The Age of Supported Independence (eBook)

Preface 6
Contents 8
Introduction: Stake in the Ground 14
Our Approach 16
Outline of Chapters 19
References 21
1 The Demographic and Policy Context of Supported Independence in Later Life 23
1.1 Introduction 23
1.2 Key Concepts 23
1.3 The Demographic Context 25
1.4 Policy Contexts 29
1.4.1 Determining Eligibility 30
1.4.2 Regulation, Choice and Control 32
1.5 Summary: Demographic and Policy Indicators of a New Social Category 32
References 33
2 The Move from Independence 35
2.1 Introduction 35
2.2 New Life Stage 36
2.2.1 Transitions 37
2.3 Rites of Passage 38
2.3.1 Transition as a Rite of Passage 19
2.3.2 Rites of Passage: Separation 41
2.4 Summary: Separation and the Move from Independence 47
References 21
3 Space and Liminality 51
3.1 Introduction: Older People at Home: Identity, Continuity, Stability 51
3.2 Home and Space 51
3.2.1 Spatial Disruption: Transition 54
3.2.2 New Landscapes at Home 55
3.3 Becoming 56
3.4 The Ageing Body 56
3.4.1 The Extended, Altered, Damaged, Limited Body 57
3.4.2 Bodily Space: The Liminal 58
3.4.3 Re-presenting the Body to Self 59
3.4.4 Re-presenting the Body to Others 60
3.4.5 Re-presenting the Body to Care Workers 61
3.5 Summary 62
References 63
4 Temporality and Liminality 66
4.1 Introduction 66
4.2 Time: Continuity 68
4.2.1 Temporal Disruption 71
4.2.2 Separation: First Rite of Passage 73
4.3 The Liminal Stage 74
4.4 Summary 76
References 78
5 Relational Transitions 81
5.1 Introduction 81
5.1.1 Relationships in Transition---An Overview and Background 82
5.2 Assessment and the Experience of Separation 84
5.3 Agency and Worker Relationships 85
5.3.1 'Fictive Kin' 86
5.3.2 Struggle Within the Care Relationship 87
5.4 Relationships with Families: Informal Caregivers and Experiences of Transition 88
5.4.1 Developing an Identity as a Family Caregiver: Separation 90
5.4.2 Experiences of Liminality: Responsibilities with and without Authority 91
5.4.3 Experiences of Liminality: Physical Challenges 91
5.4.4 Experiences of Liminality: The Changing Spatial Environment 92
5.4.5 Experiences of Liminality: Mixed Emotions and Feelings of Grief and Loss 93
5.5 Becoming an Informal Caregiver: The Experience of Men 93
5.6 Summary 94
References 96
6 Separation, Liminality and the Potential for Reconnections at Home with Care 98
6.1 Introduction 98
6.2 Separation: Trigger Processes and Assessments 99
6.3 Personal Liminality: Dealing with the Damaged Body at Home with Care 102
6.3.1 Liminality and the Relational Landscapes Through Time and Space at Home 105
6.4 The Potential for Reconnection 107
6.5 Summary 107
References 109
7 Care Work and Reconnections 112
7.1 Introduction 112
7.2 Meanings of Care 113
7.2.1 Care … and Its Potential 114
7.2.2 Does Paying for Care Change Its Essential Nature? 117
7.2.3 The Care Relationship and Agency Control 118
7.3 Issues with Current Care Policy and Practice 120
7.3.1 What Needs to Happen to Provide Reconnective Practice? 123
7.4 Summary 124
References 125
8 ReconnectionsSupported Independence and Agency in Frailty 128
8.1 Introduction 128
8.2 New Life Stage? 129
8.3 Care Services and Experiences of Liminality 129
8.3.1 The Potential of Home Care to Address Liminality 131
8.3.2 The Passage into Supported Independence 133
8.4 Implications: Policy and Practice for Reconnections 133
8.4.1 Strengthening the Capacity of Care Workers 135
8.4.2 A Community Development Focus 136
8.4.3 Coordination Between Sectors 137
8.4.4 Supported Housing Arrangements 138
8.5 Areas for Further Research 139
8.6 Summary 140
References 141
Index 143

"Chapter 3 Space and Liminality (S. 29-30)

3.1 Introduction: Older People at Home: Identity, Continuity, Stability

In this chapter we move from outlining the processes involved in the first step of the rite of passage into supported independence, to explore the significance of the home setting and the lived experiences of change. We begin by outlining some of the essential meanings of home which are critical in creating and maintaining a sense of personal identity. Following this, we identify the often microscopic spatial alterations within the home made because of the bodily changes associated with the onset of frailty or disability.

We place in the foreground the personal experiences of ageing and disablement, such as deteriorating mobility, loss of function, and challenges in managing the ‘saggy baggy bits’ of the body. Increasing dependence does not follow a set time frame, but it is a passage from one status to another in which micro-level processes and broader structural forces shape the older person’s experience. We present here the idea of transition in terms of these bodily and spatial changes, and consider what they mean for the older person who must negotiate them when they move into receiving care in the home.

Beginning with a review on meanings of ‘home’, we highlight the important elements of identity derived from the spatial environment of the home, viz autonomy and independence, and the idealised characteristics of the home as being a site of security and warmth. Having noted these generally recognised characteristics of the home and their significance for older people, we consider the spatial disruptions that occur when the home becomes a place of formal care, especially when modifications are required to compensate for loss of function and disabilities. We consider the implications of disability on bodily space and care within the home. Our concluding discussion examines the experience of discontinuity and liminality with a focus on living ‘in the home’—home being the setting, situation and the context in which older people age-in-place (Hazan, 1984, p. 3).

3.2 Home and Space

The assumptions behind ageing in place imply that remaining at home, particularly in one’s long-term dwelling, is an important means of accommodating physical losses and facilitating adaptive responses to the physical challenges that can accompany old age. Home is, across all cultures, one of the most taken-for-granted concepts, generally characterised by warmth and stability, continuity, independence, security and autonomy, safety and familiarity. However, the accepted nature of home for older people has been the subject of considerable research over the last two decades.

Since 1983, when Powell Lawton commented that we knew little about the functions and applications of space at home, there has been increasing interest in how older people use their home space and, with the advent of sheltered care (Percival, 2001) and home care (Rubinstein, 1989, 1990a, 1990b, 1999; Gubrium & Sankar, 1990; Twigg, 2000), a growing interest in spatial adaptations and the meanings of those adaptations. Perhaps the most up-to-date discussions of the meaning of home for both independent and more dependent older people come from the European ENABLE-AGE1 project.

This research has examined the home environment and its contribution to the wellbeing, autonomy and participation of older people. It found strong correlation between good health and a firm bonding to home, and lower levels of wellbeing and a higher number of reported symptoms among individuals with ‘weaker physical and behavioural bonding to home.’ Basically, the fitter the individual, the stronger the attachment to home and enjoyment of the place. Even for the less fit, home is seen as the best place to be. Parks (2003) comments:"