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

Chapter 4: Independent Plus: Care on the 4 th Floor
Caregiving is a vague and fraught term connoting images of the frail and elderly on the
one hand, while on the other designating a list of medical products, technologies and
services in support of the activities of daily living (ADLs) and the occupational therapy
needs of long-term care facility residents. Caregiving as a normative conjures up acts of
transcendent love, family responsibilities, and intersubjective/morally-inflected
relations. The practice and discourse of caregiving bring together and conflate cultural
concepts such as autonomy, duty, dignity, self-reliance, self-care, and philanthropy in an
experiential framework—especially in organisational settings like the CCRC which are
from one perspective ‘factories of care’ and from another sites of new homes and
‘kinscapes’ (Atkinson et al. 2012) This chapter explores how residents negotiate care
and make sense of how care is performed on them. By providing a brief discussion of the
layout of the fourth floor, the ethnographic vignettes of various residents and their
interactions with the caregivers, and each other, will shed light on just what constitutes
care.
* * *
It was only after a short period of time working on the third floor that I was assigned to
the fourth floor. I took with me some of the techniques I had already learned from my
time in Memory Care. For example, I knew how to approach residents, how to organise
my tasks around the clumsy wheelchair—including how to help residents who were less
than mobile stand up from their wheelchairs—and to transfer and swivel them onto the
toilet safely and effectively. From my working experience on the third floor, I was
already conditioned to treat routines as frameworks, which needed to be adapted on a
daily basis. Something new and unpredictable was always happening. A resident might
have a fall, or display a different mood, changing the time required to assist that
resident. More importantly, changes in situation affected the planning and sequencing of
how I worked with residents in a particular section. At the end of the day, there was only
so much the caregiver could anticipate. A stomach virus might work itself through the
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