Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to (...) explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. (shrink)

In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents’ health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the (...) continuation of the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: preventability of foreseeable harm, moral agency, moral character, and moral practice (in MacIntyre’s sense). Moral character is discussed in the context of prudent versus proportionate choices. As to moral practice, it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents’ interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively. (shrink)

BackgroundThe existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values...

Infectious disease outbreaks in residential care are complex to manage and difficult to control. Research in this setting that includes individuals who lack capacity must conform to national legislation. We report here on our study that is investigating outbreaks of scabies, an itchy skin infection, in the residential care setting in the southeast of England. There appears to be a gap in legislative advice regarding the inclusion of people who lack capacity in research that takes place (...) during time-limited acute scenarios such as outbreaks. We received inconsistent advice from experts regarding, in particular, the role of nominated consultees. There is a potential inequality for vulnerable populations who cannot themselves provide informed consent in terms of their access to participation in a range of health-related research. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people (...) with intellectual disabilities.Methods:Ethnographic field study.Ethical considerations:The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Ethical challenges are traditionally described in a negative light, even though moral conflict can express the individual ability to perceive when something is not working and promote change. The true question, therefore, is not to how to silence moral conflict but how to educate it. Although the need for ethical support of health- and social-care professionals in elderly care is clearly perceived, there is no universal method for providing effective interventions. The authors hypothesize that adequate training sessions can (...) help care professionals enhance this skill, once clear goals and specific educational techniques are set. This research tests the hypothesis on twenty care professionals working in acute and residential care settings for the elderly, building on the ethics round method. Mixed methods drawn from literature and the experience of educators were adapted to meet different educational goals. Moral issues can hardly be removed from a context characterized by increasing demand and decreasing resources, but they can be recognized and addressed with common efforts, a critical attitude, and a growth mindset. Enhancing these skills in qualified workers can help them accept the reality of work, release pressure, and identify common team goals. Introducing these skills before graduation can help future workers avoid unreal expectations and reduce frustration and early job quit rates. (shrink)

This study examines the use of praise in caregiving of nursing home residents with dementia in Sweden. The data consist of video-recordings of staff–resident interaction in residential care settings where caregivers assist residents with personal hygiene. High-grade assessments accomplishing praise or a compliment such as ‘jättebra’ are routinely used online, simultaneously with the care activity, by the caregiver when the residents are requested to undertake manual tasks on their own, such as tooth brushing, washing, dressing, and getting (...) out of bed. It is shown that the primary function of the assessments is to encourage someone to do something, which is discussed as an institutionally related problem. These results contrast with prior research on domiciliary care in Sweden and Denmark, which show that high-grade assessment terms formulated so as to accomplish praise or a compliment are reserved for situations where the home helper’s institutional role as the senior citizen’s helping hand is downplayed. It is argued that a more sensitive use of assessments and a higher awareness of the social norms concerning epistemic primacy may be a step toward implementing person-centeredness in residential care for older people. (shrink)

There has been little previous research regarding the effectiveness of ethics education interventions for residential care‐givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care‐givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face‐to‐face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was (...) also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work‐related moral stress in the teaching arm compared with control group (p =.03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education. (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

In this article, we explore the organization of assistance in multilingual interaction in Swedish residential care. The data that form the basis for the study cover care encounters involving three residents with a language background other than Swedish, totalling 13 hours and 14 minutes of video documentation. The empirical data consists of a collection of 134 instances where residents seek assistance with the realization of a practical action. For this article, three examples that involve the manipulation of (...) an object have been selected for analysis. We use the concept of ‘recruitment’ to encompass the various methods by which assistance is sought in the care encounter. In the first example, the need for assistance concerns the transfer of an object that is recognizable and physically available for both participants. This, in combination with the resident’s gestural work that pinpoints the description of the action, facilitates its realization. In the second and third examples, the realization of the action becomes more difficult because the object involved is not recognizable for the caregiver. The article highlights the collaborative ways in which residents manage to support their talk through bodily practices, and the strong and empathetic engagement with which caregivers become involved in interpreting the meaning of these practices. Finally, we discuss the implications of our findings for care provision in multilingual circumstances. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals (...) and ethicists working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

Client participation in elderly care organizations requires shifting traditional power relations and establishing communicative action that involves the lifeworlds of clients and professionals alike. This article describes a particular form of client participation in which one client was part of a team of professionals in a residential care home. Their joint remit was to plan the implementation of a new personal care file for residents. We describe the interactions within this team through an ethnodrama, based on (...) participant observations and the embodied presence of the researcher (first author). The narratives and voices of all team members are dramatized in this ethnodrama. Throughout the project the team members experienced confusion relating to the confrontation between lifeworld and system, as experienced by the client and professionals in the team. We analyze these tensions by making use of a Habermasian theoretical framework. We conclude that forms for collective client participation in residential care homes should be developed based on communicative action between clients and professionals, with room for emotional engagement. (shrink)

Client participation in elderly care organizations requires shifting traditional power relations and establishing communicative action that involves the lifeworlds of clients and professionals alike. This article describes a particular form of client participation in which one client was part of a team of professionals in a residential care home. Their joint remit was to plan the implementation of a new personal care file for residents. We describe the interactions within this team through an ethnodrama, based on (...) participant observations and the embodied presence of the researcher (first author). The narratives and voices of all team members are dramatized in this ethnodrama. Throughout the project the team members experienced confusion relating to the confrontation between lifeworld and system, as experienced by the client and professionals in the team. We analyze these tensions by making use of a Habermasian theoretical framework. We conclude that forms for collective client participation in residential care homes should be developed based on communicative action between clients and professionals, with room for emotional engagement. (shrink)

Die Pflegequalitätsprüfungen nach § 114 ff SGB XI und die Begehungen der FQA (ehemals Heimaufsicht) wurden mit Abklingen der Pandemie wieder aufgenommen. Trotz der Einführung eines neuen Prüfinstruments führt dies weiterhin zu Irritationen und auch ethisch gerahmten Problemen in der Praxis. Dies war ab Sommer 2021 Gegenstand eines Beratungsprozesses im Ethikbeirat der Hilfe im Alter gGmbH der Inneren Mission München, Diakonie München und Oberbayern und führte zu einer Bearbeitung in der Frühjahrssitzung 2022 mit Vertretern des StMGP (Staatsministerium für Gesundheit und (...) Pflege, heute StMGPP) und des MDB (medizinischer Dienst Bayern, der im Auftrag der gesetzlichen Kranken- und Pflegeversicherung tätige medizinische und pflegerische Beratungs- und Begutachtungsdienst), sowie zu einem konsentierten Papier des Beirats. Die Ziele der Prüfung, die Prozesse dazu in den Einrichtungen und ihre Auswirkungen auf die pflegebedürftigen Menschen und das Pflegepersonal wurden darin unter ethischen Gesichtspunkten thematisiert. Auch wenn die Notwendigkeit einer externen Kontrolle nicht grundsätzlich in Frage gestellt wird, ist der Aufwand für die Indikatorenerhebung, die Herausforderung des Fachgesprächs und die Art und Weise der Ergebnisformulierung weiterhin kritisch zu diskutieren und weiter zu entwickeln. Es zeigt sich die organisationsethische Relevanz der Pflegequalitätsprüfung sowohl hinsichtlich der strukturellen Verankerung im einrichtungseigenen Qualitätsmanagement als auch hinsichtlich der Notwendigkeit einer Beteiligungskultur der Betroffenen. Damit wurde einmal mehr evident, wie wichtig das Anliegen des Ethikbeirats „Betroffene zu Beteiligten zu machen“ für die Mitarbeitenden und die Kultur der Einrichtungen ist, aber auch für alle anderen Ebenen der Versorgung und politischen Willensbildung, die hierfür verantwortlich Entscheidungen treffen. (shrink)

Despite the centrality of the term within the title, the meaning of ?care? in residential child care remains largely unexplored. Shifting discourses of residential child care have taken it from the private into the public domain. Using a care ethics perspective, we argue that public care needs to move beyond its current instrumental focus to articulate a broader ontological purpose, informed by what is required to promote children's growth and flourishing. This depends upon (...) the establishment of caring relationships enacted within the lifespaces shared by children and those caring for them. We explore some of the central features of caring in the lifespace and conclude that residential child care is best considered to be a practical/moral endeavour rather than the technical/rational one it has become. It requires morally active, reflexive practitioners and containing environments. (shrink)

Residential child care in Scotland has seen huge changes over the last thirty years, arguably as a consequence of a number of UK wide inquiries into failings within the system (Corby, Doig, and Rob...

Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised (...) case study of a couple—Norm and Carol—who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol’s presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how (...) important aspects of care are constantly negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

Recording is a task often perceived by residential child care workers as boring or taking time away from the ‘real work’, direct engagement with young people. It is required by legislation and policy but has been undertheorized and treated as a technical/rational task. In this essay, Foucauldian and feminist perspectives are applied to shift recording, a routine aspect of residential practice, in order to problematize the positivist approach assumed in legislation and policy. The analysis suggests that this (...) approach represses emotional aspects of care and subjugates particular forms of knowledge, such as young people’s experiences. Recording inevitably involves ethical choices and treating it as technical/rational task obscures its ethical implications. This essay concludes that greater attention needs to be given to the ethical aspects of shift recording in order to challenge practice that oppresses young people by failing to recognize their individuality and silencing their voices. (shrink)

People with dementia at times exhibit threatening and physically aggressive behavior toward care staff in residential aged care facilities (RACFs). Current clinical guidelines recommend judicious use of antipsychotic (AP) medications when there is an immediate risk of harm to care staff in RACFs and non-pharmacological interventions have failed to avert the threats. This article examines an account of how this recommendation can be ethically defensible: caregivers in RACFs may have a prima facie ethical justification, in certain (...) cases, to use APs as an act of self-defense. The author examines whether such uses of APs meet the three commonly invoked conditions of ethically permissible acts of self-defense—namely, the conditions of liability, proportionality, and necessity—and argues that such conditions obtain only in a restricted range of cases. The liability constraint can be satisfied if residents are the only ones who are causally responsible for the threats they pose. Further, the condition of proportionality obtains if there is sufficient objective ground to demonstrate that the harm of using the medications does not outweigh the good to be secured. Lastly, the necessity condition obtains when the medications are used at their lowest effective dosage and caregivers in RACFs can reasonably assume that, for the purpose of averting threats posed by residents, the use of APs is the only available course of action. Not meeting any of these fairly stringent conditions renders uses of APs as acts of self-defense in RACFs morally impermissible actions. -/- . (shrink)

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to (...) explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. (shrink)

Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose. For older people with dementia living in residential aged care facilities (RACFs), however, the issue becomes more complex. Staff often struggle to balance residents' rights with their duty of care, and negative attitudes towards (...) older people's sexuality can lead to residents' sexual expression being overlooked, ignored, or even discouraged. In particular, questions as to whether residents with dementia are able to consent to sexual activity or physically intimate relationships pose a challenge to RACF staff, and current legislation does little to assist them. This paper will address these issues, and will argue that, while every effort should be made to ensure that no resident comes to harm, RACFs must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships. (shrink)

The aim of this article is to reveal how care workers in the home-help services handle the process when older people’s relocation to a residential home is under consideration. Since the care workers are engaged daily in defining care receivers’ needs and yet have no formal influence on care decisions in Sweden, the focus is on how they solve this dilemma. In this inductive study, the theoretical framework is based on occupational alliances, relationship-based practice, and (...) discretion. Thirty-three care workers in home-help services are included in open semi-structured interviews. Prominent features in the findings are that the care workers take their stand at the borderland of care management, when they know or try to find out what is right. The conclusions drawn are that care workers find ways to informally influence the decision-making process, quite contrary to the idea of approaches referred to as purchaser/provider models. The implications for social work policy and practice are that a distinction between assessment and intervention may not benefit the field of eldercare and should therefore be regarded as an area in need of thorough reconsideration. (shrink)

The practical and ethical issues associated with obtaining informed consent from children and young people living in residential state care for their participation in a research study are explored in this paper. Research involving the participation of these young people has received comparatively limited attention in the social sciences: this is due to several reasons including the challenging methodological and ethical issues associated with undertaking such research. These can be categorized as the practical issues of gaining direct contact (...) with these young people through gaining the consent of relevant gatekeepers and the process of gaining a favourable opinion from a research ethics committee. Whilst the principles of clarity and consistency of practice are key elements in the process of accessing consent to participate in research, flexibility and imagination are also important skills for the researcher when developing the appropriate protocols for research in an area of social policy which can be methodologically and ethically complex. (shrink)

Residents’ councils in Quebec’s residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can express themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what (...) makes management receptive, or not, to what the committee members say. The councils’ ability to express them selves is, in fact, inseparable from its capacity to listen to the management teams, and we seek to determine the conditions required to perform this dual capacity. (shrink)

During the past thirty years a high proportion of all long stay hospital beds have been closed. The responsibility for those who would have occupied those beds previously has to a large extent been transferred from health to social services departments, or to family, voluntary and private care. The overall effect has been to prioritize acute medical care, and to expose the public provision and funding of long term residential care, whether medical or social, to the (...) direct determination of political and economic forces. These policy changes have been introduced under the banner of community care, but are dependent on complex concepts which are morally contentious and often obscure. The purpose of this paper is to analyse these processes as a prerequisite to devising better policies in future. (shrink)

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care‐givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care‐givers to assume the profile of elderly care‐recipients for a 24‐hr period. The care‐givers were student nurses. The (...) project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those “most delicate and evanescent of moments,” for the sustainability of ethical care. (shrink)

Human death is a mystery. Although scientists have identified the criteria, states, and signs of biological death, undoubtedly the issues of dying and death have a wider meaning. In this book, the authors present current research in the study of the ethical issues, practices and challenges of end-of-life care. Topics discussed include a spiritual perspective of end-of-life experiences; a veterinary oncologist's interprofessional crossover perspective of euthanasia for terminal patients; diabetes and end-of-life care; helping families to cope after the (...) death of a loved one; multidimensional aspects of nursing care for dying patients; spirituality at the end-of-life; challenges of promoting end-of-life care in residential care homes in Hong Kong; and the current situation and challenges of home end-of-life care for the elderly in Japan. (shrink)

There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called ‘culture change’. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project (...) is presented as a case study. This study examines what has contributed to the improvement of participation of older people with dementia in daily occupational and leisure activities according to practitioners. Data was collected by participant observation, interviews and focus groups. The results show that simultaneous to the improvement of the older people’s involvement in daily activities a cultural transformation took place and that the care became more person-centred. Spontaneous interactions and responses rather than planned interventions, analysis and reflection contributed to this. Furthermore, it proved to be beneficial that the process of change and the facilitation of that process reflected the same values as those underlying the cultural change. It is concluded that changes arise from dynamic, interactive and non-linear processes which are complex in nature and difficult to predict and to control. Nevertheless, managers and facilitators can facilitate such change by generating movement through the introduction of small focused projects that meet the stakeholders’ needs, by creating conditions for interaction and sense making, and by promoting the new desired cultural values. (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more (...) autonomy in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

This paper examines extracts from a daughter’s blog about her father’s time in a care home in the north of England from June 2015 until his death in January 2016. Through these extracts, the author of the paper, who is also the daughter of the title, provokes key ethical issues concerning the identity, agency and voice of an elder in the context of residential care. The wider, rapidly deteriorating, political and economic climate for the care of (...) older people is briefly discussed and the paper makes reference to a feminist ethics of care, in order to both critique and celebrate women’s central place in caring for elders. The paper explores how the ethnographic process of writing about care for another can be considered a route to ethical care practice and it suggests that this blog is part of an autoethnographic analytic tradition [Anderson 2006. “Analytic Autoethnography.” Journal of Contemporary Ethnography 35 (4): 373–395]. Finally, the paper asks questions about the ethics of blogging about and on behalf of an elder that, in this case, played a significant role in bringing not only the daughter-author but also other family members closer to the life of their father, grandfather and great-grandfather. (shrink)

In this paper I examine the intracultural variability of parental and alloparental caregiving among the Aka foragers of the Central African Republic. It has been suggested that maternal kin offer higher frequencies of allocare than paternal kin and that maternal investment in infants will decrease when alloparental assistance is provided. Behavioral observations were conducted on 15 eight- to twelve-monthold infants. The practice of brideservice and the flexibility of Aka residence patterns offered a means to test the effect of maternal residence (...) on parental and alloparental investment. There was significant variation in the frequency of investment and who supplied care to infants depending on whether mothers resided with their kin or their husbands’ kin. However, in spite of the variation in allocare, when all categories of caregivers were examined collectively, infants received similar overall levels of care. (shrink)

We explore our role as researchers and witnesses in the context of an emerging partnership with the Penelakut Tribe, the aim of which is to locate the unmarked graves of children who died while attending the notorious Kuper Island Indian Residential School on their territory (southwest British Columbia). This relationship is in the process of taking shape, so we focus on understanding conditions for developing trust, and the interactional expertise necessary to work well together, with a good heart. We (...) suggest that, in some respects, this may be usefully understood as a practice of witnessing on several dimensions. (shrink)

Paper-based stool records are used in public and private residential homes throughout Denmark. Although they represent a simple technology, they are an important tool in ensuring proper personal hygiene for residents. This article shows how the use of stool records involves both scientific and everyday forms of knowledge. While the activity of keeping stool records derives its legitimation from the scientific study of feces, those who work with the stool records on a daily basis have found some very different (...) applications for the technology. These applications foster a variety of understandings of stool records in residential homes. Is it their aim to help satisfy biological needs? Is it to ensure control? Is it to ensure individual freedom? Is it to ensure efficiency? Is it to display professionalism? Is it to maintain order in the everyday operation of the residential home? To explore the answers to these questions, the article introduces insight from the work of the German sociologist Niklas Luhmann that bear upon how a mundane technology like stool records can function as a mediator between theory and practice, the body and the social, and between different care tasks in residential homes. (shrink)

In this paper I examine the intracultural variability of parental and alloparental caregiving among the Aka foragers of the Central African Republic. It has been suggested that maternal kin offer higher frequencies of allocare than paternal kin and that maternal investment in infants will decrease when alloparental assistance is provided. Behavioral observations were conducted on 15 eight- to twelve-monthold infants. The practice of brideservice and the flexibility of Aka residence patterns offered a means to test the effect of maternal residence (...) on parental and alloparental investment. There was significant variation in the frequency of investment and who supplied care to infants depending on whether mothers resided with their kin or their husbands’ kin. However, in spite of the variation in allocare, when all categories of caregivers were examined collectively, infants received similar overall levels of care. (shrink)

Monique Lanoix convincingly argues that what she calls ancillary work requires both communicative and strategic action. As she makes clear, in residential care communicative work is foundational both because strategic speech acts are not enough to fulfill the needs of either residents or care providers and because the space in which they live and work is a home; it is not a system but a lifeworld. As is the case with most interesting articles, this one prompts expansion (...) and additional questions that further complicate the work. I raise some of them below with the goal of promoting further development of the complex issues she addresses. While there are multiple spaces for complementary discussion, I .. (shrink)

Based on an ethnographic study in a Danish residential care center, this article shows how the interplay of a sensor-floor technology and currently influential values of person-centeredness, privacy, and security in care transforms care work and care interactions between residents and care workers. Based on an understanding of care as realized in a heterogeneous collective of human and nonhuman actors, this article illustrates how new modes of monitoring and interpreting residents’ care needs (...) at a distance arise, and how a new organization of work focusing on quick and responsive care is established. These new care practices lead to conflicts between the values of privacy and security, to ambivalent experiences among care workers of simultaneously increased security and insecurity in work, and, paradoxically, also often to a decentering rather than person-centering of care. Instead of accommodating simultaneous compliance to the values of privacy, security, and person-centeredness, the use of the sensor-floors makes the tensions between these values continuously and loudly present in daily care practices. (shrink)

Christians care for orphans and children without parental care in different forms. However, in the Global South, care is primarily provided in orphanages or large residential settings. Despite good intentions, there are limitations to provide a nurturing family environment for the children in such care environment. With current knowledge of alternative child care and in light of the holistic ministry, this article suggests an approach for the church to care for orphans and children (...) at risk by focusing on the family and the local community. Additionally, simple steps to transition to holistic orphan care are offered. (shrink)

One of the most important goals of out of home placements is to reduce vulnerability and to enable well-being in the long term. This article hermeneutically reconstructs biographies decades after leaving-care to understand the impact of residential care experiences on selected dimensions of care-leavers’ well-being, that were discovered in the data material. For this article three analytic areas were selected from the core of the narratives of former care leavers: Social networks, parenthood and state interventions. (...) The selected findings on long-term outcomes presented here are based on a qualitative research project funded by the Swiss National Science Foundation on life trajectories after residential care. The authors have conducted 37 biographical narrative interviews with former children placed in residential care between 1950 and 1990 in the Canton of Zurich, Switzerland. The analysis of these narrative interviews was structured by the inductive procedures of Grounded Theory. Its foundation is the conceptualisation and dimensionalisation of data through inductive coding within the narratives. Research question: We mainly were interested in aspects of transitions exclusively relevant from the actors’ point of view. The objective of this paper is to learn for the future by taking biographical experiences and long-term outcome in account. As we know residential care facilities have changed in last decades, but structurally some key figures are still continuing. They still interrupt the life course two times: when you start to the live in the institution and when you leave. One main question is how young people manage to integrate residential experiences through their life course and where they keep on struggling until the end of their lives. From a life-course perspective, the impact of social service intention on individual life courses, behind sending the individuals to such facilities, are important to investigate. They implicate relevant information concerning current practice and impact of placing children in residential care. Social networks and experiences of parenthood show why we must frame and accompany transitions out of care. (shrink)

Older people living in a residential setting have the right to respectful care based on professional ethics. The aim of this study was to describe employees' and clients' lived experiences of elder abuse. A qualitative phenomenological method was used with 26 employees and 20 residents from four homes for elderly people in the town of Ostrava, Czech Republic, and two managers from outside these institutions. All complaints about elder abuse (n 5 11) received by Ostrava Municipal Authority during (...) the period 2003 to 2007 were examined. Two main dimensions of the examined phenomenon were identified: forms of elder abuse and causes of elder abuse. Established forms of elder abuse were summarized as rights violation, financial abuse, psychological abuse, physical abuse and neglect. Causes of elder abuse included institution, employee and client characteristics. It is necessary in residential settings to create preventive policies that will focus on supervision regarding elderly people's rights violation and psychological and physical abuse, as well as on building organizational cultures that will respect ethical principles. (shrink)

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the (...) North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention. (shrink)