Abstract

The market-based innovation known as assisted living (AL) has changed the landscape of long-term care in the US. Using Edgar Schein’s three-level conceptual framework of organizational culture and data from a two-year qualitative study of five AL facilities located in suburban Philadelphia, we argue that misalignments among publicly stated values, material artifacts, and underlying assumptions can create a climate that fosters ethical tension. Drawing on forty-five in-depth interviews with staff at all levels, we derive five operational assumptions that guide behavior in the facilities included in our study, and we describe how facility artifacts and espoused values give rise to ethical tensions and, at times, ethical violations. The findings highlight the imperative for providers and managers in all industries to look beyond the façade of artifacts and espoused values to underlying assumptions, and to recognize that these three levels must be aligned in order to create and sustain a culture in which ethics is a visible and enduring element and where ethical conduct is encouraged on an everyday basis.