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Declining Body, Institutional Life, and Making Home—Are They at Odds?

The Lived Experiences of Moving Through Staged Care in Long-Term Care Settings

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Abstract

This study examines elderly residential life in long-term care settings, focusing on the ways residents interact with their physical and social environments. It further proposes that the residential environment is an important player for everyday ethics in long-term care settings, and is also an important factor in enhancing the quality of life for residents. By employing the theories of place identity and environmental meanings and listening to the voices of the elderly collected through an ethnographic field study in elderly homes of life care, the study reveals the residents’ experiences of going through declining health and moving through the stages of care. Two major themes were identified. The first theme of liminal life portrays the elders’ fears as they move through the stages of care. This theme includes four sub-themes: (1) the loss of home and the loss of autonomy; (2) impending loss and its constant reminders; (3) the social classification of “us” and “them”; (4) the irreversibility of moving. The second theme of relational life describes the keys to successful transitions as experienced and told by the residents. The second theme includes three sub-themes: (1) shifting identity and the acceptance of old age; (2) human interdependence and building trust; (3) an accompanied death. Study implications are further discussed, including specific suggestions for social programs and revisions to the physical environments. A more fundamental question about place-based staged care is also raised so as to serve as a point of departure for reflections and discussions amongst health professionals, planners and designers, and other decision-makers.

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Notes

  1. Depending on the sources of information, 35–50 % of Americans will receive some nursing home care in their lifetime (Gillick 2007, p. 123; Kemper et al. 2005), 18 % will live in a nursing home for at least one year, and 5 % for at least five years (Kemper et al. 2005). If both CCRC and other residential care facilities are included, the chance will likely be higher.

  2. For an extensive discussion on the matter, see, for example, “Ethics, Aging, and Society: The Critical Turn,” particularly chapter eight (Holstein et al. 2010, pp. 147–172).

  3. Operated under various names such as almshouses, poor farms, country infirmaries, asylums, or county homes (Stevenson).

  4. Medicaid currently covers approximately 45 % of the total nursing home revenues in the U.S. (Holstein et al. 2010, p. 149).

  5. By its definition, it provides a bundle of housing, personal care, and nursing home services in exchange for various combinations of pre-payment when the resident enters. To provide a continuum of care, it also requires monthly and specific fees for services in the form of a long-term contract (Sloan et al. 1995, pp. 76–77).

  6. (1) St. Joseph’s Home of the Elderly in Palatine, IL, the provincial motherhouse in the Chicago province; (2) St. Mary’s Home in Chicago, IL; (3) The Queen of Peace Residence in Suwon, Korea, the motherhouse in the Korean Province; (4) Jeanne Jugan’s Home in Seoul, Korea. (1) and (3), two provincial motherhouses, were the major research sites, while (2) and (4) were minor research sites where I walked through the facilities and conducted interviews with the Mother Superior of each home.

  7. At the time of this writing, the congregation has homes in 31 countries in 6 continents. See, http://www.littlesistersofthepoor.org/ourlife/worldwide-expansion.

  8. Many of their branch homes regularly receive an overall rating of five stars from the Centers for Medicare & Medicaid Services (http://www.usnews.com/pubfiles/Five_Star_Nursing_Homes_Metro_List.pdf). Only about 10 % of nursing homes receive such a high rating (Center for Medicare Advocacy, 2013).

  9. Sheltered care is for the ambulatory senior who needs minimal assistance and who can perform daily personal care independently, including dressing and bathing. Intermediate care is also for the ambulatory senior, but one who needs some level of nursing care and minimal to moderate assistance with daily personal care.

  10. During the time of this study, the first research site was serving around 90 residents. Over the course of the study, this number fluctuated with incoming residents and the death of existing residents. There were 19 sisters, around 100 staff members, and a great number of volunteers throughout the year. The second research site was similar in scale. The organization used two upfront admission criteria: the resident had to be old and poor. In addition, the elders had to be relatively healthy to be admitted. This was because of the organization’s effort to keep a homelike atmosphere, rather than one like a hospital.

  11. I used the method to allow flexibility, a higher level of conceptualization, and to remain truthful to the data (Seale 2004). I first read the elders’ interview narratives, which were fully transcribed in advance, to get familiar with their stories. Then, I coded any emerging core categories. At this point, I identified two core categories: (1) making home; (2) from independence to interdependence. Then, I proceeded to the next stage of selective coding where I collected, analyzed and coded the data that are directly related to the identified core categories. Analysis and findings of the first core category is reported elsewhere (Shin 2014). The second core category served as the basis for the main title of this paper.

  12. Depending on the source of information, the median length of stay in assisted living/residential care ranges from 18 to 30.8 months (Chapin and Dobbs-Kepper 2001; National Center for Assisted Living 2010).

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Acknowledgments

I deeply appreciate the Little Sisters for allowing me to connect with the elderly residents and the participants who shared their life stories. The study was generously funded by the Graduate Fall Research Competition at the University of Wisconsin-Madison and the Academy of Korean Studies in Korea.

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There is no actual or potential conflict of interest related to the contents of this article.

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  1. Design Studies Department, University of Wisconsin-Madison, 1300 Linden Dr., Madison, WI, 53706, USA

    Jung-hye Shin

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Shin, Jh. Declining Body, Institutional Life, and Making Home—Are They at Odds?. HEC Forum 27, 107–125 (2015). https://doi.org/10.1007/s10730-015-9269-5

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