Institutional attention and the disablement process: How safety governance shapes functional trajectories in later life

The disablement process model identifies institutional environments as modifiers of the pathway from pathology to disability, yet has not specified the mechanisms through which they accelerate or interrupt disablement. This article proposes institutional attention ecology as a theoretical construct addressing this gap: the patterned distribution of organizational vigilance, investigation, and accountability across outcome domains within care institutions. In post-acute skilled nursing facilities, this ecology has become asymmetric, intensely organized around discrete safety events while leaving functional recovery largely outside institutional response. Drawing on the disablement process, relational autonomy theory, and qualitative evidence, we trace how this asymmetry reshapes functional trajectories and the conditions for authentic agency in later life. We propose attention ecology as a meso-level extension linking institutional context to resident-level outcomes. Nationally representative facility-level data (N = 13,713) support the predicted dissociation: safety performance and functional outcomes are essentially uncorrelated (Pearson r = 0.018). We advance three propositions: attention ecology operates as a formal extra-individual modifier in the disablement process; attention asymmetry produces structurally imposed dependency distinguishable from chosen dependency; and the disablement process in institutional settings is embedded in a moral ecology shaping which forms of diminishment are recognized as problems and which are normalized as aging.