Institutional care for the elderly in Scotland and in the US--focusing on human, personal solutions. Professor Kayser-Jones (Nursing, Univ. of California, San Francisco) looked at the smallest of samples: two ""typical"" nursing homes similar in size and structure. She found, not surprisingly, that the care in Scotland was superior (using as the ultimate measurement the happiness of residents) and concentrates on the exchange theory as an explanation. In both societies, the ""transaction of labor, resources, and services"" is vital to social life. But, since the American nursing-home residents, with few exceptions, had nothing to offer those providing their direct care, they were infantilized, depersonalized, dehumanized, and victimized--all types of ""negative reciprocity"" in which one party gets something for nothing. The Scots, on the other hand, had more spending money, could more easily shop, and were more likely to produce crafts. Kayser-Jones points out that poor working conditions in the US, and poor pay for nursing home aides, interact in a vicious circle with the absence of personal involvement and social bonds. She also examines some institutional barriers to better care: lack of leadership and responsibility for care of the aging on the part of physicians and nurses; accountability not to health professionals but to the profit-seeking proprietors of the institution; and the organization and financing of health care, which contributes to ""pauperization and stigmatization"" of the elderly. Stocked with stories of residents in both institutions, her study provides a new view of a distressing situation and reminds us that the remedies should not be restricted to changes in financing and regulation.