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

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just down the road from Tacoma Pastures. Additionally, I will also draw some examples from Tacoma Pastures in order to juxtapose these two ethnographic settings. A Tale of Two Long-term Care Facilities The LTC is a catchall phrase encompassing a wide range of institutions that cater to the elderly. Traditional skilled nursing homes are just one kind of LTC; they are usually larger establishments and carry with them specific legal and medical requirements. LTCs are not federally regulated, but are subject to different state laws in the US. Against the more conventional nursing homes in the US, a range of assisted living facilities have begun springing up, serving a host of market and social needs. Assisted living facilities are a much smaller kind of LTC, and have been labelled officially by the local state government (where I conducted fieldwork in) as adult foster care homes. While assisted living and adult foster care are terms frequently used interchangeably, the main distinction between these smaller boutique style LTCs and the larger and more medicalised nursing homes that operate much like residential hospitals, is that the adult foster care home is an informal home. Adult foster care homes provide residential care in a home-like environment to a relatively small number of elderly persons and those with disabilities who require assistance with the activities of daily living (e.g. cooking meals, bathing, dressing, doing laundry, and taking medications). These services are provided in exchange for some form of monthly payment. To become eligible as an official and operating adult foster care business, those receiving care cannot be related to the licensee or resident manager by blood, marriage or adoption. Furthermore, places like adult foster care homes are not simply bed and breakfasts. In the state’s eyes, they must be places that provide residential care. Adult foster care homes are often marketed as places that provide room, board and general supervision of care services in a ‘family home.’ These LTCs cater to both private-pay and state-pay individuals. For the most part, persons eligible for adult foster care homes must: 1) Be oriented to time, person and place and not a danger to themselves or others in the adult foster care home 2) Be unable to live independently 3) Require minimal supervision in completing some of the basic activities of daily living 4) Be capable of taking action for self-preservation in case of fire or storm with direction and 5) Have some control of 161
owel and bladder, but may have stress incontinence and/or be capable of meeting their own needs when incontinent. 28 In contrast to the adult foster care home is Tacoma Pastures. To refresh the reader, Tacoma Pastures is a CCRC that allows residents to remain on campus, permitting them to transition internally to differing levels of care. In other words, CCRCs are designed to allow people to age in place. The rationale behind this type of senior housing model is that internal moves within an institution are less stressful than external moves. Medical anthropologist Betsy Pohlman describes CCRCs as facilities in which their […] living spaces are configured along a continuum of care and organized through both social and medical models, cultivating a new sort of institutional totality that encompasses social wellness or illness and physical wellness or illness. CCRCs include apartments for elders who do not need assistance, assisted living units for those who require some help, and a skilled nursing area for those who require 24-hour attention. Some CCRCs include a specialty unit for those who are cognitively impaired due to dementia. When a person enters as a new resident, it is tacitly understood that she will move progressively, or regressively […](Pohlman 2007, 5). Places like Tacoma Pastures are becoming more popular: they are marketed on the basis that once a person decides to join a community, they are guaranteed a place and professional care no matter how they age. In a conversation with the Executive Director of Tacoma Pastures, I was told that, “There is a continuum, life has a continuum and we match services and living spaces with that continuum. Life is a journey, and we are committed to that journey.” Grandma’s Place About two houses down from a 24-hour convenience store and nestled behind a sculpture garden of deer, giant mushrooms, and elves enclosed by the ubiquitous chain- 28 Description taken from a local state department of social services webpage: http://dss.sd.gov/elderlyservices/services/fostercare.asp 162
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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
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Although the fifth floor is an “i
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the fourth floor did not need much
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main floor next to the spacious for
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grapple with mechanical E-Z stands
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Grant was not the only person who c
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The situation involving these three
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Brendan escorted me into Heather’
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Teri Teri was a resident in the sam
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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
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Page 120 and 121: “Thanks.” I go into the back of
Page 122 and 123: insurmountable abyss. The silence w
Page 124 and 125: had to bring the wheelchair over, c
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 144 and 145: control, over the bodies and action
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
Page 192 and 193: y taking up oneself in real duratio
Page 194 and 195: organisation of a CCRC for example,
Page 196 and 197: Furthermore, the post-Cartesian min
Page 198 and 199: Pastures when it is institutionalis
Page 200 and 201: Appendix Ethics Form 199
Page 202 and 203: A Room with No View In the corner r
Page 204 and 205: A Blue-Gray Raga Some places the sm
Page 206 and 207: Diamond, T. Making Grey Gold: Narra
Page 208 and 209: Hummert, Mary Lee Nussbaum Jon F. "
Page 210 and 211: Nouwen, H. and Gaffney, W. Aging: T
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Williams, Allison. "Therapeutic Lan
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