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

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control, over the bodies and actions of residents and their caregivers is couched in terms of quality care and person-centred care that resists any criticisms or deconstruction. Ryvicker shows how this control over the use of language and the instantiation of different organisational cultures aimed at discursively serving up issues of autonomy, dignity, and preservation of ‘identity’ in late life can yield more sinister consequences (Ryvicker 2009). Drawing from two different long-term care facilities, her research shows that caregiving practices vary between two homes in ways that the administrators foster (i.e. control) different types of caregiving relationships. What Ryvicker found was that in contrast to the more sterile and therapeutic-like setting, the more informal and home-like setting infantilised the residents and encouraged an unhealthy passivity. The crux of the problem is that control and care in an organisation such as the CCRC feed off of each other; resorting to structuration is not sufficient for such a moral space charged with power and vulnerability. No one at Tacoma Pastures could be said to own or direct its brand of corporate culture and identity. Even though Tacoma Pastures claimed to be certified in the Eden Alternative, a set of guidelines to redefine care and transform the way elders are thought of and engaged with in longterm care facilities, no one person or office owned or controlled this initiative. As I will show, this was a corporate culture that was never ‘internalised,’ and perhaps on purpose. Nursing home reformers - colloquially known as nursing home ‘abolitionists’ in the US can trace their roots back to the work of Harvard-trained doctor Bill Thomas. 26 In the early 1990s, Dr. Thomas and his wife founded the non-profit Eden Alternative culture change model in order to work towards deinstitutionalizing long-term care facilities by alleviating their professed ‘three plagues’ of ageing: boredom, helplessness and 26 Part of the reform can also trace is roots back to the 1980s with the restraint-free movement. In a New York Times Letter to the Editor published on 02 Dec 2012, the chief executives of LeadingAge and Jewish Home Lifecare wrote: ‘The restraint-free movement has been under way for more than 20 years, and many care providers have eliminated the use of restraints completely. For years, nursing homes have moved toward creating restraint-free environments that feel more like home, promoting both the safety and quality of life for those in their care […] Bed rails, while an obvious type of restraint, are but one example; chemical restraints (mood- or behavior-altering drugs) are another. The ultimate goal: restraint-free living for nursing home residents.” Letter can be accessed through: http://www.nytimes.com/2012/12/03/opinion/restraintfree-care-for-nursing-home-residents.html 143
loneliness. These plagues soon blossomed into principles, a biblical ten to be precise, and today the international not-for-profit organization has grown in size. According to Brownie, “at least 200 American aged care facilities have adopted the Eden Alternative’, and there are ‘Eden Alternative facilities in the United Kingdom and Ireland; European countries, including Germany, Austria and Switzerland; Scandinavia countries, including Sweden, Denmark, Finland, and Norway; Japan, and other countries” (Brownie 2011). The founders of the Eden Alternative idea describe their mission as being: “Dedicated to transforming care environments into habitats for human beings that promote quality of life for all involved.” It is a powerful tool for inspiring wellbeing for elders and those who collaborate with them as care partners. Furthermore, managers working in long-term care facilities that wish to ‘Edenize’ their institutions are encouraged to: “A) Treat employees appropriately B) Ensure that decision-making is nearest the resident C) Commit to changing the living/working environment and D) Persuade everyone to grow continuously.” In a nutshell, Eden’s ten principles are aimed at granting elders more decision-making powers by reversing what is perceived as top-down bureaucracy. Lustbader and Williams state that: “Shifting these ‘pyramids of power’ [the bureaucratic and power structures topped by physicians an head nurses] turns out to be the essence of a transformed culture of long-term care. Those who have the most contact with the ill person, the nurse’s aides, must be given a primary voice on the health care team, and the locus of control must be returned to the individual, rather than retained by the institution and its staff” (Lustbader and Williams 2000, 647). Eden is also about creating more human spaces: so that plants, pets, and visits by community children to the CCRC provide, as stated on their website—‘a pathway to make life worth living’. The Eden Alternative promotes both autonomy and dependence, sending potentially mixed signals. On the one hand there is praise for self-reliance and individualism, yet on the other there is a quiet recognition of the need for dependence and interdependence in creating and sustaining social relations in places like Tacoma Pastures. Eden principle four, which is framed in each Tacoma Pastures dining room, says that people are most happy when they receive and offer help (see figure 12). Principle seven also stands out in particular, which states: “Medical treatment should be the servant of genuine human caring, never its master.” 144
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THE VICTIMS OF A SORTED LIFE : AGEI
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THE VICTIMS OF A SORTED LIFE: CAREG
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“In the animal kingdom, the rule
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ACKNOWLEDGEMENTS Many people have e
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ACRONYMS Activities of Daily Living
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The Tacoma Pastures Family ........
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Introduction i) Ageing and an Anthr
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the one hand we have the shifting p
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social relations among residents, s
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abyss that caregivers are confronte
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ased; other sponsors such as univer
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especially in light of the period
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a frozen liminality, “a sphere of
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nature of social relations. I was c
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esidents, and to abide by the gover
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order and tension that obtains betw
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offer palliation and there is a gen
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esidents for one-day plane trips to
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seriously think about.” 11 Early
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their desire to effect a plan under
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floors 1, 2, 4, and 5; 2) Personal
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chaotic back then.” I was told to
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the third floor is electronically l
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Chapter 2: The Accidental Caregiver
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transfer residents out of beds and
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on the third floor in Memory Care,
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On the second day, Nathan took me a
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Jennifer was doing so-so. He said,
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was from, even though I had just an
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affect; the balloon could be launch
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eminded me of a 1960s hospital room
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Ryan began complaining more about h
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know if you are working for someone
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in old age, especially when they al
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translation. 19 What follows is an
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class by telling us that dementia i
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The 3 rd Floor Layout Many CCRCs, i
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ested in between their tasks at thi
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sofa, others will simply give her a
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morning, the med tech and the careg
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caregivers to try their best to go
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could still communicate with me in
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In the two weeks that followed, Ken
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the trips that she remembered fondl
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Pastures received this. For now, it
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Chapter 4: Independent Plus: Care o
Page 94 and 95: Although the fifth floor is an “i
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Page 100 and 101: grapple with mechanical E-Z stands
Page 102 and 103: Grant was not the only person who c
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Page 106 and 107: Brendan escorted me into Heather’
Page 108 and 109: Teri Teri was a resident in the sam
Page 110 and 111: Lana Lana lived next door to Teri a
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Page 114 and 115: Part 2 Chapter 5: A Long Way From M
Page 116 and 117: largely associated with the domain
Page 118 and 119: into Žižek’s ticklish borders b
Page 120 and 121: “Thanks.” I go into the back of
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Page 126 and 127: drawn out process involving a mixtu
Page 128 and 129: * * * Betsy and I were subject to T
Page 130 and 131: Chapter 6: The Exigency of Care: Ca
Page 132 and 133: Betty When I first met Betty, she w
Page 134 and 135: Sometimes the caregivers were succe
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Page 138 and 139: said, slightly solemnly: “Hi.”
Page 140 and 141: Tacoma Pastures and into hospice. F
Page 142 and 143: Looking out into the setting sun fr
Page 146 and 147: Figure 12 An Eden plaque At Tacoma
Page 148 and 149: way to community. The main dining r
Page 150 and 151: They cannot just be a passive board
Page 152 and 153: hearing the director go on about cr
Page 154 and 155: golf flat-cap, and behind his squar
Page 156 and 157: This chapter has been motivated by
Page 158 and 159: complex and generative space openin
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Page 164 and 165: link fence of post-industrial subur
Page 166 and 167: The young woman came back after adm
Page 168 and 169: as she made the rounds on the third
Page 170 and 171: I decided to confront Sylvia about
Page 172 and 173: * * * Mistakes were made in the fie
Page 174 and 175: work. If care is inevitably and hum
Page 176 and 177: was being uttered in their negative
Page 178 and 179: an X-ray, and that we could issue a
Page 180 and 181: parental responsibilities and care
Page 182 and 183: caregivers and care recipients? Doe
Page 184 and 185: was not a structure or discourse th
Page 186 and 187: and McKechnie 1999, 1). Furthermore
Page 188 and 189: extending the period of training fo
Page 190 and 191: It will be useful now to venture in
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organisation of a CCRC for example,
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Furthermore, the post-Cartesian min
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Pastures when it is institutionalis
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Appendix Ethics Form 199
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A Room with No View In the corner r
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A Blue-Gray Raga Some places the sm
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Diamond, T. Making Grey Gold: Narra
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Hummert, Mary Lee Nussbaum Jon F. "
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Nouwen, H. and Gaffney, W. Aging: T
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Williams, Allison. "Therapeutic Lan
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