The meaning of home as it becomes a place for care : the emergence of a new life stage for frail older people? : a study in the dynamics of home care for older people

Abstract

This work is a study of the day to day experiences of older people in receipt of in-home care, the experiences of their family carers, and of their careworkers, resulting in a hypothesis about the structure of the lifecycle towards the end of life, and a consideration of both structured transition and individual transitions to and within this life stage. It has taken off from Laslett's (1989,1996) seminal work on age divisions, into Third and Fourth Ages.

Through an initial examination of secondary sources, I have hypothesized that the older people in this care bracket are in fact in a new life stage, between that of the independent Third Age and the dependent Fourth Age. I call this life stage the stage of 'Supported Independence'. Further references to the secondary sources, and references to the data, have supported this hypothesis, and have shown that there is a structured transition from the stage of independence to that of supported independence.

The value of building such a life stage lies in the ability we then have to emphasize the situation of in-home care, bringing to prominence the experiences of the three stakeholders in this care environment.

I have used the rites of passage concept to make known the issues involving the move from independence to dependence and those issues predominant in receiving in-home care, in being the carer at such a time, and in being the careworker within the invisibility of home. This has shown a formalized separation from the independent identity, and a prolonged stage of liminality because of an often uncertain form of service delivery. In this liminal stage also are revealed the emotions of living at home with a disability and with care, the improvisatory practices, the passivity and the assertiveness of this time of ageing.

By applying this concept also to the family carers, I show the movement of families into and through the caring role, the joy of caring and the difficulties of taking responsibility without authority. I have shown carers' own improvisatory practices, and their determination to maintain the care recipient at home as long as possible.

For the careworker, the rites of passage concept shows how she (and the careworker participants in this study are all women), can act to either maintain the liminal position of the recipients or assist in their reconnection to greater autonomy. Exploring the careworkers' own positions by means of the rites of passage concept highlights their inter-structural position between the public and private sectors, and highlights too, the care industry's position, between that of a time managed industry and a recipient-directed industry. Whether this can be regarded as liminal depends on the philosophies of care adopted by the industry.

In summary, the study examines the significance of the place of care, challenging the dominant ideology that home is best, and putting forward for consideration principles of care for other models of service delivery.