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

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Pastures when it is institutionalised. I am not concerned here with how the institution of a long-term facility reproduces itself through regimes of care. Of course things are always changing at Tacoma Pastures. New residents and workers are constantly moving to Tacoma Pastures, and even while they are there, situations emerge that challenge the normal course of things. People change: residents lose their spouses, fall down, contract viruses, and shatter femurs. The management staff and caregivers also feel and express the need for change. There are financial and regulatory changes they must address and react to. In this vein, care is not something that can be objectified, measured, and implemented in a straightforward sense. More importantly, care is something that acts as a way to mollify, buffer and filter the plethora of changes occurring at multiple registers. Care at Tacoma Pastures anticipates, however imperfectly, certain trajectories of time and the life course; it is this project of anticipation that is also being institutionalised. The next point to make explicit, and in summary fashion, is the relation between ageing and care. Ageing in the American Midwest is viewed with much apprehension, and is conceived of primarily as a problem, which first and foremost should be addressed by medicine. The uncertainty and loss associated with ageing causes people to avoid it. People tend to avoid celebrating aspects of change that are part and parcel of human life in its entirety. Loss is particularly hard to cope with. By this, I mean the residents’ loss of decision-making, of their control over daily tasks, of their ability to live out their desired lifestyles. When someone loses a particular sense, for example hearing, what is not celebrated is the enhancement of other senses such as the sense of sight. In the context of Tacoma Pastures, what is going on is a lamentation of loss. In the can-do attitude of the American Midwest, the focus is on fixing the problem, and not accepting loss as a welcomed change. Care does not substitute for medical interventions and cures, but provides comfort as a professional service. The caregivers at Tacoma Pastures ensure that the activities of daily living, and the chores of keeping up one’s physical body and room are front and centre in this culturally-inflected idea of care as comfort. Not only is one’s body of concern, but the resident’s room and the state of their bed is brought into the sphere of care at Tacoma Pastures. In this sense, self-care is not just symbolic, but also can be detached from one’s personhood. Care objectifies aspects of the body and 197
one’s immediate environment, freeing the culturally-inflected and ageing soul for ontological respite and relief. The third point is what to make of the relation between professional (formal) caregivers and care receivers. Conventional wisdom suggests that family caregivers are somehow better caregivers, because they know and love their elders. Yet, there is the also idea that sometimes, family members are too emotional and close to their loved ones, making it hard for them to provide objective and effective care. What is the right distance then, and what does this say about the kind of intimacy and empathetic/emotive space being carved out by new forms of caregiving relations. This <strong>thesis</strong> has gestured toward exploring this aspect for further research. How people ground these emerging relations, especially in late life, is ontologically interesting. New subjectivities and commitments will continue to evolve no doubt. Lastly, the residents at Tacoma Pastures are not victims in the jerk sense that somehow the long-term facility has injured or taken away their personhood. Neither are they victims in the sense that society has offered them up for sacrifice in some kind of ritual arrangement. Rather, they are victims because they have been duped into thinking that life can and should be arranged and sorted, especially in old age. Many questions remain unanswered, and some have yet to be formulated. One question that I have not yet adequately answered is whether or not we can say that there is such a thing as a ‘bad caregiver’. In the face of human vulnerability, and given the fact that much of formal caregiving, at least in the context of American long-term care facilities, is reflexive across social and generational boundaries, and evokes certain ontological and relational commitments through empathy and vicarship, the probability of an amoral and indifferent caregiver seems unlikely. Caregivers are more than just manual labourers; they may also be moral agents of change. Their work cannot be viewed without this moral and emotional context. It is perhaps a mark of our evolutionary history that the longer we live, the more social and interconnected we find ourselves, and that money isn't really everything—even in the business of ageing. 198
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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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on other residents, but for some re
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Part 2 Chapter 5: A Long Way From M
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largely associated with the domain
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into Žižek’s ticklish borders b
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“Thanks.” I go into the back of
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insurmountable abyss. The silence w
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had to bring the wheelchair over, c
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drawn out process involving a mixtu
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* * * Betsy and I were subject to T
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Chapter 6: The Exigency of Care: Ca
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Betty When I first met Betty, she w
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Sometimes the caregivers were succe
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company. The CHR is licensed differ
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said, slightly solemnly: “Hi.”
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Tacoma Pastures and into hospice. F
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Looking out into the setting sun fr
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control, over the bodies and action
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Figure 12 An Eden plaque At Tacoma
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Page 164 and 165: link fence of post-industrial subur
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Page 176 and 177: was being uttered in their negative
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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
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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 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
Page 212: Williams, Allison. "Therapeutic Lan
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