1.3.5 Coping with relocation
We have seen that attachment to place can be important in terms of developing and maintaining feelings of security and a sense of self-identity However, care for some people involves relocation.
Changes of place often involve people in coping with other types of change such as:
changes of role (for example from being a homeowner to being a resident of a home; or from being a hospital resident to being a resident in the community)
changes of status (for example, from being a child to adult, from being unemployed to being employed).
While the focus here is on place, the importance of these other changes needs to be taken into account. They are often interlinked. So for example a change in place may give rise to a change in role.
All change demands some personal or psychological adjustment, although some situations will be experienced as more stressful than others. People facing a move in the research by Hudson et al. saw ‘fears of (and subsequent adjustment to) a major change of environment and living circumstances’ as a major obstacle to moving (1996). How people cope with adjustment is at the heart of change. In terms of changing places this can often relate to their attachment to where they have come from and to the impact which moving may have on their self-identity which we talked about earlier in relation to issues of belonging, permanence and security.
Click to read Alison Norman's piece on 'Losing your Home'.
Activity 7: Losing your home
Click on the link above to read the piece on 'Losing your Home'. Here Alison Norman talks about what she sees as the devastating effects that moving can have on an older person. As you read the extract try to answer the following questions:
How does the author Peter Marris, who is quoted in the article, describe the experience of losing your home?
What may help people cope with a change in place?
What may be the negative effects for older people of moving into an institutional setting?
How might moving from one care setting to another increase the likelihood that older people may be less in control of the situation?
Marris equates losing your home with bereavement or losing a close relative. He comments on the anger, grief and pain experienced by people who have lost their homes through urban renewal schemes, and it is suggested that older people may experience similar feelings when moving into sheltered housing or residential care through losing their home, their neighbourhood and their possessions.
It is suggested that if people can recreate their social status and way of life within a new place then they will work through their loss.
However, older people may find it more difficult to ‘make a positive effort to identify with their new life’ and this is seen as one of the reasons for the high death rate among some older people during the first year after ‘relocation’. It is often those in poor health who do not survive the move.
For some older people moving from hospital back to their own home may be more difficult due to what Alison Norman calls a closing up of their ‘social space’. In other words, the support which they had before going into hospital may break down and this may lead the person to have far less choice over where they are discharged to, often having to move to either a residential care home or a nursing home.
For some older people entering residential or nursing home care means a devaluation of their past lives and a loss of self. In this case relocation may involve enormous loss, especially if the move has been relatively unplanned and from hospital without the opportunity to say goodbye to your home. But it could also be seen as a positive move by some offering less anxiety, more stimulation and engagement.
The research discussed in the chapter linked above suggests that the degree of control which the individual exerts over the moving process is crucial to how they adapt to such change.
Activity 8: The move to residential care
Read through the case study of Mr and Mrs Smith who moved first to a residential home and then later became separated. What are the main differences between the initial move made by the Smiths and the later moves? What factors have affected how they have coped with these changes?
Mr and Mrs Smith were a couple in their 80s who had decided to move into residential care because of the increasing frailty of Mr Smith and the stresses this placed on his wife. They chose the home partly because they already knew people there, and they appeared to settle in well. In the first interview after their move, Mrs Smith expressed relief at having more support and the reassurance of readily available help, and the couple spent some evenings visiting or being visited by other residents. Although Mr Smith complained of having ‘too much leisure’, they both felt that the purpose of their move had been achieved – the stress of caring for Mr Smith had been taken over by the staff.
Two months after their move, Mr Smith had a stroke, and was admitted to the local hospital. From there he was discharged to a nursing home nearby as the residential home did not have the staffing mix appropriate to his nursing needs. This left the couple in two different establishments. Mrs Smith could not follow her husband to the nursing home because the higher cost prohibited this and they were financing their care themselves. If the cost had been affordable, however, there were other objections – the Smiths did not know anyone at the nursing home and the move would mean leaving friends. When visited by the researcher at this time, Mrs Smith recounted the story, sometimes breaking into tears when she thought of her husband, but interspersed her story with rationalisations and justifications which seemed to be partly derived from the discussions she had had with the staff in the home and her family. She showed no anger about the decisions which had been made about her husband's care and her response seemed to be to accept the situation as one over which she had no control: Well you have to go where is suitable, haven't you’.
(Reed and Roskell Payton, 1995)
The main point to strike me about this case is the level of control the Smiths were able to exert over their first move and the subsequent loss of control. Their first move appears to have been a conscious decision on their part. They moved into a setting where they had friends and were able to adapt to their new circumstances. It has been Mr Smith's subsequent ill-health which has led to their separation.
This vulnerability has meant that he needs more nursing care and has had to be accommodated in a nursing home. They have also lost financial control over the situation. It is interesting that one of the reasons Mrs Smith did not want to move to the nursing home was because she would lose contact with her friends. So the Smiths demonstrate some attachment to the first residential home which they would lose if they both moved. By staying, Mrs Smith maintains these contacts.