Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-28T18:00:17.407Z Has data issue: false hasContentIssue false
  • English
  • Français

‘Independence’ among older people receiving support at home: the meaning of daily care practices

Published online by Cambridge University Press:  03 October 2017

RACHEL BARKEN
RACHEL BARKEN*
Affiliation:
Department of Sociology, York University, Toronto, Canada.
*
Address for correspondence: Rachel Barken, Department of Sociology, York University, 359A York Lanes, 4700 Keele St., Toronto, ON M3J 1P3, Canada E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Later life care practices are closely entangled with the ideals of independence and dependence. Based on an interpretive analysis of qualitative interviews with 34 people aged 65–100 receiving home care in Ontario, Canada, this article explores older people's subjective interpretations of caring for themselves (i.e. independence) and receiving support from others (i.e. dependence). Findings suggest that individuals construct subjective meanings of independence in relation to their changing physical capacities, and in the context of their relationships with family members, friends and formal care providers. First, participants considered their care activities to be a way of maintaining independence when they undertook certain practices with the intention of staving off dependency and future decline. Second, when they accepted assistance, many engaged in care relations that allowed them to preserve an independent identity in the face of limits to physical self-sufficiency. Third, participants reached the limits of independence when they lacked adequate assistance, and were unable to care for themselves in desirable ways. Findings illustrate how objective circumstances related to social and financial resources as well as access to formal services shape subjective interpretations, allowing some older people to hold on to independent identities while exacerbating feelings of dependency among others.

Keywords

ageinghome careinformal careself-carehealthinequalityqualitative methods
Type
Article
Information
Ageing & Society , Volume 39 , Issue 3 , March 2019 , pp. 518 - 540
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ball, M. M., Perkins, M. and Kemp, C. 2004. Independence in assisted living. Journal of Aging Studies, 18, 4, 467–83.Google Scholar
Baltes, P. B. and Baltes, M. M. 1990. Pyschological perspectives on successful aging: the model of selective optimisation with compensation. In Baltes, P. B. and Baltes, M. M. (eds), Successful Aging: Perspectives from the Behavioural Sciences. Cambridge University Press, New York, 1–34.Google Scholar
Bowen, G. 2006. Grounded theory and sensitizing concepts. International Journal of Qualitative Methods, 5, 3, 2–9.Google Scholar
Breheny, M. and Stephens, C. 2012. Negotiating a moral identity in the context of later life care. Journal of Aging Studies, 26, 4, 438–47.Google Scholar
Brennan, D., Cass, B., Himmelweit, S. and Szebehely, M. 2012. The marketisation of care: rationales and consequences in Nordic and liberal care regimes. Journal of European Social Policy, 22, 4, 377–91.Google Scholar
Brookman, C., Jakob, L., DeCicco, J. and Bender, D. 2011. Client-centered Care in the Canadian Home and Community Sector: A Review of Key Concepts. Saint Elizabeth Health Care, Markham, Canada. Available online at https://www.saintelizabeth.com/getmedia/4aba6e8e-0303-4b9c-9117-a8c22a43f8bd/Client-Centred-Care-in-the-Canadian-Home-and-Community-Sector.pdf.aspx. Accessed November 3, 2013.Google Scholar
Byrne, K., Frazee, K., Sims-Gould, J. and Martin-Matthews, A. 2012. Valuing the older person in the context of delivery and receipt of home support: client perspectives. Journal of Applied Gerontology, 31, 3, 377–401.Google Scholar
Charmaz, K. 2006. Contructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage, Los Angeles.Google Scholar
Colombo, F., Llena-Nozal, A., Mercier, J. and Tjadens, F. 2011. Help Wanted? Providing and Paying for Long-term Care. OECD Health Policy Studies, OECD Publishing, Paris.Google Scholar
Corbin, J. M. and Strauss, A. L. 2008. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage, Los Angeles.Google Scholar
Cox, E. O. and Dooley, A. C. 1996. Care-receivers’ perception of their role in the care process. Journal of Gerontological Social Work, 26, 1/2, 133–52.Google Scholar
Craft, B. J. and Grasser, C. 1998. The relationship of reciprocity to self health care in older women. Journal of Women and Aging, 10, 2, 35–47.Google Scholar
Crawford, R. 1980. Healthism and the medicalization of everday life. International Journal of Health Services Research, 10, 3, 365–88.Google Scholar
Crist, J. D. 2005. The meaning for elders of receiving family care. Journal of Advanced Nursing, 49, 5, 485–93.Google Scholar
Dean, K. 1989. Conceptual, theoretical and methodological issues in self-care research: introduction. Social Science and Medicine, 29, 2, 117–23.Google Scholar
Fine, M. D. and Glendinning, C. 2005. Dependence, independence or inter-dependence? Revisiting the concepts of ‘care’ and ‘dependency’. Ageing & Society, 25, 4, 601–21.Google Scholar
Funk, L. M. 2013. Home healthcare and family responsibility: a critical discourse analysis of talk and text. Healthcare Policy, 9, Special issue 87–97.Google Scholar
Goffman, E. K. 1963. Stigma: Notes on the Management of a Spoiled Identity. Prentice-Hall, Englewood Cliffs, New Jersey.Google Scholar
Grenier, A. 2012. Transitions and the Lifecourse: Challenging the Constructions of ‘Growing Old’. Policy Press, Bristol, UK.Google Scholar
Hale, B., Barrett, P. and Gauld, R. 2010. The Age of Supported Independence: Voices of In-home Care. Springer, Dordrecht, The Netherlands.Google Scholar
Hammarström, G. and Torres, S. 2010. Being, feeling and acting: a qualitative study of Swedish home-help care recipients’ understandings of dependence and independence. Journal of Aging Studies, 24, 2, 75–87.Google Scholar
Higgs, P., Leontowitsch, M., Stevenson, F. and Jones, I. R. 2009. Not just old and sick – ‘the will to health’ in later life. Ageing & Society, 29, 5, 687–707.Google Scholar
Holmberg, M., Valmari, G. and Lundgren, S. M. 2012. Patients’ experiences of homecare nursing: balancing the duality between obtaining care and to maintain dignity and self-determination. Scandinavian Journal of Caring Sciences, 26, 4, 705–12.Google Scholar
Holstein, J. A. and Gubrium, J. F. 1995. The Active Interview. Sage, Thousand Oaks, California.Google Scholar
Horton, S., Baker, J., Côté, J. and Deakin, J. M. 2008. Understanding seniors’ perceptions and stereotypes of aging. Educational Gerontology, 34, 11, 997–1017.Google Scholar
Hurd Clarke, L. and Bennett, E. 2012. Constructing the moral body: self-care among older adults with multiple chronic conditions. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 17, 3, 211–28.Google Scholar
Janlöv, A. C., Hallberg, I. R. and Petersson, K. 2005. The experience of older people of entering into the phase of asking for public home help – a qualitative study. International Journal of Social Welfare, 14, 4, 326–36.Google Scholar
Katz, S. 2000. Busy bodies: activity, aging, and the management of everyday life. Journal of Aging Studies, 14, 2, 135–52.Google Scholar
Kelly, S. E. 2010. Qualitative interviewing techniques and styles. In Bourgeault, I. L., Dingwall, R. and De Vries, R. G. (eds), The Sage Handbook of Qualitative Methods in Health Research. Sage, Los Angeles, 307–26.Google Scholar
Kemp, C. L., Ball, M. M. and Perkins, M. M. 2013. Convoys of care: theorizing intersections of formal and informal care. Journal of Aging Studies, 27, 1, 15–29.Google Scholar
Koren, M. J. 2010. Person-centered care for nursing home residents: the culture change movement. Health Affairs, 29l, 2, 312–7.Google Scholar
LaRossa, R. 2005. Grounded theory methods and qualitative family research. Journal of Marriage and Family, 67, 4, 837–57.Google Scholar
Lloyd, L., Calnan, M., Cameron, A., Seymour, J. and Smith, R. 2014. Identity in the fourth age: perseverance, adaptation, and maintaining dignity. Ageing & Society, 34, 1, 1–19.Google Scholar
Locher, J. L., Bronstein, J., Robinson, C. O., Williams, C. and Ritchie, C. S. 2006. Ethical issues involving research conducted with homebound older adults. The Gerontologist, 46, 2, 160–4.Google Scholar
Loe, M. 2010. Doing it my way: old women, technology and wellbeing. Sociology of Health and Illness, 32, 2, 319–34.Google Scholar
Martin-Matthews, A., Sims-Gould, J. and Tong, C. E. 2013. Canada's complex and fractionalized home care context: perspectives of workers, elderly clients, family carers, and home care managers. Canadian Review of Social Policy, 68/69, 55–74.Google Scholar
Minister of Industry 2013. Immigration and Ethnocultural Diversity in Canada. National Household Survey, 2011. Statistics Canada, Catalogue Number 99-010-X2011001. Available online at http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.cfm [Accessed 20 March 2017].Google Scholar
Ministry of Health and Long-term Care 2006. Community Care Access Centres: Client Services Policy Manual. Available online at http://www.health.gov.on.ca/english/providers/pub/manuals/ccac/ccac_mn.html [Accessed 20 March 2017].Google Scholar
Moore, L., Frost, J. and Britten, N. 2015. Context and complexity: the meaning of self- management for older adults with heart disease. Sociology of Health and Illness, 37, 8, 1254–69.Google Scholar
Morden, A., Jinks, C. and Ong, B. N. 2015. Risk and self-managing chronic joint pain: looking beyond individual lifestyles and behaviour. Sociology of Health and Illness, 37, 6, 888–903.Google Scholar
Morrongiello, B. and Gottlieb, B. 2000. Self-care among older adults. Canadian Journal on Aging, 19, S1, 32–57.Google Scholar
Orbuch, T. L. 1997. People's accounts count: the sociology of accounts. Annual Review of Sociology, 23, 455–78.Google Scholar
Ory, M., DeFriese, G. and Duncker, A. 1998. The nature, extent, and modifiability of self-care behaviors in later life. In Ory, M. and DeFriese, G. (eds), Self-care in Later Life: Research, Program, and Policy Issues. Springer, New York, xv–xxvi.Google Scholar
Peckham, A., Williams, A. P. and Neysmith, S. M. 2014. Balancing formal and informal care for older persons: how case managers respond. Canadian Journal on Aging, 33, 2, 123–36.Google Scholar
Penning, M. J. 2002. Hydra revisited: substituting formal for self- and informal in-home care among older adults with disabilities. The Gerontologist, 42, 1, 4–16.Google Scholar
Plath, D. 2008. Independence in old age: the route to social exclusion? British Journal of Social Work, 38, 7, 1353–69.Google Scholar
Rozanova, J., Miller, E. A. and Wetle, T. 2016. Depictions of nursing home residents in US newspapers: successful ageing versus frailty. Ageing & Society, 36, 1, 17–41.Google Scholar
Soodeen, R.-A., Gregory, D. and Bond, J. 2007. Home care for older couples: ‘It feels like a security blanket…’. Qualitative Health Research, 17, 9, 1245–55.Google Scholar
van den Hoonard, D. K. 2005. ‘Am I doing it right?’: older widows as interview participants in qualitative research. Journal of Aging Studies, 19, 3, 393–406.Google Scholar
Wiles, J. L., Leibing, A., Guberman, N., Reeve, J. and Allen, R. E. S. 2012. The meaning of ‘aging in place’ to older people. The Gerontologist, 52, 3, 357–66.Google Scholar