2.3 Older lives and elder care homes: care and control
The de facto constitution of workhouses as ‘older’ spaces can be viewed as representing a precursor to public elder care homes as these developed later in the twentieth century. Indeed, the numbers of older people in such care homes today remains consistent with the 5 per cent of older people inhabiting workhouses at the end of the nineteenth century (Midwinter, 1997). Constituted as sites of care rather than control, these homes have nonetheless been subject to considerable critical scrutiny by social policy analysts. Their work chimes with investigations of the institutionalisation of other social groups constructed as having ‘special needs’. Emphasising the complex relationship between care and control, such investigations demonstrate the tensions between the two; with care relations providing a medium through which various forms of control can be exercised (Fink, 2004; Goldson, 2004; Shildrick, 2004). Further demonstrating how institutional environments profoundly shape individual experiences in ways that deny and delimit social rights of representation, autonomy and privacy are in widely reported accounts of elder and child abuse among ‘cared for’ groups in institutional settings. However, institutional care can also involve subtler, but nonetheless invasive, forms of control. This is illustrated by the interview extract below, in which Mrs Hatter describes a typical day in her life as an elder care home resident in the 1980s.
Extract 3 Mrs Hatter
Well, I get up by half past six, between six and half past, and of course it takes a bit longer to get dressed now … Then we have a cup to tea about seven, and they come and give you a tablet … I don't need it but you have to take it from them so then I put mine down the sink. Breakfast is at half past eight … We get a cup of tea around quarter past ten but I've already told them I won't bother this morning because I don't want them coming in. After breakfast you just have to sit … I do an awful lot of just sitting! They bring more tea and you can have a biscuit but then at half past five it's supper … But I tell you what: least said, best said about lots of things here … [There was a knock at the door and an attendant came in without waiting for a reply. He did not seem to have to come in for any particular reason and looked around and went out again.] You see, that's the trouble with this place [she whispered]. Often they don't even knock. I told them not to come in today.
The presence of paid carers in shaping Mrs Hatter's experience of living in residential care is clearly important. Paid carers intervene in some of the most intimate aspects of our personal lives: a feature that shapes the experiences of both carer and those for whom they care. In the account Mrs Hatter provides, it is apparent that the interventions of paid carers and her response to them give structure to the day. It is also clear that dimensions of ‘control’ are present: a feature that evokes subtle forms of resistance as Mrs Hatter attempts to define and maintain her personal boundaries and space. Therefore, although workhouses represented a harsher and more overtly controlling environment for older (and other) social groups, the controls mediated through practices of care in elder residential homes of the present are also apparent. This theme of control marks an important point of continuity between the two periods, in terms of constituting and delimiting how older people living within such environments experienced and experience their personal lives.
The growth of specialised elder care places such as sheltered housing, residential and nursing homes, provided the basis for an increasing commodification of care, and so created a growing and largely low-paid sector of care workers. Further, the composition of this workforce both mirrors and reproduces ingrained patterns of inequality mapped around differences of class, gender, and ethnicity. Further, these patterns of labour market inequality, as suggested below, often have a negative effect on the retirement incomes of such low-paid workers.
Take a moment to study Figures 2, 3 and 4. As you do, think about the ways in which older people are constructed within them. Now read Extract 4, which describes the marketing of Sun Cities, a number of ‘designer’ retirement communities in the USA. What images of old age are suggested by this extract? How, and in what ways, do these differ from the constructions of older people represented in preceding images?
Extract 4 Sun Cities
Coloured brochures show golfing couples on a fairway in front of an artificial pond … Other images include a team of women syncronized swimmers, lawn bowlers and a couple in formal wear enjoying ‘fun-filled evenings out on the town in neighbouring Palm Springs’ … The level of activity in these images suggests that the reader could be perusing a brochure for a resort instead of a retirement community. The resort image is continued in an advertisement for a ‘very affordable resort-style getaway’ that invites potential residents to ‘try it before you buy it’. Packages ‘include deluxe accommodations, free 18 holes of golf, and access to our multi-million dollar recreational facilities, where you can play tennis, lounge by the pools and more’. Like cruise ships, Sun Cities are relatively self-contained. But, as with a cruise, residents can ‘go ashore’ to purchase goods and services not available on board.
The images and extract are all focused on the experience of being older, and offer descriptions and representations of older spaces. Figure 2 showing older people with a carer in a public care home is perhaps one we are most familiar with. Here, it is clear that older people are being constructed as dependent, and so ‘other’ to the socially constituted ‘norm’ of an independent adult (paid) worker. Studies exploring the way in which older people are constructed within photographic representations indicate this to be the dominant form of representation (Johnson and Bytheway, 1997). Thinking about the inter-generational relationship suggested by the care home image, it is also apparent that older people are being shown as dependent on younger people; a feature concealing the ways older people themselves are often implicated in giving care to spouses, adult off-spring, grandchildren, friends and others (Fink, 2004).
Figure 3 also sets the two older people apart, in the sense they have just bought a private residential development specifically built for older people. The humour of the image and the related newspaper feature suggests an implicit ageism, but nonetheless seems to invite us to share in the good fortune of the couple as they move into their new and relatively spacious accommodation. The marketing image for similar retirement ‘cottages’ in the same area, depicts a seemingly idealised image of an older, heterosexual white couple. The image of older age outlined in Extract 4 turns on active and conspicuous consumption. Living in Sun Cities is clearly only an option for relatively affluent older people who have accumulated significant amounts of wealth during their working lives. Further, it suggests an image of older age characterised by a lack of ethnic and sexual diversity, and exudes a sense of a youthful, mobile and independent older age.
All three contrasting representations are anchored in the material; in that the personal lives they represent evidence obvious and apparent economic differences and inequalities permeated by class inequality. This is most apparent in the case of Extract 4, which is predicated on wealth, and contrasts sharply with the relatively impoverished background of the elder care home. As we move through the following section, try to hold these different images of older age in your mind and think about how the different policies we explore might have been implicated in shaping the personal lives they suggest. For example, what kind of pension and employment biography might you imagine for the Sun Cities resident or the women living in the elder care home?