Illness career descent is a process involving the downward trajectory of chronic illness and the residents' downward movement through the organizational structure of the retirement facility. This structure can be conceptualized as a "descending" hierarchy where residents experience downward mobility through successively lower statuses. These conceptualizations are grounded in three years of participant observation and interviews with over 150 residents at a multilevel care retirement facility. Downward mobility, within the facility, entails relocation to more regimented and stigmatized residency situations. The individual's goal is to slow down the pace of this illness career timetable. Descending hierarchical structures within facilities for the aged exacerbate the effects of the residents' declining health by disrupting social networks, decreasing control, and negatively affecting the resident's self-concept.