The Age of Supported Independence - Voices of In-home Care

"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:"