Philip Y. Kao PhD thesis - Research@StAndrews:FullText

Chapter 6: The Exigency of Care: Caught up in the Transitions of a CCRC
This chapter explores the transitions residents make in Tacoma. Pastures. When I first
began my fieldwork working as a caregiver, I thought I would be assigned to the more
independent wing of Tacoma Pastures before graduating on to what I assumed was the
more challenging work—that is caring for residents with Alzheimer’s Disease. Contrary
to what I initially thought, the opposite occurred: I was actually assigned to the
dementia unit first. I came to learn that because independent residents were capable of
requesting more things like additional food and drinks, in addition to instructing
caregivers on how they want their food delivered and their beds made, working shifts in
the independent sections were faster paced and hectic. Caregivers in these sections had
to respond to a large number of call buttons being pushed by residents almost every ten
minutes, in addition to their scheduled daily tasks. In contrast, dementia residents
pushed their buttons seldom.
Different levels of care are assigned to residents, and associated with varying physical
locations within the CCRC complex. Each level is associated with certain services, tasks
and responsibilities. Care Level 1 stipulates that the caregiver must give verbal
reminders to their residents about bathing, dressing, eating, and ‘self-managed
continence programs.’ Care Level 2, however, requires the caregiver to physically assist
with dressing, grooming and bathing. Of course, different levels come with different
price tags, and this is one of the reasons people do not want to transition to another floor
or wing.
Some researchers working within the field of nursing and social work have looked into
how a resident’s network might change as a result of relocations within the CCRC. They
have also studied whether or not residents in a CCRC are more social, and capable of
maintaining various hobbies and occupations (Shippee 2009). What has not yet been
explored, is what actually changes in this continuum, and what these changes for the
resident actually reveal about the CCRC as an institution; how aging, personhood and
care are interpreted; and how these interpretations are taken up or resisted by the
residents. There are competing exigencies between the experience of aging and the
practice of caregiving that are constantly in negotiation. Unlike the sunrise/sunset
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