotheses hold true. The ‘‘expansion’’ hypothesis suggests that further reductions in old-age mortality will expose the remaining population to a longer duration in which the nonfatal diseases of senescence are likely to emerge. The disabled portion of elderly life span will increase faster than the healthy and active portion. If this hypothesis holds true, with growing proportions of the ‘‘older-old’’ in the populations of most countries, there will be a steadily growing demand for community and institutional LTC provision. (See Table 1.)

Alternatively, the compression of morbidity hypothesis holds that mortality and morbidity will be simultaneously compressed and that lifestyle changes will reduce the risk of death from fatal and nonfatal diseases of senescence. A compression of morbidity is likely to have crucial implications for LTC need and provision, but precise details are difficult to assess. It implies that fewer people will need to live for long periods in institutions; conversely, there will probably be an increased need for social and community LTC for increasingly elderly population. Many of these people will be single and may not be very well provided for financially. This is especially true for single (usually widowed) elderly women, among whom many aspects of poverty are concentrated in many societies. They may disproportionately require low-cost or publicly funded communitybased LTC. However, while there is some evidence, it is still early to state categorically that compression of morbidity will occur uniformly or continuously. Rather, there is increasing evidence of health variations both within and between populations and subgroups.

SERVICES AND PROVIDERS IN LTC

Nursing and Residential Homes. These are the institutions many people associate with long-term care. Definitions of nursing homes vary internationally, but, we will consider a home to be in this category (rather than as a retirement home, as old people’s home, a board-and-care home, or the like) if it provides a specified amount of actual nursing and personal care and attention. Internationally, a nursing home has been defined as ‘‘an

Table 1

SOURCE: Peace et al. (1997, p. 23)

institution providing nursing care 24 hours a day, assistance with ADL and mobility, psychosocial and personal care, paramedical care, such as physiotherapy and occupational therapy, as well as room and board’’ (Ribbe et al. 1997, p. 4). In general, nursing homes provide the highest level of nursing cum medical care outside acute hospitals. In many countries, especially in the developed world, they are licensed and inspected and subject to a variety of rules and standards. Some nursing homes have a medical or nursing teaching affiliation. Although the majority of long-term care is home-based and provided by informal caregivers (see below), nursing homes still epitomize the popular view of LTC, especially among those responsible for financing and legislating in this area. Indeed, this view of institutional care as the dominant form of LTC is rather difficult to change and represents a challenge to social scientists.

International Variations in Nursing Home Provision The proportions of people living in nursing homes and the per capita provision manifestly vary internationally, compounded by differences in definitions of nursing and residential homes. (See Table 2.) However, relative preponderance can be illustrated from a multicountry study of provision and structure of LTC systems. The countries studied are developed nations with high life expectancies; they include Sweden (with the oldest population in the study), Iceland (with the youngest), and Japan (forecast to have the highest aging rates in the coming three decades). Between 2 and

5 percent of elderly people were found to live in nursing homes, with variable percentages in residential homes (although the definitions also varied). Iceland, with the youngest age structure, actually showed the highest rates of institutionalization and nursing home residence, while Sweden, with the oldest, had a relatively lower percentage. This study found little correlation between the aging status of a country and the number of nursing home beds. Institutionalization rates differ as much according to population age structure and need as to differences in organization and financing of LTC services, the responsibility assumed for the care of elderly people by various sectors and the availability of LTC beds. Cultural factors and traditions of family care also influence strongly these levels of provision and uptake in any given country.

Residential Homes. Residential homes offer lower levels of care compared with nursing homes and they, rather than nursing homes per se, often provide the bulk of serviced accommodation for elderly people and adults with moderate disabilities. The terminology, scale, standards, registration, and licensing of ‘‘residential homes’’ vary considerably internationally. This category can include old people’s homes, old-age homes, homes for the elderly, residential homes, board-and-care homes, boarding homes, and elderly hostels, among others. Many are small-scale, board-and-lodging establishments with few residents, no specialist staff, and very few facilities. Others are specialized

and provide high-standard, often high-cost, residential care with full meal service, facilities, grounds, and services. In some systems, most are licensed and inspected (above a certain size); in other systems, regulations are far more relaxed.

Admission to a residential setting often stems from an inability to manage at home because of difficulties with activities of daily living (ADL). In some residential homes, assistance is given with basic activities of daily living. In others, admission may be for social reasons of company or a lack of wish to maintain a home. However, while most residents will be basically ambulatory, in many aging nations there is a growing overlap among residents in residential homes and those in nursing homes. Indeed, increasing age and deteriorating health status can alter the case mix of some residential homes so that they sometimes resemble nursing homes but lack specialized facilities and staff. This can present a serious problem to the delivery of appropriate and quality care.

Sheltered Housing. Sheltered housing is generally purpose-built accommodation in which residents live in their own unit, with their own front

door, but in a group development, with a system of linkages or alarms and served (usually full time) by a supervisor or warden. A range of services such as cleaning, shopping and entertainment, and common facilities may be provided on site, but these vary a great deal among sheltered housing schemes. Some schemes are small scale and involve only a handful of houses and residents. At the extreme, retirement villages established for older adults, increasingly common in North America and Australia, may be regarded as a type of sheltered housing. In many countries, various types of congregate housing are central to LTC.

Sheltered housing may be publicly provided, but it can be individually owned and provide a means for elderly people to remain in owneroccupancy. Increasingly, in countries such as the United Kingdom, a distinction is emerging between ‘‘ordinary’’ sheltered housing and ‘‘very sheltered’’ accommodation. In sheltered accommodation, residents generally require little more than suitable housing with the moral support of an alarm system to call emergency assistance. Very sheltered accommodation provides a greater intensity of services more akin to those in residential

care settings. Many people feel that sheltered or very sheltered housing is an ideal form of accommodation for LTC delivery, and it certainly does have many positive aspects when the designs are appropriate and residents able largely to live independently. However, the question of what happens when tenants become older and more frail is difficult, as are the potential for ghettoization of elderly people (Tinker 1992, 1997). In a highdensity accommodation society such as Hong Kong, sheltered housing has been adapted to accommodate unrelated single elderly people for whom the provision of totally independent homes has proved difficult. Since the late 1980s, under the Housing for Senior Citizens scheme, public housing apartments have been provided. Usually three elderly people share an apartment. Each has an individual bedroom, and they share a communal living room and kitchen. Alarm systems and a warden provide continuity of contact, and certain communal activities are arranged for residents.

Care for Younger Adults: Psychiatric and Group Homes. Younger adults are often in need of LTC because of physical or mental incapacity. Sometimes, specialist care and accommodation is required because of, for example, spinal cord injuries. Younger LTC residents often also have different needs and perspectives from older recipients: a goal might be to find ways to assist younger people get out and about, commute to work, enjoy a full range of activities, and be contributing members of society. Homeand commu- nity-based services are as important for the younger as for the older persons in need of LTC (Binstock et al. 1996). However, some younger adults, for example, with severe mental or physical problems, might remain in LTC psychiatric accommodation or community-based group homes or hostels for a very long period of time, while receiving various forms of adult day care or respite care (see below).

Home and Community Care. Community and home-based services have the main aim of enabling people to continue living in their own homes or in the community for as long as possible. They involve a wide range of types of services and facilities provided by the formal and informal sectors. Home health care programs deliver health care and related services to people’s homes; they have been called ‘‘hospitals without walls.’’ Again, as in LTC generally, definitions of ‘‘home care’’ vary among countries. A recent study of fifteen

countries in Europe found considerable variation and defined home care as care provided at home by professional home nursing organizations and home help services. Other professionals—such as general practitioners (family doctors), occupational therapists, and physiotherapists—were excluded, although it is recognized that they do have a clear function in delivering care and often enable people to continue living at home (Hutten and Kerkstra 1996). Home nursing services include rehabilitative, promotive, preventive, and technical nursing care, with an emphasis mainly on the nursing of sick people at home. Home help services can provide a wide range of care, including shopping, cooking, cleaning, and laundering. They sometimes help with dressing and washing, and they often help care recipients to do administrative paperwork, pay bills, collect pensions, and the like. Many studies show that a home helper is also valued for providing company and someone to talk to. Clients are generally elderly (for example, in Britain, almost 90 percent). In some countries, the growing frailty of clients has led to the development of more intensive home care schemes that provide personal care in addition to doing simple cleaning and other tasks.

Several factors have raised the importance of home-based care: increasing demand from aging populations; policies of substitution of home care for institutional care (hospital care for the sick and residential care for elderly people) because of health care costs; and the changing nature of home care itself, with its increasing ability to deliver innovative services at home. However, while home is becoming the venue for delivery of care for many people of all ages, it is not necessarily a cheaper option than institutional care, especially for those requiring twenty-four-hour care. In addition, its future is not necessarily troublefree. The increasing numbers of older-old mean that complex home and family settings may evolve. For example, there will be increasing numbers of adult children in their sixties caring for parents in their eighties or nineties; likewise, there is an increasing number of elderly parents caring for adult disabled children at home. This is likely to require a very complex mix of support services to be delivered in the community and to people’s homes.

Community-Based Care Facilities. These are also very varied and can provide care or more