Transitions in Belonging and Sense of Community in a Long-Term Care Home: Explorations in Discourse, Policy and Lived Experience
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This research examined notions of belonging and sense of community through a set of layered lenses that integrated a social model of aging with phenomenology to gain a better understanding of the lived experiences of individuals residing in a long-term care (LTC) home. Conducted in a for-profit LTC home in Ontario, this study analyzed messaging in marketing materials supplied to potential residents and their families in anticipation of a move to a LTC home and in the staff policies and procedures manuals using document and narrative analysis. Themes emerging from this phase were then compared with the first-hand experiences of living in a LTC home as told by residents through the use of a focus group (n=6) and individual interviews (n=6) and experiences of working in a LTC home as described by interviews with staff (n=6). Analysis of marketing documents revealed the theme of let us be your caring community. As messaged in these documents, the LTC home supported residents by caring, embodying the ideals of home through natural living spaces, and supporting meaningful personal connections. This contrasted with messages found in the staff policy manuals. Divided discourses highlighted the tangible complexities of implementing a person-centered philosophy within a business model by describing the industry of care, prescribed customer service, fabricating normalcy and, to a much lesser extent, promoting the practice of person-centered care. Residents’ phenomenological stories illustrated variable un/belonging within a LTC home. Personal experiences of the institutional erosion of belonging, congregate nature of living in a LTC home, changing nature of personal relationships and the prescriptive living environment routinized day-to-day experiences and provided a stark contrast between belonging in community and un/belonging in a LTC home. Weaving belonging into daily tasks described how staff members laboured daily at working to personalize LTC home living, and how they were helpless to prevent losses in community and belonging. After completing the research and analysis of the promotional materials, policy and procedures manuals, and resident and staff transcripts I conducted a broader level analysis of all four sets of themes in order to get a sense of the whole. I concluded there were five tensions of: constructing home from the outside; person-centered care within a biomedical, business model; promoting individuality in a congregate structure; synthetic connections at the expense of long-standing relationships; and fostering living in a death-indifferent culture which justified society’s need to divide and regulate. Incorporating a range of data including promotional materials, policy and procedures manuals, and the voices of both residents and staff, these tensions are not only implicit in the culture of Manor House but within the overarching structure of LTC homes in general and have deep implications on the standing and status bestowed upon older adults in Canadian culture. My intention was to bring to light the contextualized lived experiences of individuals living at Manor House and highlight the structural and social barriers that continue to produce discrimination by “problematizing” aging and subsequently fostering notions of presumably acceptable dividing practices (Foucault, 1982) within society. By examining meanings and experiences of community in a LTC home, and also recognizing the systemic, structural and cultural factors that may shape those experiences, I sought to gain a more comprehensive understanding of the lifeworlds of individuals living within a LTC home.