ABSTRACT
We start by reviewing the "classic" studies on control among institutionalized elderly. Although these studies offer provocative evidence on the relevance of control issues in helping, we argue that current conceptualizations of "control" need to be expanded to capture the key issues in helping the elderly. As an alternative, we present the analysis of Brickman, Rabinowitz, Karuza, Coates, Cohn, and Kidder (1982), which formally considers the issues of control (i.e., responsibility for solutions to problems) and blame (i.e., responsibility for causing problems) as critical ingredients that define four unique models of helping. We review the potential advantages and disadvantages associated with each model and apply our analysis to both institutional and community-based care, arguing that the efficacy of the help is determined by the appropriate matching of help to recipient. We point out two potential barriers to the appropriate matching of models, a general bias for a medical model and conflicts between helper and recipient over what constitutes appropriate expectations for help.
