“THE SENSE OF HOME IN FEMALE RESIDENTS OF CARE HOMES: THE RELEVANCE OF RECIPROCAL RELATIONSHIP-A QUALITATIVE STUDY”
Faculty of Health and Life Sciences
MSc Psychology – Blended learning 2016/2019
Index
Abstract…….. 3
Introduction….. 4
Literature Review …… 6
Method
Results
Discussion
References
Appendices
Abstract
Introduction
The sense of home in care homes is a crucial factor of consideration due to its dependence on multifactorial phenomena. Such factors have been viewed as essential in improving the sense of identity and wellbeing of residents in care homes. In most cases, people are taken to such homes due to an increased need for special assistance as well as the vulnerability of their well-being in society (Falk et al. 2013). People in such homes are always in need of social support rather than increased medical concerns. Therefore, the arrangement of care homes should focus on the homelike feeling notions rather than the primary organisation of the healthcare facility. However, creating a sense of home has been viewed as a challenging task due to differences in personal and social characteristics of the residents (Hoof et al. 2016).
The arrangement of the care homes can be understood in terms of physical, social and psychological or emotional environments which seek to provide a homelike identity. In this case, therefore, phenomenon factors which are the subset of physical and psychological environments are of critical consideration in providing the needed assistance (Ryan and McKenna 2015). Social interactions that arise within the homes and factors that contribute to such interactions may be a crucial predictor of the sense of home outcomes for the residents of care homes.
Purpose of the Study
The above background information has postulated the existence of specific factors that are needed in increasing the sense of homes for residents of care homes. In that case, the primary focus of this study is a qualitative analysis regarding the impact of relationships on the sense of home for female residents in care homes. Additionally, the study seeks to analyse the relevance of reciprocal relationships on the sense of home for residents in care homes. Therefore, the crucial factors regarding development and changes in the relationships for residents in care homes would be of critical concern to the study.
Study Questions
The current study seeks to answer the following questions:
1. How does the relationship affect the sense of home on female residents?
2. What are the crucial factors contributing to the homelike feeling?
3. What is the relevance of reciprocal relationships on the sense of home?
Conceptual Framework
The current study is based on the development of a sense of home among residents in care homes by the use of relationship as the contributing factor. Therefore, the research is anchored on the assumption that reciprocal relationship for female residents can have a significant impact on the sense of home in care homes. Organising the care home environments in the manner that there is increased social interaction with other members of the public would be salient in bringing the ideals of homelike feeling to female residents. Additionally, relationships with other members in the residential care homes which may be viewed as the reciprocal relationship as well as the relationships with significant others would be seen as a critical predictor of the sense of home by the female residents. The conceptual variables are reciprocal relationships, relationships from significant others, and relationship from other members of the society.
Figure 1.1: The relationships between a sense of home and other variables
Chapter One: Literature Review
1.1 Homelike Feeling: The Importance of Feeling at Home
The relevance of homelike feeling for the residents in care homes can be viewed on how powerful it is in view of the physical and psychological well-being. Rijnaard et al. (2016) conducted a systematic review of the factors that influence the feeling of home in care centres. The study found out that the sense of is established by the interactions of the family members with the residents and considered as a crucial remedy in the improvement of well-being. The finding is corroborated by Boer et al. (2018) who observe that good physical environment is essential for people living in care homes. Similarly, studies show that increased interaction is vital for treating individuals particularly those suffering from dementia in care homes (Rijnaard et al. 2016; Wang et al. 2018; and Smith et al. 2017). Brown Wilson et al. (2013) agrees with the above finding by stating that frequent visits meant to improve homelike feeling is encouraged in the care homes. However, Hoof et al. (2016) present contracting that such interactions cannot be termed as an automatic factor leading to the increased homelike feeling since it depends on social and personal attributes which vary from one resident to the other. Moreover, Hoof et al. (2016) assert that the sense of home is a gradual process that takes time to develop to accommodate specifications for everyone in a care home.
Falk et al. (2013) carried out a research on the sense of home within residential care and reported that three dimensions are involved; the attachment to place, circumstances for creating attachment, and the institution. Similarly, Brown Wilson et al. (2013) report that psychosocial processes the entail both shared beliefs and attitudes are equally important. Wang et al. (2018) point out that the value of homelike feeling for the residents of care homes is that it eliminates the social isolation and loneliness. The finding is emphasised by Kihlgren et al. (2015) who found that social isolation is typical when the care institution no longer supports the ideals of community and homeliness. The authors further observe that health issues such as depression are common when family visits are limited, and the homelike feeling is eliminated in care environments. Hall, Dodd, and Higginson (2014) conducted qualitative research involving residents, community nurses, staff, and families. The study revealed that the relevance or the importance of the homelike feeling could be viewed on its ability to foster continuity and dignity of residents. Congruently, Boer et al. (2018) note that homelike environment that is created in the care home is essential in influencing the daily activities and social interaction of the residents. The author’s emphasis that the rationale of this is the increased impact in the treatment of people with dementia especially the provision of a familiar, homelike atmosphere. Studies have suggested that homelike environments have been critical in offering social support, familiarity and security to residents in care homes (Kolk et al. 2018; Hall, Dodd, and Higginson 2014; and Falk et al. 2013).
Furthermore, studies have indicated that homelike environment for the residents in care homes has been the most appropriate therapeutic remedy especially considering the frail nature of the elderly (Hoof et al. 2016; Wang et al. 2018). The homelike feeling is essential since it develops a sense of self-governance that is critical to the establishment of self-identity for the residents in care homes. Although Nakrem et al. (2013) indicate that allowing residents to carry out their chores improves their freedom and self-governing, Hoof et al. (2016) offer a divergent view that some of them prefer when most of the tasks are being taken care of by others. However, Brown Wilson et al. (2013) agree with the findings of Nakrem et al. (2013) by suggesting that giving the residents an opportunity to exercise freedom is essential in the promotion of homelike feeling. Similarly, Hoof et al. (2016) found out that homelike environments are viewed as potential spaces to foster social belonging, independence, and recognition which are essential in improving the wellbeing of the residents.
1.2 Ageing and Changes on Social Support
Ageing has been associated with increased disabilities such as the inability to perform daily activities as well as the engagement in social networks. Kihlgren et al. (2015) conducted study on the reciprocal relationships among elderly persons in Sweden. The authors found out that the elderly see ageing as threatening their sense of significance, and as a result, they tend to experience multiples losses. The finding is corroborated by Wang et al. (2018) who argue that the perceived frailty of the elderly leads to the loss of trust in the functioning of their bodies. As a consequence, Kihlgren et al. (2015) observe that this group of people concentrates their physical mental and social functioning in their homes which leads to increased social concerns. In addition, the authors point out that these social concerns become the basis of the establishment of active ageing.
According to Wang et al. (2018), active ageing has been associated with an increased individual ability to perform instrumental activities of daily living independently. The researchers further stress that ageing and social support correlate because old people tend to keep contact with friends and relative for emotional, social support. The finding is supported by Cho et al. (2017) who state that residents in care homes indicated that the facility was essential in maintaining their physical and cognitive functions as part of active ageing. Congruently, the two studies reveal the role played by care homes in developing a sense of continuity for the residents.
According to Wang et al. (2018) social support is a form of help that arises from interpersonal social networks which may include the relationship between individual residents with other residents. The authors argue that such support has been a crucial predictor of the ability to perform crucial activities of daily life among the residents in care homes. Similarly, Smith et al. (2017) state that ageing calls for increased social support to foster and maintain interactions necessary for increasing self-efficacy and improving well-being for the elderly population. Moreover, Parsons et al. (2013) observe that due to increased physical and social disability associated with ageing; old people are viewed as the potential recipient of social support. Contrastingly, a study by Wang et al. (2018) indicates that there is a shift in such a paradigm since older adults are seen as a potential source of social support to other members of society. The authors emphasise that social support becomes a mutual phenomenon in the sense that the elderly population receives social support and provide the same.
According to Smith et al. (2017), older adults have increased chances of experiencing higher levels of loneliness which ideally means increased demands of social support. The argument is reinforced by Parsons et al. (2013) who found out that as people age, they encounter significant life events that tend to isolate them from society hence increasing the need for social support. Studies suggest that retirement, health complications, and moving to care homes decrease social interactions of older members of the society thereby necessitating social support (Wang et al. 2018; Cho et al. 2017; and Kihlgren et al. 2015). Similarly, Smith et al., 2017 state that such an event has been associated with reduced physical activities levels for the elderly population which significantly shows elevated levels of social isolation. Moreover, Kihlgren et al. (2015) state that alienation and loneliness increase with age but can be reversed by enhancing social support. Studies suggest that the model of care plays a protective role that seeks to bring the residents close to the activities happening in the wider society (Kihlgren et al. 2015; Parsons et al. 2013). Furthermore, Kihlgren et al. (2015) found that elderly individuals use television to connect with activities and the events happening in society hence instilling a sense of belonging.
1.3 Living in a Care Home
In most cases living in a care home is construed to be where one or more residents are housed with limited geographical movement. Living in such facilities have also been viewed in terms of improving health. According to Dijck-Heinem et al. (2014), transforming these shelters to become homes for the residents requires favourable conditions that promote the sense of homelike feeling. Similarly, Cho et al. (2017) state that the surroundings of the care homes should facilitate ambulatory exercises essential in increasing movements to foster the development of meaningful interpersonal relationships. The arguments are supported by Wang et al. (2018) who report that living in such care homes means contributes to the feeling of connectedness. In their study, the authors point out that the elderly population is perceived to have a positive attitude towards the facility. Additionally, Kihlgren et al. (2015) assert that living in a care home can strengthen an individual’s resolve to engage meaningful daily life activities as well as maintaining routines and habits.
According to Nakrem et al. (2013), the decision to live in a care home is necessitated by various factors which seem to affect the well-being of the elderly population. Reed et al. (2012) identify the quality of life of the elderly, reduced mobility, social isolation, and mental health as crucial issues prompting people to opt for a care home. In this regard, Boer et al. (2018) emphasise that the care home environment needs to offer treatment or remedy for the pressing issues. Similarly, Reed et al. (2012) observe that poor quality of housing and insufficient heating are among significant problem prompting people to sign up for a care home. In addition, the authors noted that other non-health issues include employment and retirement which generally affect older adult’s economic status and subsequent quality of life. According to a report by Heath (2011), living in care homes should be characterised by a feeling of living in “one’s own home;” the fundamental human rights are a must. In essence, therefore the residents in care homes have similar rights and freedom as any other citizens of the country. The finding is corroborated by Parsons et al. (2013) who posit that there ought to be equality and fairness. Also, Heath (2011) argues that an individual should not be restricted from engaging in a consensual intimate relationship with their partners.
1.4 Factors Contributing to the Homelike Feeling
According to Hoof et al. (2016), factors that may lead to the development of a homelike feeling seek to reassure residents of their comfort and value to society. Similarly, Smith et al. (2017) note that a homelike feeling is characterised by security which enables individuals to live at least satisfactorily. The observation is supported by Parsons et al. (2013) who found out that an appropriate setting and a sense of home supports these people to connect with like-minded peers. The assertion is reinforced by Cho et al. (2017) and Eijkelenboom et al. (2017) who argue that security and comfortability constitute the environmental while the social interactions foster connectedness. However, Hoof et al. (2016) offers slightly different perspective when analysing the factors that lead to a sense of home among residents. The authors state that these issues ought to be examined through social, psychological, and physical environment lenses for a holistic understanding. (Boer et al. (2018) agree with Hoof et al. (2016) when they emphasise the importance of social factors that entail interactions and relationships with friends, family members, other residents, members of staff and other specific activities. On the other hand, psychological factors include preservations of individual culture, habit, values, and autonomy as well as coping mechanisms to the new environment (Hoof et al. 2016).
According to Rijnaard et al. (2016), social interaction which includes closeness and involvement of family members in the affairs of the residents in care homes environments is associated with homelike feeling. The findings corroborate those of Cho et al. (2017) who found that people in the care homes feel more included and more at “home” when they participate in meaningful interpersonal relationships with other members of the care homes. However, Hoof et al. (2016) pointed out that meaningful interactions among the residents and other members of the family are hindered by health issues such as dementia and ambulatory limitations. Additionally, Eijkelenboom et al. (2017) assert that environmental factors such as personal belongings are identified as crucial facets in the development of homelike feeling. The finding is supported by Hoof et al. (2016) who observed 2 percent of the residents cited personal belongings as crucial items in making them feel at home. Studies confirm that a sense of home is associated with the feeling of familiarity with others (Hoof et al. 2015; Cho et al. 2017; and Nakrem et al. 2013). Eijkelenboom et al. (2017) found out that providing a private room especially bedroom for the residents was essential in improving the sense of home. The authors argue that desire for a private room promotes privacy as well as having personal belonging around themselves. In agreement, Hoof et al. (2016) observe that for the environment to support a sense of home, the residents must feel familiar with it.
Nakrem et al. (2013) state that environmental factors such as the design of the care homes to match that of the previous residence is another crucial factor contributing to homelike feeling. In contrast, Eijkelenboom et al. (2017) report that such a design has been viewed as an architectural challenge by facility managers due to its integration to meet the requirements of creating a sense of home. The finding is corroborated by Hoof et al. (2016) who assert that in most cases specific personal belongings such as pictures have been associated with a sense of home. The authors further found out that residents do not feel the same connection with personal items as that brought by interactions with their relatives and grandchildren. Similarly, Boer et al. (2018) emphasise that a care home environmental plan and should be considered in the development of homelike feeling. The authors state that smaller spaces bridge the social distances between the caregivers thus improving social interaction which is essential in homelike feeling. The argument is supported by Hoof et al. (2016) who suggest the inclusion of public spaces which encourages community activities and other crucial social interactions.
Studies have also indicated that the environmental factors are crucial in care homes in providing person-centred care approaches and therapeutical needs which increases the effectiveness of the facility (Eijkelenboom et al. 2017; Reed et al. 2012). However, Hoof et al. (2016) present a contrasting view that even if the physical environment is deemed as a crucial factor in the development of homelike feeling, emotions and personal experiences too are predictors of sense of home. Furthermore, Hoof et al. (2016) indicate that emotional and personal issues develop crucial psychological aspects that tend to give the homelike feeling.
1.5 Elderly Inter-Relationships; Perceptions and Expectations
According to Parsons et al. (2013), the interrelationships in care homes have been looked at in terms of the ways in which older adults help each other to cope in different situations. The observation is supported by Milligan (2016) argues that this form of relationship is explained based on reciprocity since there are mutual benefits within residents in care homes. The authors further state that such interrelationships have been crucial in allowing residents with physical disabilities to benefit from their peers and help in creating networks. Eijkelenboom et al. (2017) point out that the perceptions in such interrelationships are that residents would benefit from each other physically and financially. Similarly, Milligan (2016) indicates that reciprocal relationships may arise leading to social and emotional sustenance. The residents can provide their social support to each other thus increasing a sense of community network. However, Cho et al. (2017) offer a divergent view by arguing that since the expectation of the elderly is to gain meaningful interpersonal relationship, lack of such aspect leads to increased loneliness that affects their sense of belonging.
The expectation of the inter-relationship among the elderly in care homes has been associated with decreased levels of social dysfunctions. Watson (2019) terms the condition as social death since it limits individual ability as a social actor regarding events happening in other people’s life. Similarly, Rijnaard et al. (2016) present a case where a sense of home is attached to both the insider and holistic perspective of the residents which therefore indicates the relevance of various relationships in care homes. Eijkelenboom et al. (2017) found out that the perception from the case social death revilves around the residents having a quality of life issues and relationship disorders. Watson (2019) stresses that the condition is common with advanced dementia. The author further point out that due to reduced interrelationships, such people are perceived to be passive recipients of care.
1.6 Social Exchange Theory and Ageing
Wan and Antonucci (2016) explains that social exchange theory is centred on the idea that social interactions and behaviours among people result from an sharing process. In this case, the theory suggests that the relationship between people is generated by the pursuit of benefits from either side. The authors argue that these interactions allow the individual to learn which one brings rewarding or harmful behaviours. Similarly, Rasoolimanesh et al. (2015) state that having positive behavioural outcomes reinforces the ability of a resident to live normally in the care homes. The argument is reinforced by Cho et al. (2017) who posit that in view of ageing, social exchange theory can be explained in terms of allowing and fostering the development or continuation of a relationship. Additionally, Wan and Antonucci (2016) note that when the residents see fault in the outcomes of specific relationship they may tend to terminate it. The authors further point out that such form of theory is viewed the as interdependence notion of social exchange theory since it is centred on the balancing or equitability in the relationship. In agreement, Nakrem et al. (2013) observe that imbalances in relationships occur when one party is giving more than what is received.
Ageing brings new concepts regarding the expectation of the elderly population from the developed relationship that include peer, family, friends, and staff in care homes. According to Wan and Antonucci (2016) as people grow old, rewards, and benefits associated with social interactions determine individual social status and personal resources which diminishes with an increase in age. However, Nakrem et al. (2013) point out that the theory has been perceived to appraise the equality in social exchange since the disadvantages experienced by the elderly population are not long term. In support, Wan and Antonucci (2016) state that any aid given to the elderly in care homes by the family member is considered repayment for the actions or contributions received earlier in life. Indeed, Watson (2019) argues that a child’s financial support to the elderly may be viewed as the reward of financial assistance that the child received when the parent had all the capabilities. Social exchange is viewed through the closeness perceived by the elderly when they interact with the young and the benefit such young people gain from the interaction. According to Wan and Antonucci (2016), young generation benefits from the relationship with the elderly population through learning the norms and values from one generation to the other.
1.7 Importance of Reciprocal Relationships
Accorging to Watson (2019), reciprocity in care homes has been argued in in terms of the interdependent nature of human beings. Similarly, Kihlgren et al. (2015) emphasise that human beings are interdependent and benefit from another every other time. Studies suggest wellbeing is achieved by relying on each other in all life events (Kihlgren et al. 2015; Watson 2019; and Rijnaard et al. 2016). Furthermore, Kihlgren et al. (2015) found that residents in care homes had shown kindness as results of kindness attributed to them by the staff. The authors further argue that reciprocity in this case is essential in the development of collaborative and positive relationships between the caregivers and the residents. Additionally, Wahrendorf et al. (2010) report that reciprocal relationships valuable given its ability to influence the existing relationship between the resident and the caregivers. In support of this, Kihlgren et al. (2015) found that friendship among the residents and the caregivers was established in exchange for aid and appreciation. The authors warned that the absence of reciprocity in care homes could be the significant genesis of perceived alienation and isolation by the residents.
According to Wahrendorf et al. (2010), reciprocal relationships are based on the interpersonal exchange model during a social engagement in care homes leading to social-emotional gains which later influence the well-being of the residents. In this sense, any service provided by one resident to the other is expected to be returned to the provider by the recipient, and therefore social relationship may be threatened when there is a limited return of the services once provided(Wahrendorf, et al., 2010). According to a study by Kihlgren, et al., (2015), the reciprocal relationship created by the residents in care homes with collaboration staff was crucial in bringing the notion of meaningful daily life. Additionally, meaningful daily life created from reciprocal relationships was essential in the establishment of a sense of belonging in the care homes as well as the ideals of closeness which strengthens the relationships in care homes(Kihlgren et al., 2015).
According to Bradshaw, et al., (2012), reciprocal relationships in care homes are fostered by staffs, and it has been associated with good care home life. For instance, the emotional support and psychological care such as sharing by their individual life contribute in reassuring the residents and affirming feeling of self-worth which is essential in homelike feeling(Bradshaw et al., 2012).
According to Reed et al. (2012), reciprocity in care homes is fostered by mutual exchange in social relationships which entails alternating roles for both the caregivers and the care receivers. Additionally, residents in care homes express a parallel network of support that is provided by friends, family, and neighbours which creates social relationships that are integral to their wellbeing(Reed et al., 2012).
Social networks that arise from reciprocal relationships in care homes have been viewed by Reed et al. (2012) as a crucial remedy in supporting residents in care homes especially those with dementia to remain active within their community. Older people in the care homes expect that they get involved in a different form of leisure and social activities that tend to connect them with the rest members of the society(Reed et al., 2012). Such involvement tends to create a perceived notion that they have shared interests with other members of the society thus improving a sense of home(Reed et al., 2012).
In terms of reciprocity and relationship-centred care, Reed et al. (2012) have indicated the importance of focusing on other stakeholders rather than the residents in care homes. In that case, their model appraises the use of need to take in account the individual needs of both the families and caregivers as a remedy to motivate and increase involvement in care process thus improving the wellbeing and subsequent sense of home(Reed et al., 2012). Additionally, the notion of reciprocity in care homes has been appraised in terms of interrelationships between members of staffs such that their role in supporting each other which can be translated in the way they treat residents in care homes(Reed et al., 2012).
In essence, the studies have advocated for a relationship-centred care which does not only focus on the needs of the residents but also enrich an environment relevant in supporting relationships where the needs of family and staff are highly considered(Watson, 2019). In that case, therefore a person giving care, family carer should experience the essence of reciprocal relationships(Watson, 2019).
Another importance of reciprocal relationship in care homes is associated with the development of one-to-one interactions that increase the chances of establishing a person centred-care(Reed et al., 2012). In essence, such interactions allow the caregivers to have vast details regarding the specific needs of care for the residents and thus they can know the priority and routines for a particular care process of the resident(Reed et al., 2012). For instance, when staffs want to plan or organise care, they do so with regards to the specific details of care for individual residents(Reed et al., 2012). Additionally, Reed et al. (2012) indicate that reciprocity that led to an improved relationship between caregivers and the residents is essential in knowing crucial areas that the residents seek to participate in the community thus increasing their sense of home.
Reciprocity in the care homes is relevant in bringing the sense of fairness thus fostering social relationships. However, Wahrendorf et al., (2010) warn that reduced fairness in reciprocating activities or services may lead to the development of perceived injustice of exchange with influence the wellbeing of the residents in care homes. For instance, depression may occur in cases where an individual feel like being maltreated with regards to his input in the wellbeing other residents leading chronic stress reactions(Wahrendorf et al., 2010).
Reciprocal relationships can also be relevant in the establishment of a caring relationship within a care home. Such caring relationships tend to focus on the residents physical, mental and spiritual aspect thus fostering wellbeing(Walivaara et al., 2013). In essence, a mental relationship would require trust between the caregiver and the resident and this can only be attained through mutual relationships(Walivaara et al., 2013).
1.8 The relevance of the Relationship in a Residential Care Homes
Relationship-centred care environment is among the significant input by the health practitioners in care homes. In essence, this creates crucial dimensions of caring relationships between residents in care homes, family members and staffs or care home fraternity(Reed et al., 2012). Additionally, Reed et al. (2012) indicate that such a framework in the care homes is crucial in enriching the sense of care in the care homes. Studies have also appraised the relationship-centred care model in care homes as the essential remedies in the treatment of long-term conditions especially regarding people with specific needs such as aging (Reed et al., 2012).
The notion of relationship for individuals in the residential care homes is crucial especially in the development of social interactions. In this case, Hoof et al. (2016) assert that social interactions, especially with significant others of the residents, play a crucial role in fostering the experience of a sense of home. The relevance of relationships in such homes is the development of a feeling of “belonging.” In essence, Rijnaard et al., (2016) describe the sense of belonging as the sense of being part of the group and should be accompanied by solidarity, relaxation, and companionship. In another case, the relevance of relationship for residents in a care home is that it increases the connectedness of the residents with people which also fosters a sense of belonging(Rijnaard et al., 2016).
The relevance of relationships has been viewed in terms of socialisation of the residents with other members which maintains the sense of self-identity as well as the maintenance of personal values(Rijnaard et al., 2016). Although studies have majorly focused on relationships between family members and the residents of care homes, Rijnaard, et al., (2016) appraised the interactions between professional caregivers and the residents as a crucial facet in the development of effective relationships in care homes. The closeness associated with an interpersonal relationship between the caregivers and the residents in care homes has been relevant in contributing into a sense of home or the notion of homeliness(Rijnaard et al., 2016).In the same respect, studies have indicated that caregivers provide a point of contact which is crucial in improving the sense of privacy, security, and safety in care homes(Rijnaard et al., 2016).
According to Rijnaard et al. (2016), a family relationship has been viewed as relevant and crucial to the residents in care homes and that frequent visit increases the sense of home. In support of such interactions and close relationships, some studies have suggested the possible move of both partners in the same care home environment(Rijnaard et al., 2016). For instance, a study based in New Zealand found that leaving part of the spouse was a crucial source of concern regarding the relationships and the sense of homelike feeling(Rijnaard et al., 2016).
The relevance of relationships in these brings involvement of the residents with other members of society thereby creating a sense of connectedness(Bradshaw et al., 2012). Such connections represent the social ties and allow in bridging the social distance between the residents in care homes and society of the immediate community(Bradshaw et al., 2012). The connectedness and improved relationship in the care homes have also been associated with the presence of peer residents. As such, friendship is reinforced which leads to the development of self-identity and a sense of belonging which increases the sense of home in care home environments(Bradshaw et al., 2012).
Relationship and access to the rest of the community members by residents in care homes has been viewed by the extent to which it creates social isolation. For instance, limited access to the community by the residents in care have been linked to increased social isolation and loneliness(Reed et al., 2012). In essence Reed et al. (2012) indicate that residents who have dementia are always at risk of developing social isolation when they are not given a crucial opportunity to join or relate with other members of the society. However, studies have indicated that nurses always fail to address relationships and social networks in care homes as they tend to put more focus on the physical conditions of the residents(Reed et al., 2012).
Kihlgren et al. (2015), views the relevance of relationship in terms of providing meaningful daily life to the residents in care homes. For instance, relationship with friends and family was found to be relevant in creating the meaning of everyday life. Additionally, the engagement that developed as a result of such relationship made the elderly focus more other issues rather than concentrate on their illness and disabilities(Kihlgren et al., 2015). According to James, et al., (2014) the encounter between residents and staff in various activities have been crucial in making daily life meaningful in care homes. As such, therefore, members of staff are seen as essential sources for the meaning of life(James et al., 2014). The relationship in such cases have also been linked to the increased quality of life in social, physical, emotional and functional wellbeing in the care homes(James, et al., 2014).
Theoretical Framework
Social Exchange Theory
In the view of the literature review, relationships between residents in care homes seem to be centred on individual self-interest need that can be ether, economic or psychosocial needs. Within these boundaries, people are seen to be motivated to interact or exchange needs. According to Wan and Antonucci (2016), the interaction that arises may be centred on how individual measure or analyse cost and benefit factors concerning the previous relationships and the anticipated futures outcomes of the new relationships. In such instances, the interactions are seen to be centred on the ideals of social exchange notion. Therefore, it indicates that the relationship in care homes can be better understood through the lens of social exchange theory.
Furthermore, residents ability to develop a healthy relationship with other members have been seen to increase chances of interaction in care homes (Rasoolimanesh et al. 2015). In the social exchange theory, individual motivation to end or continue with the relationship depends on the changes in the relationships and how such changes are beneficial to the resident’s psychological needs (Wan and Antonucci 2016). In this view, the interaction between the resident of care home and her peers can be said to be social exchange relationship in a sense that one resident offers psychological support to her peer who later reciprocates by meeting the other needs (Rasoolimanesh et al. 2015). The young adults provide financial support for the elderly as a reward of their input in younger adult’s life. Consequently, reciprocity and mutual dependency become common factors in relationships.
Moreover, in the social exchange perspective, once a relationship is formed it serves to create benefits that later amplifies bonds in the future relationship in care homes (Wan and Antonucci 2016). In that case, the relevance of the relationship would be observed even on a long-term basis during the stay of the resident in a care home.
Methodology – Study Design
The section seeks to outline in depth the methods to be used in carrying out the research. The section includes the measurement to be undertaken and the relevance of such measurement in answering the research question or meeting the objective of the study. In essence, the methodology seeks to use a different approach from what has been used in previous studies. For instance, Bland and Altman (2003) assert that when two methods of measurements have been thought to bring the same results regarding a clinical concern, there is need to test individual approach separately to know if such methods can be used interchangeably. In that case, the impact of relationship in the sense of home needs to be tested by another approach to validate the measurements. Therefore, the current study uses Interpretative Phenomenological Analysis in meeting its objective.
Research Design
Residents enrolled in care homes are in most cases associated with a unique set of experiences that cannot be measured or understood readily by quantitative measures. Ideally, such measures fail capture the complexities of residents’ experiences in care homes adequately. In that case, a qualitative approach is usually considered as one of the most preferred strategy for such an inquiry to offer in-depth comprehension regarding the experiences of such residents. However, according to Luff et al. (2011) most of the qualitative and quantitative research methods fall short of giving a holistic account of the lives and feelings of the residents in care homes. Therefore, the study is trying to conceptualise and contextualise the lived experiences of the residents; the major methodological design follows the input of Interpretative Phenomenological Analysis. The method is essential in assessing the outcomes of the relationships and other experiences in care homes since it fosters participatory and action-oriented model which sees residents as research partners rather than research objectives (Luff et al., 2011).
Interpretative Phenomenological Analysis (IPA)
IPA is a research approach that is used to describe in-depth human experiences regarding a particular issue in society (Fade, 2004). According to Michael and Andrew (2012), the research approach is relevant in the qualitative analysis of psychological interest in how individuals make sense of the lived experiences. The model is useful in cases where the qualitative research is unable to give a full explanation with the jurisdiction of the word limits of the paper (Fade, 2004). Additionally, due to complexity issues, the reader is not able to understand what is entailed in the research framework (Michael and Andrew, 2012). In essence, IPA in most cases is used to develop models, theories and explanations regarding a human experience that allows the reader to understand the underlying concepts of such experiences (Fade, 2004). Further, the notion of phenomenology has been viewed as notion concerned with understanding human experiences, and as indicated by Husserl (1970) empirical sciences cannot be the basis for the understanding of the world due to the importance of the individual “lived experiences” (Fade, 2004).
Research Questions
The purpose of the IPA approach is to find out how people perceive particular daily events and how such events are making sense of their personal and social world (Smith and Osborn, 2007). In that case, the following questions will be essential in offering a guide in understanding the experiences of residents in care homes.
i. What impact do different relationship experiences in care homes play in developing a sense of homelike feeling?
ii. How do residents think about their treatment in and out of the care homes?
iii. Is there a difference between previous life experiences and the current one in developing a sense of homelike feeling?
iv. What role does the community play including family, friends, and caregivers in making meaning or influencing the meaning of the daily routines in care homes?
Additionally, several senses are crucial variables for this study. Such senses include a sense of security, belonging, continuity, purpose, achievement, and significance. A sense of importance is attained by valuing the elderly and appreciating self-worth. In another case, a sense of continuity involves the connectedness between past and future (Watson 2019). For the case of a sense of purpose, the aspect of care is centred on recognising the personal goals of the residents such that the resident will be able to engage purposefully with activities in life. Additionally, the parameters sense of security and belonging entails allowing the resident to feel safe and to feel part of things respectively (Watson 2019).
Preparation for Fieldwork within Care Homes
Before visiting the care homes for data collection, the researcher needs to take time in reflecting on the views of residents in care homes, their relatives, staff as well as the genesis of such view (Luff et al., 2011). Also. this is important in widening the interview questions. Planning for adequate time is crucial in preparing the residents for research purposes. Ideally, in the case of IPA, the research recognises the importance of preparing the residents since they are more of partners in data collection rather than being a research subject. The reseracher sought to adhere to cultural competence to avoid unnecessary conflicts the population within the care homes (Palmer, Fam, Smith, and Kilham, 2014). Congruently, there is a need to promote positive culture these settings. The important and useful factors to observe when carrying research in these contexts included relatives, the complexity of residents, and staff relationships and needs (Gugliucci and Weiner, 2013).
Consent
For ethical purposes, there is a need for the participant to sign a written informed consent to curb inconveniences during the research process (Moreno, Goniu, Moreno, and Diekema 2013). In cases where the participant cannot give or sign a written consent, the input of their next of keen are invited in the process with the help of welfare attorney. Additionally, family members who seek to accompany the resident during the research period may be required to give written consent regarding the whole process. The essence of the study seeking permission from the participants was to avoid compelling respondents to give information against their will. Also, the researcher ensured that all participants understood the content of the consent form before appending their signatures.
Data Collection
In collecting data that is relevant in meeting the current study objective, the is a need to get responses from the participants through a one-to-one interview. According to Michael and Andrew (2012), the IPA seeks to collect data through first-person account responses regarding the issues raised by the researcher but relevant to the life experience of the participants. In essence, since the data can also be collected from focus groups, all the 11 participants are allowed to tell their story regarding their experiences in care homes.
Before the start of the interview, it is essential to take the participants through the purpose of the study as part of the interview protocol to enhance clarity and understanding (Roberts 2013). The rationale of this in data collection is that it makes the participants comfortable to narrate their experiences regarding life in care homes in an open-ended approach thus widening the range and depth of the results. An open-ended approach has been viewed as a crucial technique in IPA methods since it allows the participants and the researcher to explore various phenomenon without constraints related to predetermined processes (Lennan 2015).
For face-to-face interviews, an audio recording would be essential to capture the experiences that are beyond the study questions. In essence, the number of participants chosen in this case is crucial in allowing for adequate time in one-to-one interviews which is also essential in getting the depth of the experiences regarding the life in care homes for the female residents.
Sampling
In using the IPA approach, the research is required to identify a pool of respondents who have experienced the phenomenon being measured or analysed by the study (Fade 2004). In the case of the current study, 11 female residents are chosen as the potential sample who have experienced relationships and sense of home issues while living in a care home. The rationale of using a small sample size is centred on the fundamental or the requirements of IPA studies. According to Michael and Andrew (2012), in the case of IPA studies, it is the quality of data that matters rather than the quantity, especially in permitting insightful analyses. Furthermore, small size samples are ideal since the aim of the study is to get detailed information about the perceptions and understandings of the respondents rather than relying on general claims regarding the research questions (Smith and Osborn 2007).
The validity of the Results
The relevance of the method used in giving valid results is based on the two principles of the IPA approach. In essence, the strategy seeks to incorporate the interpretative aspect of the researcher to the lived experiences of the participants. In that case, Fade (2004) has indicated that IPA is phenomenological in a sense that it analyse insider perspective on the individual’s lived experiences. On the other hand, the approach is interpretative since it recognises the researcher’s standpoint and personal beliefs which consequently embraces the fact that understanding requires interpretation (Fade 2004). Additionally, the approach is postulated to bring valid results regarding the study objectives as it seeks to study residents’ attitudes that of direct relevance to their lives (Michael and Andrew 2012). For instance, measuring inter-relationships and reciprocal relationship in a care home is of great concern to the residents since its central to their existence.
In most cases, the validity of results presented through a specific research approach has been viewed in terms of the number of participants. In support of this, Michael and Andrew (2012) indicate that participants may vary due to the constraints of the researcher in terms of resources and time. However, the justification of the IPA regarding validity issues can be thought in the following manner. In the first account, the approach is centred on the depth of the phenomenon rather than the number of participants (Michael and Andrew, 2012). For example, the approach permits interviewing participants twice which is an essential tool in facilitating the understanding between the participant and the researcher to enhance outcome validity (Roberts 2013). Consequently, the design is expanded to increase the depth of the results thus increasing its validity in answering research questions.
Analysis Using IPA
The approach needs for the researcher to develop a detailed, plausible, organised and transparent account that brings the meaning of data (Michael and Andrew, 2012). Such an interpretative model is developed in the current study by forming specific patterns known as major themes for qualitative interpretation. Roberts (2013) points out that the themes are drawn through the significant items discussed in the literature review in combination with the structural format of the interview or the primary data collected. In essence, the narrative part will be developed from the basis of these themes, especially in my analytic work.
The Benefit of IPA Studies
IPA research is relevant in allowing the researcher to understand the experiences of a particular group of individuals which is also essential in the development of therapeutic interventions (Michael and Andrew, 2012). For instance, the analysis of the sense of home for residents in care homes would be relevant in providing a gap for future policies. Additionally, the study is relevant in developing an understanding of the social-cultural context of the residents in care homes concerning their sense of homelike feeling. Conducting this study based on the IPA helps in identifying the immediate needs of individuals living in care homes for purposes of developing realistic policy frameworks.
Analysis and Results Presentation
As shown in chapter one and subsequent sections of this work, the aim of the study is a qualitative analysis regarding the impact of relationships on the sense of home for female residents in care homes. Also, as mentioned above, it seeks to analyse the relevance of reciprocal relationships on the sense of home for residents in care homes. Therefore, to gain a comprehensive understanding of the issue, interpretative phenomenological analysis (IPA) was applied to in answering the research questions.
These research questions together with an extensive review of literature were influential in shaping the interview protocol as shown in Appendix 1 that was used with participants and referred continually as part of the iterative analytic approach. The study also used the guidelines for performing IPA research as denoted by Alase (2017) and it helped in guiding the analysis and creating coding levels that led to the formation of essential themes in the data as shown in Appendix 2. Therefore, these were recognised within each participant’s transcripts and also connected across cases. The themes were also noted to be associated with individual interview results.
The chapter starts by presenting the popular themes that were discovered in the interview data by exploring further the themes across and within cases. The superordinate themes presented in this section include Living Well or not, Decision to move, Experience living in a care home, Sense of Home and Relationships. Under relationships, some subthemes emerged such as Relationship with the other residents. The most crucial thing in those relationships, Change in those relationships, Relationships with staff and Relationships with family & friends. The multiple subthemes offer comprehensive details to support this analysis. Notably, these sections accentuate on the unique experience of the females in care homes and also demonstrating the everyday experiences despite their distinct conditions. The final section of this chapter, therefore, answers every research questions in regards to the recognised themes.
Living Well Without Pain
The idea of a care home is always to make sure that the dwellers are living well without any problem. As a result, most of the participants reported that they were living well in the care home without any issue. For example, the first participant an 81-year-old, white British female who has been in a care home for about ten years. During the interview, reported that she was living well without any pain and is happy about her life by saying that:
“I’m ok my mind is ok no pains, no more worries. so I’m ok”.
This sentiment was also echoed by the second participant an 85-year-old Eastern European White Female, who denoted that she does not feel physically unwell living in a care home. She is comfortable because she can do most of the things herself. The third participant is a 92-year-old White European female who has been living in a care home for ten years also shows that she has been living well in the care home. She reflected coming to the care home with her husband and liked living in a care home because they were together.
On the other hand, very few participants reported that even though they were living well in the home, they were experiencing some pains. For example, the fourth participant an 87-year-old White British female who has lived in a care home for ten years indicated that she has some minor pains from the injury sustained. From the interview she says that:
“is hard hard to see my body so weak.. so weak weak”.
Additionally, the fifth participant a 79-year-old White British female who has been living in-home care for about ten years showed that she had been living well but with kept on forgetting things. The sixth participant and the last participants also showed some signs of forgetting things even though they were living well without any physical pain. It is, therefore, clear from all the eight participants that only one is suffering from physical pain; the rest are living well with any signs of physical pain.
Decision to Move
As the participants gave reflections on various aspects of their lives and their experiences leading to being taken into a care home, a theme of ‘decision to move’ started to emerge. Different conditions led to the decision to move, but eventually, they all had almost the same reason to move. The common reason for almost all the participants to move was because they were weak and could not do any substantial task at home.
Further, they needed much care which could not be offered at home but by professionals. For instance, the first participants clearly state that the main reason why she was forced to move to a care home was that her legs got weak and it was a hard to cope at home because her children had to check on her daily. Subsequently, she had to move because of her health condition, that is arthritis. The second participant also came to care because of health problems. In her view she
“had a stroke couldn`t move my left side, now I can it`s a bit better”.
Notably, conferring to her, the decision to come into a care home was because she is a stroke victim and could not move. Therefore, the daughter was unable to take care of her. As a result, they decided to move her into the home. She did not have a say and thought it was the only solution.
Equally, the stroke made the third participant come into a care home even though her case was different. She relates that the decision to move to a care home was made after her husband experienced a stroke. As a result, she sold everything, and they moved together. She was the one who decided on the place because her husband trusted her. Similarly, the fourth participant denoted that her health condition influenced the decision to move. Her morbid decreased, and the son could not help her, so they decided to move in a care home. She did not want to move because she used to be independent, but it was the only option.
Apart from other participants, the decision of the fifth participant to move was influenced by the death of her Husband. In the interview she says:
“My husband died, he was my pillar and I did not feel safe to stay alone in such a big house”.
Therefore, she did not feel safe to live in a big house by herself. Also, she felt that she could no longer take care of the house and decided to sell it when she came to a care home and she misses her home, especially the belongings. It is, therefore, clear that health condition is the main reason why most of the participants moved into a care home. However, some moved because of the death or injury of their husband at old age as seen above.
Experience living in a care home
It is evident that coming to a new place always have different experiences among the victims. As a result, this led to the theme of “personal experience while living in a care home”. Even though every participant had a different experience, one common factor is that most of them were not happy with the changes at the beginning. However, they adapted to their new environment because they did not have a choice. Another evident factor is that in their experience almost all the participants show signs of being lonely at one point. For example, as the first participant reflects, it was hard for her at first to adapt to the environment and spent some days crying. It was because she was dependent and was not in charge of her life anymore. She never felt at home and did not want to be in a care home. After knowing the place, and feeling comfortable, she has now accepted her condition. In her experience, she would never want to move into another room as she is used to the current one.
Accordingly, the second participant had a different experience, but it was also apparent that she was lonely at one point. Notably, conferring to her, the worst day is on Sunday because there are no people to talk with compared to weekdays. She also claims that the staff only help when they think it is an emergency and she is always being ignored. Thus, she is always upset and feels that she should be given more help because of her physical condition. Finally, she is not happy because she misses visiting people.
It is also worth noting that participants who did not have a choice in coming to a care home, were generally not having a pleasant experience. Contrarily, those who decided to come to a care home themselves showed to have a good experience such as the third participant. According to her, she was having a good experience and felt at home. She was able to carry all her things such as CD player which makes the care home to feel like home. Consequently, the fourth participant was also satisfied with the experience but unhappy about how weak her body has become. The participant needs help with everything and the staff try to help, but they are always busy.
Additionally, the fifth participant reflects that living in a care home has been a pleasant experience for her. However, she sometimes feels lonely and calls her friends. Unlike other participants, she does have many friends who are still alive, and they love to chat.
It was common for the participants who were forced to come in a care home to have a bad experience in the place. The situation got worse, especially if they failed to accept their fate and adapt to the situation like the six participants. In her view, she did not like the experience but preferred it to her children place. In her experience she says:
“It’s not very good, but is better than being at home is better than being at my children’s place, but it’s not good I am in my room”.
Similarly, she did not like to move around because everybody body is much older than her making her depressed. Apart from that, the rest of the participants adapted to their new environment and this improved their experience.
Sense of home
As a result of the isolation feelings or even marginalisation, another popular theme conveyed in the study by all the participants is “a sense of home”. According to all of the participants, a sense of home is always being experienced by having the same people around and also building a healthy relationship, which was never the case during the interviews. For example, the first participant made it clear that she does not feel at home because of the new faces. Even if the staff always help her, they keep on changing. Remarkably, based on the response of the second participant, she does not view the place as home. The reason is that at home, she was an active person compared to this place. She misses most of the things about the home such as neighbours, library and even seats.
The fourth participant also exhibited the same pattern. During the interview, she confirmed that her sense of home had been finished, she says:
“It finished. I don’t feel at home since I left my place in 2014”.
Initially, she was a very independent person, but things have changed, and she has to depend on others. She is afraid that things will never be the same again. Likewise, the fifth participant also made it clear that she does not feel at home but have a sense of her own space. It is because she pays for the room and that makes her feel like the owner. Evidently, most of the participants apart from the third participant did not feel at home.
Unlike the previous participants, she felt the sense of home from the beginning because she had her things and put everything the way she wanted. Accordingly, she was with her husband and had a bigger room. Therefore, having everything she needed made her feel at home. Finally, she would not want to share a room and always have her routine in the room.
Relationship
Relationship with the other residents
One of the main things the elderly are always looking for when they come to a care home is to connect with others and build a relationship. However, because of various factors, it was hard for these people to build a robust relationship with each other. Apart from the first, seventh and eight participants, the rest gave different reasons for not having a good relationship with other residents.
The following reasons were provided for not having a good relationship. According to the second participant, one can never have a good chat with the staff because they are busy. She also claims that it is hard to chat with other members. For this reason, she does not see a sense of relationship because rules govern them. The notion is also echoed from, the perspective of the third participant. She does not have a healthy relationship with other residents because of staying in her room most of the time. However, she also enjoys moving around and loves to talk with others who share a similar opinions.
Apart from that, the fourth and fifth participant had the same reason for not having a good relationship with other residents, which was due to a lack of interaction. According to the fourth participant, she does not have a good relationship with other residents because she does not interact with them. The reason is that she does not understand, what they are saying as they are mostly deaf. As a result, she prefers to talk to her friends over the phone, and they always come to visit her.
It is ostensible that the participants who had a good relationship with other residents had adapted to the care home. Subsequently, it was also their decision to come to a care home, and some even had their belongings. For example, the first participant indicated that she has a good relationship with other residents. According to her the relationship is:
“really good, as I said I don’t need much assistance.”
The seventh participant also had a good relationship with others because she talks to everybody and loves their company. She also likes to know people, their background and interest and this makes them feel closure. The sentiment was also echoed by the last participant who shares many things such as space and chats in the afternoon.
The most important thing in those relationships
Upon discussion about the relationships, a subtheme that emerged was the most important thing about the relationships. Even though each participant had a different explanation, it is clear that the essential thing in this relationship was a company. For example, the first participant believed that the most crucial thing in the relations is when they have meals together. She also likes listening and talking to people. The second participant also showed the same views. According to her, having quality time with the people she knew is essential. In her own words:
“I would like to spend time with them, go and visit them”.
She would also like to have a more extended visit from her son. The rest of the participants also showed that the most important thing is to be able to interact with each other. Noteworthy, all the participants view the company of others as the most critical thing in the relationships.
Changes in those relationships, to make them feel more at home
Another sub-theme was changed in relationship to make them feel at home. All the participants had different views, but upon analysis, a common factor was for them to have more time for interaction. For example, the first participant showed that she would prefer to have the same faces every day and that will make her feel more comfortable and at home. The participant would also want to increase companionship with other residents to feel more at home. However, according to her, they should have respect for each other’s space. The same sentiment was also echoed by the rest of the participants making it a crucial issue in this study.
Relationships with staff
When it comes to the relationship with staff members, the participants showed mixed reactions. Apart from the second and the forth participants, the rest had a good relationship with the staff. For example, conferring to the first participant, she was impressed with the staffs and their work. She also loves them because they work hard and assists when needed.
The third applicant also believes that the staff is very attentive in case of problems and helps in any way possible. The fifth participant had a good relationship with the staff but complained about specific issues. If she asks for the assistance of another person, they take it personally. For example:
“sometimes they don’t listen, and I ask for someone else assistance, they take it personal.”
Also, she likes it when the staff are listening to her, which is not always the case. Therefore, it would be better for her if the staff are well trained for the job, even though they help her a lot. The rest of the participants also showed to be having good relationships with the staff without any complaints.
On the other hand, second and the first participant did not have a good relationship because of the following reasons. For example, the second participant was frustrated with the staff because they are not lively. She complains that they sometimes come late when needed. Therefore, they need to have more time for the elderly. The fifth participants also denoted that she does not have a good relationship as she spends most of the time in her room watching television. The nurses are also unable to give her enough help because of their busy schedule making it hard for her.
Relationships with family & friends
All the participants showed that they have a good relationship with the families apart from the third participant who did not have children. In all the participants who had good relations with their families and friends liked to spend most of the time with them. For instance, the seventh participant believes that she has:
“not experienced changes, there is no before and after”.
However, when it comes to most friends, the relationship changed upon arriving in a care home as they cannot see each other compared to when they had not come to a care home.
Data Analysis
The first research question is to discern how the relationship impacts the sense of home on female residents in a care home. From the interviews, it is clear that relationships have a significant impact on the sense of home for female home residents. According to the findings of the interview, most of the participants who had a good relationship overall recorded to live comfortably in the care home without any problem. However, most of them did not feel comfortable at the place initially because some even said that they cried a lot. For example, the first applicant found it hard to adopt making her cry a lot at the beginning. Nonetheless, with time she adapted and started loving the place. All these are in line with the findings of Hoof et al. (2016) who found that the sense of home is a process that is gradual and takes time to develop to accommodate specifications for everybody living in a care home.
On the contrary, most of the participants who adapted faster had their belongings with them and even tailored the room to their specifications. Some like the third participant even come with her husband to a care home. It is apparent based on the findings of Hoof et al. (2016) that if one can be given certain specifications as they want then their living in a care home will be more comfortable. In the interview, it was only the third participant who had a sense of home from the beginning. However, it can be attributed to her bringing most of her belongings at the care home. Also, she was permitted to arrange the room as she wanted and to have her routine. This sentiment is echoed in the findings of Falk et al. (2013) who carried out a study on the sense of home within residential care. Therefore, the three dimensions entailed in the sense of home such as the attachment to place, circumstances for creating attachment, and the institution played critical roles in the sense of home among the participants as seen from the interview findings. For example, the third participant had a close relationship with her room that she became attached to it. As a result, she did not feel comfortable sharing it or even being transferred to a new room as it would destroy her sense of home.
Conversely, for the participants who did not feel at home or even felt comfortable in a care home, their beliefs and attitude played a significant part. The assertion is evident under the theme “Decision to leave”, the participants in the interview who made the decision to move from their homes adapted to the place within a short time and had a sense of home. Notably, this is apparent from the viewpoint of the third participant. Therefore, the people who made a decision, without being forced to come to a care home have positive attitude compared to their counterparts who were forced to live in a care home. The assertion confirms the findings of Brown Wilson et al. (2013) who reported that psychosocial processes that consist of both shared beliefs and attitudes are also crucial in building a strong sense of home in a care home among the residents. For example, the second participant was forced to come to a care home because of her condition. From the interview, she clearly stated that she did not have a say in the decision. As a result, she found it hard to adopt and have a sense of home because of her negative attitude. Thus, she failed to make essential relationships with others and always felt like an outsider.
It is a common notion that most people prefer living in a care home because they do not want to feel isolated socially and be lonely. The belief is supported by the findings of Wang et al. (2018) who also realized that the value of care home is the homelike feeling for the residents. It is because it removes the social isolation and loneliness as mentioned above. Remarkably, this was also true for all the participants during the interview. Nevertheless, according to them, the home like feeling was hard to achieve because they always have new faces and sometimes it is even hard to find somebody to talk to when they want to socialize. For example, the second participant stated that the worst day is on Sunday because there are no people to talk with compared to weekdays. Notably, the staff also talked to them only when necessary. The experience made most of the participants not to build a robust relationship, and this impacted their sense of home negatively.
In a care home, most of the participants did not feel a sense of home mainly because of poor relationships with different groups of people. When interviewed they showed the need to socialize and to be talked to, for them to feel a sense of home, which seems not to happen frequently in the care home according to participants. For this reason, they felt socially isolated, and they were not comfortable with the place. The finding also emphasizes the concept of Kihlgren et al. (2015) that social isolation is standard when the care home does not support the ideals of community and homeliness. Subsequently, a poor relationship with friends and families also made the lives of the residents harder. The second participant felt terrible because she does not spend more time with her son. Such feelings can quickly lead to health problems such as depression, which is common in a care home based on the findings of Kihlgren et al. (2015).
The second research question was on the factors that contribute to the homelike feeling among residents in home care. Therefore, based on the findings of the interview there are different factors that contribute to homelike feeling. However, one factor that was popular among all the participants was comfort and security. For example, the first participant insisted that having the same faces at the care home makes her more comfortable increasing her homelike feelings. The findings confirm the concept of Hoof et al. (2016), as they believed that factors that may increase the development of a homelike feeling always seek to reassure residents of their comfort and value to society. As a result, this explained the frustration of the participants who were dependent on the staff on everything and could not even move. An example is the forth participants who never had the homelike feeling because she was unable to move and do most of the things by herself. Thus, she felt insecure and could not live satisfactorily according to the findings of Smith et al. (2017).
Another critical factor for the homelike feeling is social interaction. From the findings of the interview, every participant showed that they would want to interact more with other people. In some cases, they felt lonely because they had no one to talk to or keep them company. For instance, the second and forth participants claimed that they never had a good time or even felt at home because the staff spent less time with them as mentioned above. The fourth participant went ahead to say that some are always in a bad mood making it hard to socialise. The observation is supported by Cho et al. (2017) and Eijkelenboom et al. (2017) who argue that comfortability, as well as security, constitute the environmental factors while the social interactions foster connectedness among the residents increasing their homelike feelings.
As mentioned above, the most crucial factor is relationships. The findings show that relationship with friends, members of the family and also other residents played a significant part in homelike feeling. As seen from the interview findings, residents who had a good relationship with various groups had a homelike feeling unlike those who did not have good relationships. Noteworthy, this confirms the findings of Hoof et al. (2016) as they also emphasised on the significance of social factors such as interactions and relationships with friends, family members, other residents, members of staff and other specific activities concerning homelike feeling. The participants who talked with friends and even had a constant visit from home showed signs of happiness at the care home. Notably, it is because social interactions that mainly entails involvement and closeness of various members of the family in the affairs of the residents are linked to a homelike feeling.
The management of home care is required to ensure that there is social interaction among the residents and even the staff members to increase the homelike feelings. The idea is supported by the findings of Cho et al. (2017) who believes that people living in a care home will feel more included and at home if they participate in an interpersonal relationship with other members in a meaningful way. From the interview findings, it was apparent that it was hard to form a meaningful relationship with the residents for various reasons. One of the main reason according to Hoof et al. (2016) is that meaningful interaction is always affected by health issues like dementia and ambulatory limitations. The participants also showed that it was hard to form a relationship because they usually see new faces every day and even wished to see the same people. Therefore, it can be denoted that the main factors contributing to a meaningful relationship among home care residents is relationships and social interactions.
Apart from that, environmental factors are also crucial as the participants liked their rooms and some did not even want to share. The homelike feeling also increased if they had their personal belongings as seen from the third participants who lived happily because she had most of her personal belongings. On the other hand, the fourth participant missed her home and did not have a homelike feeling because she did not carry her belongings. In this respect, the findings of Hoof et al. (2016) show that that emotional and personal issue create significant psychological aspects that tend to offer homelike feeling and explains why some of the participants did not have a homelike feeling as they missed their belongings.
The third research question was on the relevance of reciprocal relationship on the sense of home among residents in a care home. Noteworthy, from the interview findings the residents wanted people they could talk to and spend time with as they felt lonely. In most of their responses, it was ostensible that reciprocal relationship made them more comfortable and increased their sense of home. Even though the staff were caring for the participants, they did not have a sense of home because some had different complaints about the workers. For example, the fourth participant claimed that the workers are always busy and some have bad moods. The experience made a reciprocal relationship hard as the participants viewed caregivers as people who are only there for the money. The fourth participant did not also like being rushed and wanted the caregivers to have patience with her. All these support the study of Walivaara et al. (2013) that reciprocal relationships are essential in the formation of a caring relationship within home care. From the perspectives of the participants, they needed friendship from the staff to have a sense of home, not just people who are serious about their jobs.
Therefore, an excellent reciprocal relationship according to Walivaara et al. ( 2013), which accentuate on mental, physical and spiritual aspects of the residents for their wellbeing was in line with interview findings. Apart from having company, the reciprocal relationship also acts as security among the residents. These are seen from the perception of the fifth participants who come to a care home after the death of her husband. She did not feel safe living alone in a big house and wanted to live where she could form relationships with other people. For participants who did not have any good relationship with either the residents or the staff, did not like the place and failed to completely feel the sense of home compared to their counterparts who had good relationships.
It is worth noting that for a reciprocal relationship to exist, trust is required between the residents and caregivers (Walivaara et al., 2013). Among, the participants who trusted and viewed caregivers positively formed great reciprocal relationships, which made them have a sense of home. Notably, conferring to the perception of the fifth participant, she liked forming relationships, and the caregivers also liked her. As a result, they spent most of the time with her and even helped her to form another relationship with a resident upstairs. They exchanged papers even after the death of her colleague. The experience of reciprocal relationship she received made her comfortable and developed a sense of home.
However, even if the caregivers tried to have a reciprocal relationship, some residents had a negative attitude and forming a reciprocal relationship with them was hard. For example, the second participants did not generally like the care home, and she felt isolated from the beginning making it hard to develop any meaningful relationship. As a result, she was never comfortable and did not have any feeling of a sense of home in the place. Her behaviour is well explained by the findings of Eijkelenboom et al. (2017), positing that reciprocity is impossible or difficult to developed and, especially if one partner is hard to deal with and she or he is not welcoming as seen from some of the participants. The senior citizen in a care home needs a reciprocal relationship because of their emotional status and the feeling of loss. At their age they have lost many people and belongings making them insecure. Reciprocal relationship from the caregiver will, therefore, make the residents have a sense of home as they can be supported physically, mentally and emotionally.
Limitation of the study and IPA analysis
One of the limitations of the study is that it mainly focused on female residents and also they were of the same age group. This made the study result to be limited to the female population in-home care residents and not the general population of the residents that is both males and females. The ages of the residents were also advanced. Therefore, age and generational differences might have influenced some of their perceptions. It is thus recommended that further study should focus on both males and female residents to have complete results on the issue.
Many people have criticized IPA analysis because of its ambiguities and absence of standardization. Others have also pointed out that IPA analysis in most cases is deceptive and not adequately interpretative. The most vigorous IPA criticism asserts that this method is mainly suffering from four main practical and conceptual limitations.
First, IPA analysis like extensive phenomenological studies provides unsatisfactory recognition to the critical function of language. It is important to note that the main aim of IPA analysis is to understand the experience of the study participants. However, language is usually intertwined in it. Secondly, many studies show that this method is not capable of capturing the meaning and experiences accurately; instead, it only deals with opinions. Notably, it is because the method is contingent on the accounts of research and participants, but in some cases, these people do not always present themselves well when communicating their experiences. Thirdly, the method emphasis on perception and this makes it limiting and problematic to the understanding of given phenomena because it rarely explains why a phenomenon happened. Finally, the claim that IPA is primarily concerned with cognition exposes it to more criticism because some features of phenomenology are not usually compatible with the condition and its role. As a result, a given phenomenology is understood poorly.
Conclusion
The main focus of the study was to give qualitative analysis concerning the effects of the relationship, on the sense of home for care home residents. It also analysed the importance of reciprocal relationships on the sense of home for residents in care homes. Accordingly, from the interview findings and also the literature used, relationship plays an essential role regarding the sense of home in-home care residents. Most of the participants who were comfortable and had a sense of home showed that they had good relationships with the staff, other residents and even their friends and families. On that hand, those who did not feel the sense of home had no significant relationships. From the interview findings, all the participants also denoted that they would want to spend more time with other people for them to socialise and talk about different issues. This showed that a reciprocal relationship is also essential in enhancing the sense of home in care home residents.
References
Alase, A., 2017. The interpretative phenomenological analysis (IPA): A guide to a good qualitative research approach. International Journal of Education and Literacy Studies, 5(2), pp.9-19.
Bland, J. M. & Altman, D. G., 2003. Applying the right statistics: Analyses of measurement studies. Ultrasound Obstet Gynecol, Volume 22, pp. 85-93.
Boer, B. et al., 2018. The physical environment of nursing homes for people with dementia: Traditional nursing homes, Small-scale living facilities, and green care farms. Healthcare, 6(137), pp. 1-12.
Bradshaw, S. A., Playford, E. D. & Riazi, A., 2012. Living well in care homes: a systematic review of qualitative studies. Age and Aging, Volume 41, pp. 429-440.
Brown Wilson, C., Swarbrick, C., Pilling, M. and Keady, J., 2013. The senses in practice: enhancing the quality of care for residents with dementia in care homes. Journal of advanced nursing, 69(1), pp.77-90.
Cho, E. et al., 2017. Older adult residents’ perceptions of daily lives in nursing homes. Journal of nursing scholars, 49(5), pp. 495-503.
Dijck-Heinem, C. J. M. L., Wouters, E. J. M., Janssen, B. M. & Hoof, J., 2014. A Sense of home through the eyes of nursing home residents. International journal for innovative research in science and technology, 1(4), pp. 57-69.
Eijkelenboom, A., Verbeek, H., Felix, E. & Hoof, J., 2017. Architectural factors influencing the sense of home in nursing homes: An operationalisation for practice. Frontier of Architectural Research, Volume 6, pp. 11-122.
Fade, S., 2004. Using interpretative phenomenological Analysis for public health nutrition and dietetic research: a practical guide. Proceedings of the nutrition society, pp. 647-653.
Falk, H., Wijk, H., Persson, L.O. and Falk, K., 2013. A sense of home in residential care. Scandinavian Journal of Caring Sciences, 27(4), pp.999-1009.
Gugliucci, M.R. and Weiner, A., 2013. Learning by living: Life-altering medical education through nursing home-based experiential learning. Gerontology & geriatrics education, 34(1), pp.60-77.
Hall, S., Dodd, R.H. and Higginson, I.J., 2014. Maintaining dignity for residents of care homes: a qualitative study of the views of care home staff, community nurses, residents and their families. Geriatric Nursing, 35(1), pp.55-60.
Heath, H., 2011. Older people in care homes: sex, sexuality and intimate relationships, London: Royal College of nursing.
Hoof, J. et al., 2015. Picture your nursing home: Exploring the sense of home of older residents through photography. Journal of ageing research, pp. 1-12.
Hoof, J. V. et al., 2016. The importance of personal possessions for the development of a sense of home of nursing home residents. Journal of housing for the elderly, 30(1), pp. 35-51.
Hoof, J. V. et al., 2016. A Three perspective study of the sense of home of nursing residents: the views of residents, care professionals, and relatives. BMC Geriatrics, 16(169), pp. 1-15.
James, I., Blomberg, K. & Kihlgren, A., 2014. A meaningful daily life in nursing homes- a place of shelter and a space of freedom: A participatory appreciative action-reflection study. BMC Nursing, 13(19), pp. 1-13.
Kihlgren, A., Blomberg, K. & James, I., 2015. A reciprocal relationship- an opportunity and a solution for a meaningful daily life in-home care- The older person’s perspective. Clinical Nursing Studies, 3(1), pp. 71-81.
Kolk, J. S., Nielen, M. M. A. & Scherder, E. J. A., 2018. Quality of life in small-scaled homelike nursing homes: An 8-month controlled trial. Health and quality of life outcomes, 16(38), pp. 1-8.
Lennan, K., 2015. Interpretative phenomenological analysis: Exploring the formative experiences of community college students enrolled in remedial courses, Colorado: Colorado State University.
Michael, L. & Andrew, T., 2012. Interpretative phenomenological analysis. In: A. Thompson & D. Harper, eds. Qualitative research methods in mental health and psychotherapy: a guide for students and practitioners. Oxford: John Wiley and Sons, pp. 99-116.
Milligan, C., 2016. There’s no place like home: Place and care in an ageing society. New York: Routledge.
Moreno, M.A., Goniu, N., Moreno, P.S. and Diekema, D., 2013. Ethics of social media research: common concerns and practical considerations. Cyberpsychology, behavior, and social networking, 16(9), pp.708-713.
Nakrem, S., Vinsnes, A.G., Harkless, G.E., Paulsen, B. and Seim, A., 2013. Ambiguities: residents’ experience of ‘nursing home as my home’. International Journal of Older People Nursing, 8(3), pp.216-225.
Palmer, J., Fam, D., Smith, T. and Kilham, S., 2014. Ethics in fieldwork: Reflections on the unexpected. The qualitative report, 19(28), pp.1-13.
Parsons, J.G.M., Sheridan, N., Rouse, P., Robinson, E. and Connolly, M., 2013. A randomized controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people. Archives of physical medicine and rehabilitation, 94(6), pp.1015-1022.
Rasoolimanesh, S.M., Jaafar, M., Kock, N. and Ramayah, T., 2015. A revised framework of social exchange theory to investigate the factors influencing residents’ perceptions. Tourism Management Perspectives, 16, pp.335-345.
Reed, J., Clarke, C. L. & Macfarlane, A., 2012. Nursing for older adults. S .l.: open university press.
Rijnaard, M. D. et al., 2016. The factors influencing the sense of home in nursing homes: A systematic review from the perspective of residents. Journal of ageing research, pp. 1-16.
Ryan, A.A. and McKenna, H., 2015. ‘It’s the little things that count.’ Families’ experience of roles, relationships and quality of care in rural nursing homes. International Journal of Older People Nursing, 10(1), pp.38-47.
Roberts, T., 2013. Understanding the research methodology of interpretative phenomenological analysis. British Journal of Midwifery, 21(3), pp.215-218.
Smith, G. L. et al., 2017. The association between social support and physical activity in older adults: A systematic review. International Journal of behavioural nutrition and physical activity, 14(56), pp. 1-21.
Smith, J. A. & Osborn, M., 2007. Interpretative phenomenological analysis. In: J. A. Smith, ed. Qualitative Psychology: A practical guide to research methods. London: SAGE Publications, pp. 53-80.
Wahrendorf, M. et al., 2010. Perceived reciprocity in social exchange and health functionality in early old age: Prospective findings from the GAZEL-study. Ageing and mental health, 14(4), pp. 425-432.
Walivaara, B. M., Saventedt, S. & Axelsson, K., 2013. Caring relationships in home-based nursing care- registered nurses’ experiences. The open nursing journal, Volume 7, pp. 89-95.
Wang, H. C. et al., 2018. Effect of social support on changes in instrumental activities of daily living in older adults: A National population-based longitudinal study. International Journal of Gerontology, pp. 1-6.
Watson, J., 2019. Developing the senses framework to support relationship-centred care for people with advanced dementia until the end of life in care homes. Dementia, 18(2), pp. 545-566.
Appendix 1
Interview Questions
Age_____
How long participant has been in a care home_______
Gender____
Ethnicity____
What is your name? How would you like me to call you? – (remind participant that, on the study, a different name will be used – However, only for the purpose of the / during the interview, the researcher will be using/calling the participant by their own name or nick name (participant`s choice).
1- How are you?
2- Tell me a bit about yourself?
3-How did you come about moving to a care home?
4-How has been your experience living in a care home?
5-Tell me more about your sense of home since you came into a residential care home?
6-Tell me what would stop you from feeling at home?
7-Tell me about your relationships with other residents (Names not required)?
7.1-How would you describe your relationships with other residents?
7.2-What is for you, the most important thing in those relationships (other residents)?
7.3- How your relationships with other residents help you to feel at home? What would you change in those relationships, to make you feel more at home?
7.4-What do you expect from those relationships?
7.5- What do you give to those relationships/ what is your input?
8-Tell me about your relationships with staff (Names not required)?
8.1-How would you describe your relationships with staff?
8.2-What is for you, the most important thing in those relationships (staff)?
8.3- How your relationships with staff helps you to feel at home? What would you change in those relationships, to make you feel more at home?
8.4-What do you expect from those relationships?
8.5- What do you give to those relationships/ what is your input?
9-Tell me about your relationships with family & friends?
9.1-How would you describe your relationships s family & friends?
9.2-What is for you, the most important thing in those relationships (family & friends)?
9.3- How your relationships with family and friends helps you to feel at home? What would you change in those relationships, to make you feel more at home?
9.4- What do you expect from those relationships?
9.5-What do you give to those relationships/ what is your input?
9.6- Tell me about your relationships with family and friends before and after coming to leave in a care home.
10-Is there anything else you would like to add and/or do you have any questions?
Thank you
Appendix 2
Analysis of Eight Interviews Summary Transcript.
Box 3.1: Table of themes from the first participant
Themes
Living Well without Pain
– Living well with any pain and is happy about her life.
Decision to move
– Legs got week and it was a nuisance at home because her children were checking on her daily.
– Therefore, she because of her health condition that is arthritis.
How has been your experience living in a care home
– It was hard for her at first and spent some days crying.
– This was because she was dependent and was not in charge of her life.
– She never felt at home and did not want to be in a care home.
– However, after some years she has adapted to the place.
– After knowing the place, and feeling comfortable, she has now accepted her condition.
– She would never want to move into another room as she is used to the current one.
How is your relationship with the other residents?
– Have good relationship with other residents.
– Share many things such as space and chat in the afternoon.
The most important thing in those relationships
– When they have meals together is important to her.
– Like listening and talking to people.
Change in those relationships, to make you feel more at home
– Having the same faces will make her feel more comfortable and at home.
– She would want to increase companionship.
– However, they should have respect for each other’s space.
Relationships with staff
– Impressed about the staffs and believes that she has a good relationship with them.
– She also love them because they work hard and assists when needed.
Relationships with family & friends
– She has a good relationship with her children.
– Those who live locally always visit when they can.
– Nonetheless, she does not have many friends because she has lost contact.
Box 3.2: Table of themes from the second participant
Themes
Living Well without Pain
– Does not feel physically unwell.
– Can do most of the things herself
Decision to move
– Stroke victim and could not move, and the daughter was unable to take care of her. Therefore, they decided to move her into the home.
– Did not have a say and thought it was the only solution.
How has been your experience living in a care home
– Worst day on Sunday because there are no people to talk to compared to weekdays.
– It is always being helped when the staff thinks its emergency and being ignored.
– Upset and feels that she should be given more help because of her physical condition.
– She is not happy because she misses visiting people.
Sense of home
– Does not view the place as home.
– At home, she was an active person.
– Mises most of the things about the home such as neighbour, library and even seats.
How is your relationship with the other residents?
– You can never have a good chat with the staff because they are busy with money.
– It is also hard to chart with other members.
– Does not see a sense of relationship because rules govern them.
The most important thing in those relationships
– Want to have quality time with the people she knew.
– Always get a short visit from her son.
– No more relationship and family times and friends.
– They do not speak that much
Relationships with other residents help you to feel at home
– Have time to chart which makes it feel at home with the neighbour.
– Became lonely because the neighbour has not been around for some time.
Change in those relationships, to make you feel more at home
– Spend more time with her.
Relationships with staff
– Frustrated with the staff because they are not lively.
– They sometimes come late when needed.
– They need to have more time for the residents.
Box 3.3: Table of themes from the third participant
Themes
Living Well without pain
– Come with husband and liked living in a care home.
– Had the chance to choose the room herself and it reminded her of their home in France.
– Then moved to a small room.
Decision to move
– Moved to home care after the husband experienced a stroke
– Sold everything and moved.
– She chooses the place because her husband trusted her.
How has been your experience living in a care home
– She has been having a good experience and feels at home.
– Carried all her things such as CD player which makes the care home to feel like home.
– Researcher: How has been your experience living in a care home?
Sense of home
– Felt the sense of home from the beginning because she had her won things and put everything the way she wanted.
– She was with her husband and had a bigger room.
– Having everything she needed made her feel at home.
– Wish not to share a room and always have her routine in the room.
How is your relationship with the other residents
– Like to stay in her room but also enjoy moving around.
– Loves to talk with others who share a similar opinion.
The most important thing in those relationships
– Find an individual with the same interest and a topic they can both enjoy.
Relationships with other residents help you to feel at home
– When she finds somebody to talk to most of the times.
– This is because she used to talk to her husband all the time.
Change in those relationships, to make you feel more at home
– Would not change anything because likes everything the way they are at the moment.
Relationships with staff
– Have a good relationship with staff.
– Staff is very attentive in case of problems.
Box 3.4: Table of themes from the forth participant
Themes
Living Well without Pain
– Lives well in the home care with some minor pains from the injury sustained.
Decision to move
– Her morbid decreased, and the son could not help her, so they decided to move in a care home.
– Did not want to move but it was the only option because she used to be independent.
How has been your experience living in a care home
– She is satisfied with the experience but unhappy about how weak her body has become.
– She needs help with everything and the staff try to help, but they are always busy.
How is your relationship with the other residents?
– Relationship is not good as she spend most of the time in her room watching television.
– The nurses are also unable to give enough help because of their busy schedule.
Most important thing in those relationships
– Sense of humour to make her forget her problems.
– Patient is also important.
Relationships with other residents help you to feel at home
– Does not have any relationship because of her condition.
– Likes talking to people but because she is unable to move cannot go outside her room.
– Does not feel the sense of being home since she left her home in 2014.
– This is because she is very weak and has become dependent on others.
– If she can move then, she will feel at home
Change in those relationships, to make you feel more at home
– Change her condition and makes the legs strong again.
– Does not like to be in a room alone most of the time.
Relationships with staff (Names not required)?
– A good relationship with the staff.
– They are always try to help her when needed without rushing her.
– Some of them are busy and always in a bad mood.
Relationships with family & friends?
– Have a good relationship.
– They visit every week, and the granddaughter loves to see her.
– Want more visits.
– Have some friends but not close friends.
Box 3.5: Table of themes from the fifth participant
Themes
Living Well without Pain
– Window living well but with signs of dementia.
Decision to move
– Husband died, and she did not feel safe to live a big house by herself.
– She could no longer take care of the house and decided to sell for her to come to a care home.
– Misses her home especially the belongings.
How has been your experience living in a care home
– Generally, it has been a good experience for her.
– Sometimes she feels lonely and call her friends.
– Unlike others she does have many friends who are still alive, and they love to chat.
How is your relationship with the other residents?
– Does not interact with other residents.
– This is because she does not understand what they are saying as they are mostly deaf.
– Prefer to talk to her friends over the phone and they always come to visit her.
Most important thing in those relationships
– Likes to know more about people through the staff.
– Likes to associate with people of same interests.
– Likes to be assisted and listen when she needs something.
Relationships with other residents help you to feel at home
– Inexistent because she prefer her old friends.
Change in those relationships, to make you feel more at home
– Does not feel at home because things are not arranged as per her standard.
– She would change nothing.
– However, she would be upset if her friend from upstairs does not send her a paper.
Relationships with staff (Names not required)?
– They do not listen sometimes and if she ask for assistance of another person they take it personally.
– She likes when the staff are listening to her, which is not always the case.
– It would be better for her if the staff are well trained for the job, even though they help her a lot.
Relationships with family & friends?
– Family always comes because they live nearby.
– Stay in touch with friends and they come for tea.
– Most of her friend know where she is and they come to visit because it is not far.
Box 3.6: Table of themes from the Sixth participant
Themes
Living Well without Pain
– She is living well and happy to be in a care home.
– Although she loses the memory of things such as age.
Decision to move
– Moved because of a severe case of diabetes which made her lose her legs eventually.
– She could no longer cope well at home and decided to move.
– The children could no longer take care of her, and they decided to go for a care home.
Experience living in a care home
– Does not like the experience but prefer it to her children place.
– She does not like to move around because ever body is much older than her making her depressed.
– Always focus on what she can do making her comfortable.
Sense of home
– However, it does not feel at home
– Not having things she wants would make her feel not at home.
Relationship with the other residents
– She does not have any relationship.
– She does not see anybody because of her condition making her be in bed the whole day.
The most important thing in those relationships
– The most important thing is for the staff to have time for her and listen.
– She feels as if they do not always have time and does not like to be rushed.
Change in those relationships, to make you feel more at home
– Would want more time with the staff
Relationships with staff (Names not required)
– Have a good relationship with the staff.
– She talks with them the whole night
– Some are always upset when doing the job and this does not make her happy.
Relationships with family & friends
– The condition changed the way she associates with friends as she cannot go and visit them.
– Keep a close relationship with the family.
Box 3.7: Table of themes from the seventh participant
Themes
Living Well without Pain
– The participant is living well in the care home, without any pain.
– Like socialising but most of the time watch television.
Decision to move
– Moved to the home because she had a fall.
– However, still, have her house because it is hard to sell.
Experience living in a care home
– Struggle to fall asleep.
– However, she feels safe at the care home.
– Would feel at home if she had her belongings in the room.
– Would feel at home if made more comfortable.
Relationship with the other residents
– Have a good relationship with others.
– She talks to everybody and loves their company.
– Likes to know people, their background and interest and this makes them feel closure.
Sense of home
– She is comfortable but does not feel a sense home because she has not sold it.
The most important thing in those relationships
– Sharing things and taking part in various activities.
– Avoiding disagreements.
Change in those relationships, to make you feel more at home
– Prepares to have more activities so that she can interact more with others.
– She would feel more at home if she is comfortable.
– She would want more visits.
Relationships with staff (Names not required)
– She likes to be clear about what they can and cannot do.
– Likes them to listen and be reasonable.
– She would want the staff should be more assertive when excusing themes and explaining things.
Relationships with family & friends
– Friends come to visit as well as family members.
– According to her, nothing has changed.
Box 3.8: Table of themes from the eighth participant
Themes
Living Well without Pain
– Living well with any pain and is happy about her life.
Decision to move
– Legs got weak, and it was a nuisance at home because her children were checking on her daily.
– Therefore, she moved because of her health condition, which is arthritis.
Experience living in a care home
– It was hard for her at first and spent some days crying.
– This was because she was dependent and was not in charge of her life.
– After knowing the place, and feeling comfortable, she has now accepted her condition.
– She would never want to move into another room as she is used to the current one.
Relationship with the other residents
– Have a good relationship with other residents.
– Share many things such as space and chat in the afternoon.
Sense of Home
– She never felt at home and did not want to be in a care home.
– However, after some years she has adapted to the place.
The most important thing in those relationships
– When they have meals together is important to her.
– She likes to listen and talk to people.
Change in those relationships, to make you feel more at home
– Having the same faces will make her feel more comfortable and at home.
– She would want to increase companionship.
– However, they should have respect for each other’s space.
Relationships with staff (Names not required)
– Impressed with the staff and believes that she has a good relationship with them.
– She also loves them because they work hard and assists when needed.
Relationships with family & friends
– She has a good relationship with her children.
– Those who live locally always visit when they can.
– Nonetheless, she does not have many friends because she has lost contact.
Box 3.9: Table of themes from the ninth participant
Themes
Living Well without Pain
– Living well with any pain and is happy about her life.
Decision to move
– Moved due a long stay in Hospital after a hip operation. Slow recover made resident and relatives decide to move into a Residential Care Home.
Experience living in a care home
– Positive experience, resident feels safer in a residential care home.
– Knowing that she can request for help at any time of the day appears to be a relief.
Relationship with the other residents
– Does not have much contact with other residents, would like to.
– Appears to be still adapting her-self to the place, consider getting more involved on in-house activities.
Sense of Home
– She does not feel at home, but in a place where she can be assisted whenever needed.
– Resident appear to have a pragmatic view of her stay in a care home.
– As soon as she feels supported and comfortable, she feels better/safer in a care home.
– Resident value the clean, warmth and comfortable environment she found in the care home.
The most important thing in those relationships
– When they have meals together is important to her, even when not talking too much.
Change in those relationships, to make you feel more at home
– Resident stated that she would like to change, and start to interact more with other residents, by going around the home and take part of routines and/or activities.
– She would want to increase companionship.
Relationships with staff (Names not required)
– Sees staff as professional, kind and helpful.
– Resident value their attitude at work, by appearing always happy.
– Resident believes they like what they do, being passionate, caring, listening to her and professional, which she appreciates.
– She has only one complain, which is the waiting time when ringing for assistance – They take too long to respond her calls.
Relationships with family & friends
– She has a good and close relationship with her children.
– Her son lives locally visits every other day.
– However, the contact with friends is not as much as before, due life changes and loosing contacts.
– – Resident tries to keep contact with the few friends, using technology available – internet – emails and telephone.
Box 3.9.1: Table of themes from the tenth participant
Themes
Living Well without Pain
Pain under control. Feels anxious when not able to control how and when take her own medication.
Decision to move
– Became frail – with age – children living abroad have insisted that she would be better in a care home.
– It took a while for resident to make the final decision and move into a care home.
Experience living in a care home
– It has been difficult to adapt to a new routine.
– She has had difficulties to negotiate things with management – when requesting a person-centred care.
– After a while resident managed to make her-self heard and things were adapted to her her own needs, which appeared crucial for her to feel at home.
Relationship with the other residents
– Complicated relationships, resident found it hard to adapt to a new reality, having to interreact with strangers who do not know her.
– She feels that she is not accepted by who she is finding it hard to engage with other residents.
– She believes that the differences on social-economical background interfere on those relationships.
Sense of Home
– Know that her needs were taken into consideration and the management has made a few changes in order to meet her needs, she feels at home (in her room).
The most important thing in those relationships
– Resident stated that the most important thing is to feel accepted by who she is.
Change in those relationships, to make you feel more at home
– To feel accepted and respected.
Relationships with staff (Names not required)
– Resident sees staff as lovely but too obedient to the rules.
– She believes that she needs to explain the need for bending rules, so they can meet people`s needs better.
– She stated that home and staff need to adapt to the resident and not the opposite.
– She values spending time chatting with care givers.
– She would like them to have more time to spend talking with her.
Relationships with family & friends
– Close relationship with children, closer but tense relationship with daughter.
– Children live abroad.
– She knows many people but appears to have little contact with them.
Appendix 3
Semi-structered Interviews
Interview 1
Age 82
How long participant has been in a care home 10 years
Gender____ F
Ethnicity____ White British
Researcher: Hello good morning
Participant: Good morning.
Researcher: So, what’s your age 81, how are you?
Participant: Well I am ok.
Researcher: What’s your name?
Participant: My name is V*** all my life I’ve been, have never had a shorter name, my sister had one not me.
Researcher: I just want to remind you that we will not use your name on the transcription on study ,but of course during the his interview or he’ll be calling your name.
Participant: I don’t mind if you can use my name.
Researcher: Thank you for your trust, but for ethical reasons I will not use it anyway.
Participant: it’s ok love you do as you were told.
Research: Yes.
Participant: I’m ok I’m having a cup of tea and some biscuits, I can`t complain can I. I’m ok, I’m ok my mind is ok no pains, no more worries. so I’m ok.
Researcher: Can you tell me a bit more about yourself?
Participant: What do you mean?
Research: Things about you, things you would like to share.
I’m here since a few years, this is like a hotel, I like to say it this way it’s like a hotel (smiling). I hear people complaining. I don’t know of what, you have room service, for that your choice, laundry services, they help us as you need you don’t have to do a thing. None of those chores from the first day I’ve seen it in that way, it helps. I’m an older lady I used to be a midwife all my life working in a hospital.
I’ve loved it, I can say it was hard very hard job, in my days the doctors were mean for us nurses. But, I was happy I was happy person I had four children 2 boys went all the way to Australia they are really well. My daughters, they come to see me very often with my grandchild two girls. When they around everybody likes to see them.
Researcher: How did you come about moving to a care home?
Participant I was about to say when I retired, after 1 year my husband passed away. That was when I have made the decision. It was straight away my daughter told me off. She did not understand why. She said that I didn`t need it. But I was decided, I sold my house so I could move here. I wanted to do it before getting sick, in need for support. I wanted to live a stress-free.
I have visited many places, before choosing this one. I don’t regret it is better than I thought to be honest. I can go to my room anytime or come here anytime I want. I watch TV with all the people whenever I want. Is like a hotel for me I told them all the time, but they are too negative it doesn’t help them.
Researcher: Who are they?
Participant: The other people living here. They first see what is worst they think of the pains and suffer, and they suffer more. They want to be younger, some people don’t want to accept the life as it is. We get old there’s not much you can change about it.
Researcher: How has been your experience living in a care home?
Participant: I`ve adapted well, it was what I wanted, to spend my last days stress-free. I do feel at home after so many years here I walk around as I need, when I want I go to my room I can stay in my room. Is not my house I cannot say it is like my house because they are workers around, so many girls different faces all the time and at home all we have are familiar faces. Familiar faces is what we see; family, friends we know them all. Here we know them as well, but he is not under my control to decide who is around the home how to organise things to function. It need management, professionals, things need to be arranged the way it serves everybody, in a way. For me it’s good in is like in a hotel, cleaning service, we can trust them I feel very comfortable. In the lounge, I can change the channel on the TV if I want, when I’m alone. I respect the others if there are more people. I stay in the lounge with until late night. The girls are around they do talk, is a good atmosphere. I have some problems with sleep, once I am in bed I am not sleepy anymore. I struggle to fall asleep, so I go later to bed, it’s easier for me.
Researcher: How is your relationship with the other residents?
Participant: It’s ok I’m not very chatty person, I listen. At lunchtime I sit with other most of the times we sit together the three of us (B… H and myself) I sit with the same two ladies and we chat we share stories from our past, our lives, we gossip sometimes we complaint you know, (smiled) about the food and some girls are too stressed running running running, they don’t even look into your eyes, I wonder if they hear what we say. Majority are foreigners, no offence to you, but they may think they speak very good English, they speak so so fast, we don’t know what they’re trying to say and they leave, they think they said everything and we don’t know what was that. They come to collect the plates from the table, they take the plates (males a gesture of taking the plate too abruptly), is not a dining service, you know.
Well, well they are, I believe they are, very busy you know. I am well, I can help myself but other people really need help, with everything, they get confused and the poor girls you know they get stressed out. Some get very very stressed. I’m sure it’s hard for them.
Researcher: You chat about those things?
Participant: We talk about all those things, it’s a good friendship. Not like other friends, but is good, many people come temporally I have seen many many faces in this place. Here we need to learn how to say goodbye, and don’t expect very close friendships.
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: Have a nice chat watch tv together. I like in the end of the day we go to our rooms and that’s it for me is different sort of friendship it is more like chit-chat is all we need at his age. No problems to solve, life was hard, now we rest and we don’t stress about obligations. Leave the room whenever I want, everybody respect each other with the difficult ones we gave some space. The most important thing is what I said; no strings, responsibilities, there is respect, space and the chance and time and opportunity to spend with people and to be by myself, in private whenever I want with no problems. I like it makes me feel comfortable.
Researcher: How your relationships with other residents help you to feel at home?
Participant: Feeling free to be around, each one of us do what we need to do, without being on each other`s way. Is different in different ways. It’s hard to say I feel part of this place I see it as my place so I presume it might be something like a home feeling.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: No changes needed. It will be good to have the same faces around. But is not possible, some people come temporarily. Some are very confused agitated and sometimes aggressive. But, things are exactly the way I like, the way I planned. I would not change a thing I told you, I wouldn’t change a thing, for real. I know people may disagree, my daughter she hates the way I feel when I say these things. She wanted me to stay at home, she said I was too young, well anymore I’m not young anymore but when I came she was upset on me, I presume because she was worried. Now she can see me happy.
Researcher: What do you expect from those relationships?
Participant: I don’t have any problems the relationships are exactly as I expected when I took this decision to come here to this care home, which I chose, I have no regrets and to be honest with you I’ll tell you very honestly, I wouldn’t change a thing. Obviously, things are not perfect, but nothing really disturbs me I’m very happy person.
I do share a space, we need to respect, I do respect everyone, so I expect the respect. Researcher: Other expectations …
Participant: Not really, we chat as I said that but in in chit chat we have a laugh we had very different lives, we were different people we share stories. No other expectations. Well when somebody is unwell and no carers to be seen, I would expect somebody to call them for me, I have done it for other people.
Researcher: What do you give to those relationships/ what is your input?
Participant: I talked to everyone, I respect everyone, I know when to give space I am a grown-up woman, I know when people want to be quiet and when they up to a conversation and when they don’t, I respect. If they talk to me I give them attention, when they don’t I just do my thing. I like to help people, when I see somebody struggling, I go there to give a hand, but the girls tell me off. They don’t want me in troubles. I think I can help, but maybe I think I am stronger than I am (laughed).
Researcher: Which kind of help?
Participant: When some people need assistance with every everything with everything. I am still ok, you see. So, when I see them wondering, I got there I give them a little help but you know perhaps I shouldn’t we never know if they will be aggressive.
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: I have a good relationship with staff. Really good, as I said I don’t need much assistance. I have little contact with them, I talk with the girls and men, we have some men as well, they are lovely, very respectful gentlemen nothing to complain.
Researcher: How would you describe your relationships with staff?
Participant: Not very close, I see other people having more contact with them, you know their need more assistance. I can do my things, I walk I don’t need that much assistance but the girls they chat, at night when I stay in the lounge in the evening, they are around doing their things, they come and chat I guess at that time, they have more time for chatting. During the day sometimes they don’t even look into your eyes they run run run. I think they even forget about me, I don’t call them for anything.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: The most important think is the respect, knowing they are around all the time, whenever you need them. I don’t need much, but you will never know when will need them. That is why I am here that’s why I’m here you get an immediate help. If you need an ambulance. They are like angels when you are in need.
Researcher: How your relationships with staff helps you to feel at home?
Participant: having them around is enough for me, enough I’ve never had any problems and I mean no complains. I already feel at home. (long pause).
Researcher: What would you change in those relationships, to make you feel more at home?
I don’t know how else they could behave. Is good the way it is. You see, is a home but I expect it more like a nursing home, hospital no no no no not in that sense. I more like I want to know it is a care home because there are workers; nurses, carers, cleaners at home we have family and friends.
Researcher: But how do you think it helps with the sense of home.
Participant: When I`ve moved in I have met some faces, having them around since is important. It helps but there are always new faces.
Researcher: Is there anything about those relationships (participant interrupt)
Participant: To change?
Researcher: Yes.
Participant: No. I don’t think so. If I could keep the same faces, it will help. When someone new come we need to tell them everything about us, everything, and it happen all the time. Is easier when they already know how you take your tea, when do you like your bath how much you eat, what are your likes and dislikes.
Researcher: What do you expect from those relationships?
Participant: I expect them to help if I need to be polite and respectful
Researcher: What do you give to those relationships/ what is your input?
Participant: I am appreciate the help and kindness and I told them I tell them I do appreciate their work. I really do, they are on their feet all day. There are many workers here, the chefs, laundry ladies. Here we need all sort of workers. I don’t have much contact with others, only the nurses. The chef sometimes comes to the dining room, but it is always a different face as well.
Researcher: Tell me about your relationships with family & friends?
Participant: Very good, is good my children speak to me everyday, and my daughter she lives nearby she comes over every week on Sunday or Saturday, she stays with me and the little girls my grand granddaughter’s, when she can they come the 5 of them.
Researcher: How many grand grandchildren?
Participant: I have 2. So, they come my daughter, my granddaughter and her husband, well her partner and the two girls 4 and 6 years old.
We go out for lunch, sometimes my son is in Australia but when he comes, he always visit me, they take me to their place. We are very close. I am happy, I’m happy I like to have them around on the weekend we seat in the lounge or in my room. They didn’t want me to come here, they thought it was too early for me but now they have got used to it and respect my decision is a choice they have to respect. T
They are good.
Researcher: Friends?
Participant: I haven’t got many friends but some they do come for dinner with my daughter, when she takes me out and then we go to the restaurant, my two old friends always try to make it. I had other friends, I use to work with many many people, we were close and had lovely friendship. But some of them friends moved to other cities, one moved to their children’s place in the North. I didn’t want that for me I’m very independent.
Researcher: you mean moving to your it children’s place?
Participant: Yes, that’s not for me.
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: Trust, being close, supportive, help each other. Listen to each other opinions.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: Having them around helps. When they visit me and stay for a couple of hours it does help.
Researcher: What would you change in those relationships, to make you feel more at home?
We are very close, we have always been. We always have been very close. It is good when they come here and I know they come often there is a routine, a weekly routine for me. Without their visits I would find it difficult. 9.4- What do you expect from those relationships? (with family and friends)
Researcher: What do you give to those relationships/ what is your input?
Participant: I give them advice. I have experience in life, they respect my opinions they asked me for advice and I am happy to give them advice and I don’t expect them to do as I say but I’m happy that I can help, listening to them. People like to be listened.
Researcher: What are your expectations in those relationships – with family and friends?
Participant: I expect no changes (smiled). That`s it. No changes. I am here for them living in a different place but I am the same mother, grandmother and they know it.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
10-Is there anything else you would like to add, and/or do you have any questions?
Well, I know I have nothing to say but I really wish you good luck with your study. I hope you can achieve all you deserve in your life and be happy.
Have a stress-free life, don’t worry too much. Listen I’m an old lady most of the things are not as important as we think, as you grow old you realise that; most of the things aren`t important.
Researcher: Thank you very much at has been a pleasure.
Participant: All the best.
Researcher: I am leaving you the information we went through at the beginning of our interview. It’s for you, don’t hesitate to contact me, or any of the other contacts, these if you feel distress or too emotional, so you can speak to somebody. The nurse on duty is also aware of the interview, I’m sure she or any member of staff will be happy to help you if you feel in need. You can also contact me if you decide that you don’t want to take part of the study anymore no problem.
Participant: I will. Thank you very much.
Interview 2
Eastern European-White
Researcher: Hi hello so I’m just taking note of your age
Participant: I’m 85 so your name is P******
Researcher: How are you?
Participant: I am fine thank you, just here in these chair as you know what can I tell you? Nothing changed or what you know is what everybody knows. I’m frustrated I can’t do things for myself keep ringing the bell all the time for someone to come and help me. I rang 4 times today no one came, today isn’t it not very nice day. if I’m not very well today.
Researcher: Do you feel unwell physically?
Participant: oh no way I was just, I just wanted to grab something from the table, that people I want the papers on the table, that one over there and then they said a minute a minute, she’s not an emergency, she said to the other one.
Reseacher: The staff?
Particpant: yes, yes the nurses. No, it’s not emergency, but I need I need something from the table and I can’t walk.(long pause) Nothing Else matters.
Researcher: How did you come about moving to a care home?
Participant: I’ve had a stroke couldn`t move my left side, now I can it`s a bit better. You see, my daughter couldn’t take me, so they decide to put me here. I didn’t have a say well I knew that was the only solution, what could I do? I couldn’t go back in time and prevent a stroke. Maybe I could (pause) well God knows.
Researcher: How has been your experience living in a care home?
Participant: Here, the Sundays are the worst. No people to talk. During the week days, I have these people round to talk about talk, they take good care, because they help me, but when they decide is not emergency (upset, pause), they pass by and ignore me. When they think is not important they say that they need to go to other people. I think it is important for me to have help, after I had a stroke and fell, now I can`t bend, I can`t stand, but I am not the priority is not an emergency (upset). Sometimes I’m grumpy, I feel like I’m visiting somebody I used to visit some people in care homes now I am here then
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participant: I don’t see this place as my home. At home, I was a very active person. Now I miss my neighbourhood, my library my sofa, they were very good my sofas. I have bought them 35 years ago, me and my husband. I had to sell everything, it was heart breaking. Had to sell everything thing, all these things I bought.
Researcher: Tell me what stops you from feeling at home?
Participant: Just the simple fact that it is not my place. I will not feel at home here, never. No one does. I don`t see a point in what you are doing. Who feels at home in a residence?!
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: you can’t really have a chat with them the girls are nice but they’re busy for the amount of money. I pay these should have more time which relationships is not is not no you don’t.
Researcher: How would you describe those relationships?
Participant: I wouldn’t describe it as a relationship we just leave under the same rules that is all that is all everybody has their own problems that’s it.
Researcher: What is for you, the most important thing in those relationships (other residents)?
I would like to spend time with them, go and visit them. Is difficult. When my son comes is rushing, he can’t take me there
Researcher: To his place you mean?
Participant: Yes. The problem is I need assistance to to (pause) do to do everything he is busy no time no time no more relationships no more family time or friends.
Researcher: Tell me about your relationship with other residents?
Participant: lady next door shoes very nice we did chat a lot, we talk about the things that happen here around, well recently has not ben around, I’ve been rather lonely this week.
Researcher: Tell me about your relationship with staff?
None. They don’t have time I become frustrated sometimes they come with the bad face. I don’t like it sometimes it’s me I’m tired, I’ve been waiting for them for a half an hour and then they come and I have to tell them. Today (pause) it’s difficult for them, it’s difficult for me here, it is it’s a necessity nothing else, they come they do the job I need them then they need, they need me. I need to change, you know they need to do, to have more time. I don’t know how they work, needs more girls. We pay, I pay and, I would like to have somebody to come and to talk, honestly just now this makes me feel good. But I will die waiting for things to change.
Researcher: What are your expectations about those relationships?
Participant: I told my expectations I would like them to have more time because I am paying for that.
Researcher: What do you give of yourself in those relationships / your input?
Participant: Well depends how they approach me I can go either way I can give them my smile or not. Depends, one example; they get in my house.
Researcher: Your room you mean.
Participant: yes this room is my house I pay for it, they must say hello, good manners, then we talk, then you take it from there. People get what they deserve.
Researcher: What do you mean by that?
Participant: They are rude, what they expect, I pay for care not for moody to invade my house, my room, whatever. No.
Researcher: Tell me about your relationship with family and friends?
Participant: well we don’t speak as much we don’t see each other that much.
Researcher: What do you expect from your relationships with family and friends?
Participant: I expect them. I would like them to visit me but obviously I can`t ask for it. I`ll need to arrange transport, it’s very inconvenient for them and for myself. I can’t walk I can go by cab, but I guess, (pause) since I’m here I feel very demoralized I have the feeling to go, but when it comes the time to go out, then I don’t. (appearing stressed about the topic).
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home?
Participant: I live in the same street for 16 years I was raised there I got married I bought a house. I was married for 50 years, we were same age more or less, my husband was 1 year older than me. We had 1child and a happy marriage. Our friends we used to go out together, go to each other`s place for dinners, parties, they use to come over, no need for knocking, we didn’t lock the doors, it was a sense of community we did help each other, always and for me it was very important. We use to go to D**** on holidays together. The couple next door, he has passed away he passed away and then she moved to a nursing home. My other friends (participant tearful), have also dyed, ah.. M***** she moved to her children`s place in D***** she was unwell. Everything changed for me it will be nice if some friends could come around. But is all gone now. My son is now divorced, he has his own troubles. Asking him to come more, would be unfair.
I used to work when at home I use to cook I love cooking I was putting food to my neighbours baking cakes they would come over with things. It use to be lovely.
Are done? how many more questions do you have? I took a strong painkiller and I’m starting to feel quite drowsy.
Researcher: Is there anything else you would like to add?
Participant: Oh no I think I told you everything, I am very tired I need to go and sleep. I haven’t no nothing else to say.
Researcher: No problem. Thank you very much have a good afternoon. I’ll leave these papers with you so we have all the contacts and everything o
Participant: Oh yes yes you told me it’s fine I understood I understood what you`re doing but I’m tired it’s ok I’ll keep it and all the best for you.
Researcher: thank you
Interview 3
Age 92
How long participant has been in a care home 10 years
Gender____ F
Ethnicity____ White European
Researcher: What is your name? How would you like me to call you? – (remind participant that, on the study, a different name will be used – However, only for the purpose of the / during the interview, the researcher will be using/calling the participant by their own name or nick name (participant`s choice).
Participant: A.
Researcher: How are you?
Participant: I am very well, thank you.
Researcher: Tell me a bit about yourself?
Participant: I am 92 and I have been living in this place for nearly 10 years. I came with my husband, initially to a bigger room and then when he passed away I have moved to this small room (pause.. looking around the room). I had the chance to choose this room, I really like it, it reminds me the room I have had in France, it has this lovely balcony to have my coffee and read the paper, when the weather (smiled) is good. Do you want to see, open the curtain there are a few tables, I only need one but other people can use the space as well, but no one uses it.
Researcher: How did you come about moving to a care home?
Participant: Is a long story, I use to live in France where I met my husband, I am from Austria, but during the war my family moved to France, where I have met my husband, we have lived there for a couple of years in a lovely apartment in a ground floor, we had a balcony at the back like this one (pointing outside). After the war things were not easy, so we have decided to move into England where we were very well received, well I will spare you my life story. But yes we got old, my husband had a stroke and we decide to sell our place and move into a care home, we had our savings as well. I was the one who chose the place, My husband always trusted me to make decisions (smiled).
Researcher: How has been your experience living in a care home?
Participant: Your study is about feeling at home, so I feel at home. As you see my room is like my home, I have in here all my things, the way I like, my CDs, I love my music, I could not leave without music, my CD player is always on… not always sometimes I listen to the news on this little radio (pointing at a radio in bed) I keep it in bed so I can turn it on and off whenever I want in the night.
This furniture, the bed mattress, table chairs is all mine, just the bedding is from the home, I had my own bedding, but it disappears (laughed) we need to be careful with our clothes because it get mixed up with others and disappears, I never understand why, perhaps it gets very busy too much laundry I presume. Is not an excuse… but I got used to it, and found my ways – you see behind the door I keep all my laundry in the net and give no permission to remove it, I don’t know if they do it or not, but since a while ago I haven`t noticed clothes going missing, it appears to work (smile).
Researcher: So tell me a bit more
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participant: To be honest from the beginning I felt at home. I have my own things and I did put everything the way I liked, my husband was with me and we had a bigger room upstairs (obviously smaller than our house, but big enough under the circumstances, we definitely needed to downsize. So, we kept what was really important for us, my husband liked music as well. Our life was around books, news papers and classical music (pointing at a big collection of CDs). So, for us having that was all we needed to feel at home.
Researcher: Tell me what would stop you from feeling at home?
Participant: If I had to leave my belongings behind, or forced to share a room…I don’t know, not allowed to have my own routine in my room.. but I don’t think that would happen. I create my own home in my room, I always did, throughout my life I have adapted to many different places, countries and I have learnt to create my own home in those new places.
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: I prefer to stay in my room, but I also enjoy going around, sometimes have my lunch in the garden, stay in the lounge for activities, I like to talk with XXXX she is a lovely lady, she has travelled the world we always have something to talk about (Smalling).
Researcher: How would you describe your relationships with other residents?
Participant: I don’t know everybody, I enjoy a good conversation with somebody who shares the same interests. Is not easy to find. I talk to everyone just prefer to talk to xxxx
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: Finding someone with similar interests, have a topic we both enjoy.
Researcher: How your relationships with other residents help you to feel at home? What would you change in those relationships, to make you feel more at home?
Participant: If I have somebody to talk to, it helps me to feel at home, I use to talk to my husband all the time, we were both very talkative and passionate about things, literature, music (thinking …pause)
I wouldn`t change anything. I like the quiz and the occasional conversations.
Researcher: What do you expect from those relationships?
Participant: I don’t think I expect much. I would like to have someone to talk once in a while, but I also enjoy staying in my room listen to my music. I enjoy the solitude.
Researcher: What do you give to those relationships/ what is your input?
Participant: What I do to keep those relationships you mean?
Researcher: In those interactions what do you do …
Participant: I tend to initiate conversations, I like to have a good conversation. When someone new arrive, I like to ask about them selves and get to know the person. I share some stories; which people may find interesting. I have lived during the war, as many other people, but I was very close to Nazi families and many many episodes, unbelievable stories. I enjoy listening to people`s stories as much as sharing my own stories. I don’t know how much I give but I never had enemies (laughed) I was always very lucky with the people I met
Researcher: You mean in a care home?
Participant: Not only, in my life, always had good friends, respectful and generous people and here is the same.
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: I have a good relationship with everyone, nurses, carers, cleaners, XXXX (the laundry girl – I had some problems with some items going missing, she has been very attentive, came here very apologetic I appreciate it.
The same with the carers they are kind and caring, they listen to me and always help me at any time.
Researcher: How would you describe your relationships with staff?
Participant: Is like a world relationship but a good one (smiled), we do small talk, it`s always pleasant.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: The most important thing, the most important thing is that they listen to my requests and try to find solutions for what I need.
Researcher: How your relationships with staff helps you to feel at home? What would you change in those relationships, to make you feel more at home?
Participant: Helps me because they help me to keep things the way I like. They come and clean and they leave things the way I like. The managers let me decorate my room… No one ever question my routines, my preferences. I always get my special requests for food – I like greens and salads they don’t offer very healthy food, so I write down on the menu what I like.
I will not change anything.
Researcher: What do you expect from those relationships?
Participant: I expect them to help me and listen to my requests, think with me to find solutions when I need help. I expect them to call a doctor if I am not well, to give me a pain killer if I am in pain.
Researcher: What do you give to those relationships/ what is your input?
Participant: I share with them my stories my passions, when I see them curious and interested. I don’t rush nobody, we cannot get things done properly rushing. I understand they have other jobs, when they delay I never tell them off or complain. They are always very apologetic.
Researcher: Tell me about your relationships with family & friends?
Participant: Family… (…) I have only my cousin, and xxxx which is a friend as well (refer to another resident in the home).
Researcher: No children?
Participant: No children. My cousin comes every week, on Sundays has a lunch with me and stays the afternoon, sometimes we have a nap together, when is sunny we seat in the balcony, have a cup of tea. My friend comes every other week, he lives far. We are on the phone all the time. I also have friends back in France and Austria we do talk on the telephone, every day I talk to one of them. I like to keep in touch, they call me I call them.
Researcher: How would you describe your relationships s family & friends?
Participant: Is a good relationship we have this routine which suits us.
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: Keeping in touch.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: keep in touch, talking over the telephone.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I would rather have all my relatives and friends in England and see each other, it will be better. But I have got used to speak on the telephone, since many years ago.
Researcher: What do you expect from those relationships?
Participant: I expect them to stay in touch to visit me… (pause) I expect no changes.
Researcher: What do you give to those relationships/ what is your input?
Participant: The same as I said before, I do get in touch as much as I expect them to call. I ask them about them-selves and I care for them and they know. I tell them how much I care, they know.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participant: Before I had my husband and a house, we use to receive people all the time, visit them in France. We were very social, not party people but family people, we had our small circle of friends and we were always in touch. Now some have passed away. The other relatives and friends we keep in touch over the telephone. We do speak often, and we have long conversations. I like to talk on the telephone.
Researcher: Is there anything else you would like to add, and/or do you have any questions?
Participant: So, about your study, do you want to prove that we feel or don’t feel at home?
Researcher: I don`t have a Hypotheses, as we read on the participant information sheet, is a research to explore if there is a link in between reciprocal relationships and the sense of home.
Participant: Well I think there is, for me having visits, my own telephone to talk to my relatives and friends whenever I want helps me to feel like at home, but perhaps other things are as important, having my own furniture here with me and my music to play at any time definitely makes me feel more at home.
Well, I hope you get your results and finish your graduation. Good luck and thank you it was a pleasure to help. All the best.
Researcher: Thank you for your participation.
Thank you
Interview 4
Age 87
How long participant has been in a care home 10 years
Gender____ F
Ethnicity____ White British
Researcher: What is your name? How would you like me to call you? – (remind participant that, on the study, a different name will be used – However, only for the purpose of the / during the interview, the researcher will be using/calling the participant by their own name or nick name (participant`s choice).
Participant: Susanna
Researcher: How are you? Could be better (laughing). I am old (laughing), pain pain pain
Researcher: Tell me a bit about yourself?
Participant: My name is S. I have been here for 8months, I use to be a very active (emphases on the word “very”), I was totally independent until 5 years ago. I was driving and doing everything in the house without any help (pause) no need for help. Then everything has changed (sad face – pause). I had a fall hurt my hips and here I am (pause) depending on carers to take to the loo (sad face– pause). I am a chatty person, I love to talk to people (said with eyes wide open and enthusiasm).
Researcher: How did you come about moving to a care home?
Participant: It was a fall I had 5 years ago, I went to live with my son but as my mobility decreased and I needed more support they couldn`t help and we decide to move in a care home, I didn`t want, but is for the best ( pause) I know but is hard to accept the situation. I was so independent (…)
Researcher: How has been your experience living in a care home?
Participant:Is okay. What can I do, I have to accept, is hard hard to see my body so weak.. so weak weak, I need help for everything. They help me but not when I need, they are busy and I avoid to disturb. They might think “oh no this one again” (laughed).
Researcher: Can you tell me a bit more?
Participant: I spend most of the time in my room, watching tv, waiting for help to use the loo, to dress.. undress.. put creams and creams, lots of creams, my skin is too dry, it was always dry. But, when you depend on help and they don’t have time for you (pause) they came is like a second “here it is.. I have to go is too busy today” Is busy everyday. I don’t want them to think I am a nuisance.
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participant: It finished. I don’t feel at home since I left my place in 2014. I was a very independent woman and when I had a fall my life changed, and it will never be the same I am afraid. I can`t get use to it, this legs can`t take me no where (shake head with sad face).
Researcher: Tell me what would stop you from feeling at home?
(question changed to what stops you from feeling at home – due previous answer it made more sense).
Participant: My health. My mobility. If I only could do this little things for myself, I would not feel so dependent and a nuisance, always ringing for help.I like this place, they are good to me. It is my health, pains and weakness. Is like my life is over.
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: I don’t know other residents, I see xxx the lady next door, nobody else. I need help to go down stairs, to come upstairs it is too hard for me (pause) I prefer to stay in my room. They bring me my meals. Sometimes I go for physio, and I talk to everyone, I am a chatter box (laughed laud).
Researcher: How would you describe your relationships with other residents?
Participant: Occasional chats (laughed).
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: I don’t know. Sense of humour helps me to forget my condition (pointing at her lower body-legs).
Researcher: How your relationships with other residents help you to feel at home? Participant: It does not help me to feel at home. To feel at home, I would need to feel more independent to go around. But I would not be here. When you are not well and depend on others for everything you don’t feel yourself or at home.
Researcher: And what would you change in those relationships, to make you feel more at home?
Participant: But if I could change, I would change my condition, make these legs strong again and go around, not stay in my room waiting for help.
Researcher: What do you expect from those relationships?
Participant: I don’t expect anything. They have their own problems, otherwise they wouldn`t be here isn`t it?! We share experiences when we take part of the physio sessions – the disable ones (laughed) we get tired on the first 5 minutes (laughed) very hard those exercises (smile), but we must do it to prevent the worst. We do it twice a week.
Researcher: What do you give to those relationships/ what is your input?
Participant: Not much, I have nothing to give. Not anymore. No (sad)
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: It`s okay. They are so many (smilled) I like xxx and yyy they always try to help me properly they don’t rush me. YYY makes me laugh she is always in a good mood, she sings (laughed), she likes her job. But some of them they come quick quick is a second and they have to leave, the bells are ringing. I know there are more people, I have to be patient and wait for my turn.
Researcher: How would you describe your relationships with staff?
Participant: I never had problems, I don’t complain. Some have more time for me than others. At night they have more time, I like to talk when they stay a bit longer we chat is good.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: Patience. I need them to be patient with me.
Researcher: How your relationships with staff helps you to feel at home? What would you change in those relationships, to make you feel more at home?
Participant: It helps me to feel good when they are patient and don’t rush me. I don’t feel at home but feel, feel better, it helps me to forget a little bit about my situation.
Researcher: What do you expect from those relationships?
Participant: Patience and understanding. Kindness and time to help me without rushing me, or living me half dressed, waiting in the loo (..) they go for emergencies, they say so, and I am here forgotten.
Researcher: What do you give to those relationships/ what is your input?
Participant: No much, what can I give, I chat, maybe they don’t like it they may think “look at this old one, what she wants” (laughed).
Researcher: Tell me about your relationships with family & friends?
Participant: Very good. I have a lovely family, they come every week. Do you work here?
Researcher: No.
Participant: Of course not, Don’t mind me, but the staff have met them, my grand daughters they love to see me. I look forward their visit all week.They call me mostly every day, but I prefer to have them here. We do go out for lunch, they are very patient with me, help me to get downstairs, to get in the car (tearful) I am so lucky, blessed.
Researcher: How would you describe your relationships s family & friends?
Participant: Very good. I am the luckiest mum and grandmother.
Researcher: Any friends?
Participant: I have some friends but not very close, we send cards for Christmas. With age life changes.
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: Their love, patience, coming to visit me, take me out on Sundays.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: It helps me to keep going, to have something to look forward. I would change (pause)
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I would change my condition if I could so I could go and see them more often, and make their life easier when they come and take me out.
Researcher: What do you expect from those relationships?
Participant: I expect them to be patient with me, I hope they will not get fed-up (laughed).
Researcher: What do you give to those relationships/ what is your input?
Participant: I don’t know, you need to ask them (laughed) I tell them how much I love them all the time. My granddaughters are beautiful and lovely young ladies. I tell them to follow their dreams and take advantage of their youth (laughed). To be strong.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participant: I use to be a very independent person, active doing things, meeting people. Things didn’t change when I came here, it has changed when I had a fall and suddenly became dependent. I have moved to my son`s place and since then everything changed. I was no longer able to drive, visit friends. Since I`ve moved into this place, I see my son less, but is better this way, he has his life and it was too much for him. Now I have 24h care and he comes to see me (pause) Is different. No necessary worst or better.
Researcher: Is there anything else you would like to add, and/or do you have any questions?
Participant: No. I told you everything (smiling).
Researcher: Thank you for your participation.
Thank you
Interview 5
Age 79
How long participant has been in a care home 10 years
Gender____ F
Ethnicity____ White British
Researcher: What is your name? How would you like me to call you? – (remind participant that, on the study, a different name will be used – However, only for the purpose of the / during the interview, the researcher will be using/calling the participant by their own name or nick name (participant`s choice).
Participant: N
Researcher: How are you?
Participant: I am alright. Thank you. Yourself?
Researcher: Tell me a bit about yourself?
Participant: Myself?! I am N I have been living here for 10 years, nearly 10 years (thinking) 9 nearly 10, I don’t know, yes 9 for sure. I am a widow. What else do you need to know?
Researcher: How did you come about moving to a care home?
Participant: My husband dyed, he was my pillar and I did not feel safe to stay alone in such a big house. I used to live down the road, we had a detached house with a lovely garden, where we have spent almost 50 years. But I could not take care of it by my-self, I had carers coming twice a day, but eventually I have chosen to sell it and come into a residential. I have always somebody around to assist me in whatever I need. No everyone is very efficient but is safer. It was hard to move, I had a house a big house with lovely furniture that my husband and I had chosen over the years, lovely tapestry he have bought abroad, expensive beautiful. My husband was a man of refined taste, so am I. We both like good quality. Now all I have is what you see (looking around the room) and some other valuable pieces are in my children`s houses.
Researcher: How has been your experience living in a care home?
Participant: Overall it has been a good experience. When I moved in I was more independent, I use to spend some time at my daughters and she was coming here (pause) every day!! She lives down the road. I have been in the same room since. Sometimes I feel lonely and I call my friends – I do have many friends alive, contrary of what you might think, and they love a good chat with me. I was a very social lady, we use to organise dinners, invite people. We knew many people in XXX. My husband was a well-known gentleman and I use to go with him to events, concerts, theatre.
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participants: It changed very much. I don’t feel at home, but I pay for this room and had it arranged in my way, so I feel in my own space.
Researcher: Tell me what would stop you from feeling at home? (adapted to feel in your space – to facilitate understanding).
Participant: If I would not feel in my own space, with everything arranged in my way, I would not be here. Do you know how much I pay for this little .. well little, they say this is the biggest, for me this is a small room (I will show you a bill if you want to see)
Researcher: No, is not necessary I believe you.
Participant: Yes, they have to treat me like a 5 stars hotel (smiled).
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: I don’t interact with other residents, not anymore. When I have moved, I use to have my dinners with others, stay for activities but not now. I don’t enjoy, some shout and I don’t understand what they say they are deaf (smile). I prefer to talk to my own friends over the phone. They come here for a tea, here in my room.
Researcher: How would you describe your relationships with other residents?
Participant: As I said, inexistent. Not that I don’t like, I don’t want you to take me wrong, I just prefer to talk to my own friends, we know each other you see.
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: I know about them through the staff, when a new lady comes I like to know about them (smiled). I have a “friend” upstairs now (smiled) I know she reads the same papers and she shares the same interests, But I have never met her, I know her name is XXXX. We speak through the staff, I send her my papers she sends me hers, so we don’t have to pay for both papers she pays one and I pay the other (smiled).
Researcher: Would you like to meet her?
Participant: Maybe, I don`t think about it, but if she wants she is welcome to come for a tea.
Researcher: How your relationships with other residents help you to feel at home? It does not.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: Well, now I am thinking .. I could invite XXX for a tea, I have to check when I have time.
Researcher: What do you expect from those relationships?
Participant: Nothing. I have got used to have the paper, but would bother me if she does not send it. Is an informal agreement you see.
Researcher: What do you give to those relationships/ what is your input?
Participant: I share my papers everyday, you see on top of that chair they all there waiting for her, she has been away – they did not tell me where, I have tried but no one seems to know – well, they might know (smiled).
(EXTRA INFORMATION- REVELANT FOR THE STUDY AND ANALYSIS OF THIS Interview – STAFF HAS SHARED WITH RESEARCHER THAT THIS “FRIEND” HAS PASSED AWAY TWO WEEKS AGO – N DOES NOT KNOW)
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: I have my favourites (smiling). People need to listen to me, when I talk I want them to listen to what I am saying. Some girls don’t stop to listen, they start doing things without listen first. I like things done in certain way, they need to listen.
Researcher: How would you describe your relationships with staff?
Participant: On and off (smiled). Sometimes they don’t listen and I ask for someone else assistance, they take it personal. One little girl came, she was not listening I told her to call XXX
Researcher: other carer?
Participant: Yes, very lovely girl, I knew she was on duty I ask for her, she knows me and listens. The little girl was crying, XXX told me. I felt sorry for her and apologised.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: The most important thing is to be assisted when I need and they have to listen to me. I prefer the ones who have worked here for longer, they know my routine better.
Researcher: How your relationships with staff helps you to feel at home? What would you change in those relationships, to make you feel more at home?
Participant: They help me to keep things tidy, clean. Obviously it helps. But it will be better if the staff are well trained for this job.
Researcher: When you say trained, can you be more specific?
Participant: They need to listen to people, how they expect to help without listening to what people need?!
Researcher: What do you expect from those relationships?
Participant: Qualified staff, with experience.
Researcher: What do you give to those relationships/ what is your input?
Participant: What do you mean? They need to help me, in what sense could I help them? I learn their names, I am polite with them, I tell them my routines and how I like things done.
Researcher: Tell me about your relationships with family & friends?
Participants: We stay in touch, they come over for a cup of tea. I am lucky because I use to live down the road. They all know where to find me (smiling). We speak over the phone mostly every day. My friends are all widows we have lost our husbands in the last 10 years, I was the second one, is sad. My husband was a lovely husband he treated me like a princess (smiling), he was tall good looking. The women were jealous of me. I was very lucky (smiling).
Researcher: How would you describe your relationships s family & friends?
Participant: Close relationships, everyone lives in this area, so they come all the time.
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: Loyalty, they are all old friends we know each other well.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: Not here. Well I can receive visitors at any time I want, except at night time. I presume it helps.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I cannot deny that it helps massively. Having them around as I use to have in my house, it does help. Well there is nothing that I can change. If I could go back in time, but that is not an option. My daughter comes, brings me eggs, she has some chickens, and some of the staff buys her eggs, they are good big, proper eggs, not those from supermarket. Well, I have never been in a supermarket, I had a lady who use to buy me the groceries, my husband never let me do those tasks, he could pay somebody.
Researcher: You have never been in a supermarket?
Participant: No, I haven`t. But I know what is good quality and what is not (smiling).
Researcher: What do you expect from those relationships? (with family and friends)
Participant: I expect loyalty. We know each other very well since many many years ago.
Researcher: What do you give to those relationships/ what is your input?
Participant: I never forget special dates, I call them and make sure we don’t loose contact. I make them little surprises, send them little presents, cards and letters. We know how to spoil each other (smiling). I am very creative when I send cards, they love my cards.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participants: I think I have responded to that question before, haven’t I?
Researcher: Somehow, would like to add something?
Participant: What is the question again?
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home?
Participant: It was obviously better, I had a big house to receive them, we were much younger, use to go out together, we were very social. Now we are less, our husbands have passed away, is different. But we keep in touch anyway.
Researcher: Is there anything else you would like to add, and/or do you have any questions?
Participants: No. Will you share my answers with staff?
Researcher: As I told you this interview will not be shared with any one else. (Researcher went through the debrief sheet and Participant Information sheet again)
Researcher: Do you have any questions or anything else you would like to add?
Participant: No. I am satisfied with the explanation and the papers, can I keep them?
Researcher: They are for you. My contacts are here (pointing at the contacts on debrief sheet). Thank you for your participation.
Interview 6
Age 79
How long participant has been in a care home 4 years
Gender____ F
Ethnicity____ Eastern European
Researcher: Hello so can I just take a note of your age well
Participant: I am 70 very young probably one of the youngest do you think.
Researcher: What’s your name? I won`t be using your name on the results on the study.
Participant: Yes, I understood. I think I have an idea about these things, my son has a post-graduation. I used to hear him talking about is dissertation. I have an idea yes. My name is L***
Researcher: How are you L?
Participant: I’m ok I’m alright happy to see you today so something is happening.
Researcher: How are you know
Participant: I’m in this bed then you get bored just the TV and nothing else happened, to have somebody to talk.
Researcher: I’m happy that so I can bring a bit of a change in you and your day and so tell me a bit about yourself.
Researcher: How did you come about moving to a care home?
Participant: I’ve been here for like a long 3 years. 3 years I’ve been here, and I have moved because I had a problem with my health and diabetes, it went really bad so I had a major surgery and eventually I have lost my legs and I couldn’t cope at home, with the weight, I have started to put on weight. My children couldn’t take care of me, it was too much and I told them; look listen we have to think about a solution a reasonable solution so we did. Oh I am happy to have you today, I love a good chat I’m happy to talk to you today. I like butterflies, you can tell (pointing around the room – with butterflies).
I love a good movie. Oh yes, I really enjoy to watch a good movie.
Researcher: How has been your experience living in a care home?
Participant: It’s not very good, but is better than being at home is better than being at my children’s place, but it’s not good I am in my room. I don’t go around. I don’t like to go around. Everybody is much older than I am, it makes me feel depressed. They wonder around the corridors, they have dementia. He’s a different reality then mine.
Researcher: So tell me more about your sense of home since you came into this care home?
Participant: Sense of home I try to focus on what I need to do to today, not that I can do much but I can watch my movie, check what’s on telly, choose my food for tomorrow, think about what they can do what I will dress, the girls help me to dress. They`re lovely, they`re beautiful, very beautiful really good. Every day’s a different day and I try not to think too much.
Researcher: Tell me what would stop you from feeling at home?
Participant: But as I said I don’t really feel at home I tried to take one day at a time but I think it’s my condition, it’s not the care home, is my condition. I like my room everything is decorated the way I want. I love to put the stickers on the wall I have my own curtains. I like it purple so everything is purple (laugh) and it’s my little place. I think if I could not have it the way I like, it would stop me to feel at home.
Researcher: What would stop you could feel as you saying in your place?
Participant: Well not having the things the way I like, that would stop me to feel less homely, and I don’t know if I would be able to cope. To feel the things are the way I liked so I feel at home yes yes, yes I feel this is my place. Having the room beautiful, when your room is beautiful the girls come they help me to do it, and my boys.
Researcher: Your sons?
Participant: Yes. They do it lovely and beautiful.
Researcher: Tell me about your relationship without the Residents?
Participant: I don’t have any relationship with the residents. I don’t see anyone I can hear them from my room. I know their names because the girls they tell me about it, whose new whose left, who passed away, and I get to know who is next door who is upstairs. I think I know almost all of them. I think I know their names but I have never seen them. I think I have never seen anyone. I just see through the door when the door is open. It happened to look and then I see but it’s not like I can put the face to a voice. I hear the voices shouting at night. Oh my god some really shout during the night. Nut I don’t have any sort of contact with that them. I don’t I would make friendship with some people but I don’t get to know them and I don’t really try I don’t want to get out of bed I am I’m in bed and III is a big challenge for me and I don’t really want to talk about it today
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: Oh yes the girls are lovely. I like them we chat all night. They stay here sometimes chatting. M**** she stays sometimes more than she should, I guess, because the other ones come to complain (laughing). I do like a good chat some girls. I love a good movie, some have watched the same movies as well and then they tell me what’s going on and what movies are good. Witch movies are on which ones are good and then we comment the stories.
I really I really like the cinema now I have it in my room but it’s ok . It helps me to past my time, I watch many many movies on the telly. You can find really good movies on the telly. They sometimes repeat it, you watch the same, but I don’t mind, if it is a good movie, I can watch it over and over and over again I don’t mind.
Researcher: I would describe this relationship with the staff?
Participant: I have a good relationship with them, they are beautiful girls and I will love to have a good chat they come they help me. I really love it. Yeah! They`re lovely.
Researcher: What is for you the most important things on those relationships?
Participant: Important things (pause) the most important things are; when they have time. When they have time. I don’t like to be rushed and I can see sometimes they don’t have much time for me and for me the most important thing is when they can take their time, listen and talk to me and you know, and I no rush because if they rush they don’t clean me properly. I’m in bed you need to do it right so that’s for me the most important thing for them to come and spend enough time looking after me. I understand they have more people to look, to look after, but I need the assistance for everything and I need them to come with time and spend time doing things right, be pleasant have a smile in their face. Some sometimes I don’t know, but they look upset. I like when they come with a smile on their face yes, a smile in the face and the job well done.
Researcher: So, tell me about family and friends?
Participant: I have two sons they come to visit me, not as much, as much as they can. For me I would have them everyday. They have their lives, they have to go work, I understand I understand. We, we talk on Phone. Yeah, I have two lovely Sons.
Researcher: How would you describe those relationships?
Participant: Good good good my granddaughter she comes she brings me all these butterflies she comes; “nany nanny look I brought you another one” (laughing). They are lovely they`re beautiful.
Researcher: So what is for you the most important thing in those relationship?
Participant: Is when they come they come and see me.
Researcher: What do you what do you expect from those relationships?
Participant: Expect them to love me, show their love. They they don’t forget about me, visit me. They share with me things about their lives they asked me how I am. They help me to take care of papers and things that. I am limited here can’t access many things they need to do for me, I expect them to help me, to let me know what’s going on to tell me the truth.
Researcher: In your opinion what do you give into those relationships?
Participant: I have no much to give, I would love to give them much more be able to go visit them to have my own place not being here so they don’t have to sort out things for me at least. I can’t do much.
So what do you think you can give, under the circumstances?
Participant: I do (pause) I love them and making surprises remembering their birthday, ringing them. I always make sure I ring them in the morning they like it. Sometimes I’m not very happy but for them, I put a smile on my face and I can I show my appreciation for what they do for me. Yes, that’s that’s all I can do and I am happy that I can do that but that’s all I wish I could do much more but.
Researcher: Tell me about your relationship with family and friends before and after coming to leave here?
Participant: So physically, before I was always able to go around to meet friends to do my things and that was the biggest change. My disability changed my life forever is not something we can repair it’s changed. Some friends are gone.
Researcher: So in what sense?
Participant: It changed because I can’t do anything for myself and I’m dependent. I was dependent on them so they have to come here I am too young for a care home. I was used to have a normal life people around. But it changed. I have never had many friends, I had a few good friends not many friends. I was always very a family person. I was always with my husband and our children and then everything changed and then my husband decided that he he he wanted to start a new life with somebody else it was too much for him it’s not easy is not easy (pause).
Researcher: No, it doesn’t seem easy. It must be difficult for you to talk about all these things. As I told you at the beginning there is some contacts on the papers I gave you and you (participant interrupt)
Participant: Thank you. I am okay.
Researcher: I spoke to the staff there will be more than happy to speak to you in the end of our interview. If you feel like. If you feel that this is too much for you, you can always call me as well and withdrawn from the study, if you don’t feel like taking part of the study anymore.
Researcher: We have finished now, it is there any and yet at any anything else you’d like to add or any questions you have?
Participant: No I don’t have any questions. I would like to add something, you know my situation is probably very different from everyone else, because I didn’t come here because of my age or dementia. It was unfortunate, it was a situation that I never imagined going through, I have never thought about moving into a care home. I was too young and different situation of course. I’m happy to take part of your study. I’m happy to have somebody to talk today is lovely. But, yes I feel ugly, bit sad sometimes, I cry you know, have a good cry, because things are not easy when you too young and you see yourself bedbound is not easy. I have tried my best keep going, avoid thinking too much, and take one day at a time. Is not easy but it works some how it works.
Do I feel at home? Not really but I feel this is my room.
Researcher: Thank you very much for your participation
Participant: Thank you very much it was a pleasure.
Interview 7
Participant – 7
White British
Age_81
Female
Researcher: Hi hello and so we will start going to view so I am going to start to ask our how are you today.
Participant: I’m ok today actually lovely day sunshine I am ok today.
Researcher: What is your name? So I will call you by your name during these interview but I know you use your name and under study as well as we discussed before we start the interview itself you can withdraw from the study at any time where is if you if you don’t change your mind and we will not use your name but a completely different name so your identity won’t be revealed.
Participant: Oh no! I want my name on it (laughed) I am kidding. What are you writing down?
Researcher: I’m just taking notes of your gender.
Participant: Of course, I know it’s the studies about females that you are British and your age?
Participant: 81
Researcher: thank you. So, tell me a bit about yourself?
Participant: My name is Joanne as I told you. I’ve been here for 8 months came because I had a fall and I’ve broken my ankle and since then I struggle around the house. I had a big house with stairs they couldn’t get one of those lifts on the chair, on the stairs. We struggle because of the design of the house It was too Narrow. So the best was to look for a proper long term solution. I am telling you know no more troubles now. My children live in the North my grandchildren they have their studies and still very young to look after me. I wouldn’t expect that. So I`ve decided to come here. I don’t know how long I’ll be here, might be forever I might be just another 8 months let’s see how I`ll recover. More things about myself (pause) II like painting, you see some paintings on the wall I’ve done some of them.
Researcher: They look lovely.
Participant: Thank you. Yes, I do like I do like painting I like football and tennis. I I’ve learnt to like it with my husband. My husband used to watch football all the time and tennis. So I got used to it so now when I watch it remind me, (pause), anyway it doesn’t remind me of him anymore it just makes me feel good. So, I watch it. I like it, I enjoy it I know I check on you Tv magazine, to check the sports, matches` dates, I cross it and look forward it, is like a hobby for me.
I also like to go downstairs stay with the other ladies, but I prefer the quiet.
Researcher: How did you come about moving to a care home?
Participant: So, as you said, I had a fall. Basically that was the reason. I still have my house. Selling a house is not what you think, (pause) it is not what I thought I mean (smiled), it is really hard it’s really hard to fix something, to repair, to update, you can’t just sell it. Is a trouble, takes time to someone to be interested and buy it. Nor easy, it needs to be updated, arrange views, sometimes views are too late, inconvenient hours, I need to find someone to go with them.
So, I still have my house. Sometimes I ask my grandchildren to take me there for the weekend. But I don’t stay longer than 2 days. At this moment it wouldn’t be safe for me.
Researcher: So, tell me about your sense of home, from since you came here since you move to this residential care home.
Participant: My sense of home?! So, I still have a home. In the back of my mind I know I have my house, it is there it’s not sold.
In here, I have my room I like my… my TV. I have my own TV is bigger, has a bigger screen than the other ones they have here in the rooms. They’re small and I can’t read the subtitles. I like to watch a movie and then I can’t read it and I cannot put it loud you see, the ladies need to sleep and I spend all night awake.
I struggle to fall asleep it keeps me entertained with a company. I put a movie and I watch it at night so I need a big screen so I can read the subtitles instead of having it too loud.
I think I feel safe here, but I don’t have the same sense of privacy and more the sense of home I wouldn’t say that. For instance; I can’t sleep with door closed doors so I needed it opened. In my own house my room doors are never close, here is the same. I can’t sleep with the doors closed so they are opened overnight. The girls can come at anytime, they just check on me and I wanted to be checked, so I asked them to do it so. In most of the checks, I’m awake. I see them coming they pop in (laughed) I say hello, sometimes they get scared, because they think I’m asleep.
Is not the same I wouldn’t say I feel uncomfortable here I do, but it’s not a sense of home as you saying. I`ve read your papers I don’t think I feel that way.
Researcher: So tell me what would help you to feel more at home?
Participant: I don’t know. I don’t really know. (pause) I think I need to stay longer to get that feeling, to bring my belongings here, my furniture, decorate a room with my own and furniture, my own blankets and towels my own curtains movie player and movies.
Because, I still have my house where I go quite often. I I don’t know if (pause) probably it will be very important to make the room more accommodating.
Researcher: Tell me what would stop you from feeling at home / comfortable?
Participant: More comfort, or wait, what would stop it, less comfort. I have my routines I can walk watch the sports, and no one sets the routines around my needs, but when I ask for some changes they did try to meet my needs and but I can’t change the entire routine of this place. It suits me the way things are done. I have my my snack at night. I know the people complaint but I bet they could have it if they ask for it. I asked for it – small changes, and no one argued. They did many other little things, special requests. The home tries to meet my needs. I bet is a negotiation, if I have special requests.
I would feel less comfortable if people come into my room without knocking at the door. It’s nice if you knock, keep the things as you find. They have to come in, they have to make my bed, clean, collect laundry. I am not fussy, I was never fussy, I’m easy to please.
Researcher: Tell me about your relationship without the residents no names are required?
Participant: I do participate in all the activities, all of them. I asked for the list of activities the calendar, and I see what’s happening every week every day and I go for everything I need some help sometimes, but sometimes I go on my own and I take part of everything. I do have my meals downstairs. I stay for quizzes, arts and crafts, painting and physio. I have to do the physio is not an option anymore.
And once I’m there I talk to everybody. we must talk to each other to make it work and I enjoy it so few people talk more than others and we get to know each other. Get to know people, their background the interests things make you think that makes you closer to some people more than others.
Researcher: Would you describe your relationships with other residents?
Participant: I suppose they are good relationships. I don’t think I have any enemies here laughing. Sometimes I’m more quiet than others but I listen and I am there with them and I enjoy. I enjoy the interaction.
Researcher: So what is for you the most important thing in those relationships with the residents?
Participant: Sharing, things, taking part of activities together, respect, get involved, avoid disagreements. Everybody has different opinion. When people disagree with me, I don’t have to worry, we are seniors, we don’t do that. Why?! I don’t and I don’t find it helpful in our situation living here we need to be tolerant.
Researcher: How do you think your relationship with other residents helps you to feel at home?
Participant: It helps me to feel more involved, more part of it, helps me to keep going. I don’t know if it helps me to feel more at home I don’t know what to call it, is is is a good feeling, feeling comfortable feeling that is the place where I live and it does help me to keep going, does help me to feel more familiar with the space(long silence).
Researcher: What would you change in those relationships to make you feel more at home?
Participant: Perhaps more activities. So, we could interact more. Activities during the weekends because we don’t have anything over the weekend. I usually go to my place, but when I stay, I`ve found it boring if no one is coming to visit me, there are less people sitting around and sometimes the TV is off, switched off, no radio (pause) is that silence no one talks. So, promoting more activities having something going on all the time, would be good. I would definitely go and it would definitely help me. It would help me to keep going, to feel more involved, absolutely.
Researcher: What do you expect from those relationships?
Participant: I I think I might expect tolerance, because we are living in the same home, we share the space and so I expect a certain level of tolerance. If not, I expect the staff to promote that tolerance and the respect, I expect the staff to mediate those interactions. So, no one is disrespected or abusive towards anyone.
Researcher: So what do you think is more important in those relationships?
The same, Tolerance.
Researcher: What do you give of yourself into those relationships?
Participant: I give my time, I have my lunch with people, even if they are a bit rude, I`ll ignore. I don’t think too much about what the people say, we all have different backgrounds. I let go and next day I go back and seat with the same people, no hard feelings, some don’t know the meaning of words, their memory, the mind is not there anymore, we can`t take things personal, and we are not on our thirties anymore, we pick our battles, or don`t pick battles at all (laughed0.
Researcher: Tell me about your relationships with staff? No names are required but of course if you say a name is okay, but I will not take note of the name.
Participant: Ok. I like them, everyone is polite, very professional they tend to all they can to meet our our needs, my needs, they do. When I ring for assistance I have heard people complaining that they don’t come when they need, I haven’t experienced that. They always speak calmly with me, they listen to me. Sometimes they shared their stories, they tell me they are tired and why and then I told them a bit about my day, we have these chit-chat, I like it.
Researcher: I would you how would you describe those relationships with the with staff?
Participant: Professional, pleasant and enjoyable.
Researcher: What is the most important things in those relationships? With staff?
Participant: For me the most important thing is clarity. Knowing what I need and I know what they can do. They cannot do everything, they can’t. They have to respond they have to call emergency lines deal with it. The nurses, they have to speak to the managers to take some decisions or to allow us to do certain things. We need to be aware of this, be more conscious of their duties and responsibilities and what can and cannot be done. Communication is the key. I believe we can avoid all sort of troubles with a good conversation.
Researcher: How your relationships with staff helps you to feel at home?
Participant: Is just what I`ve said. To be clear about what can or cannot be done. A good explanation, being reasonable, both sides myself and them. To be honest and open about things. We need each other, certainly for distinct reasons but we do. Is much better to be open and honest about everything. getting angry does not solve anything. (pause) To be clear about their roles and duties. Staff to be more assertive when excusing themselves, when explaining. A good conversation can clarify and make agreements.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I have no complaints, But I have witnessed some situations when conflicts could have been avoided. So, less disagreements. We don’t need it.
What do you expect from those relationships?
The same. (referring to previous answer). Clarity.
Researcher: What do you give to those relationships/ what is your input?
Participant: My input?! I remain calm. I do listen to them. I don`t take things personal. I hope it helps them to feel better about their job. Being rude to the staff does not help, it just make things worst. it generates misunderstandings, hard feelings, preferences. We need clarity.
Researcher: Tell me about your relationships with family & friends?
Participant: I have contact with all my friends and family as before. Things have changed over the years when my children have got married and moved to the north.
Researcher: Does it help you to feel at home here?
Participant: It does help me to feel loved and looked after. because despite me being here we keep the same relationship.
What I would change .. I would rather have them near by.. but I would be selfish. They have their lives and they have their jobs everything in M******* They have moved years ago.
Researcher: Friends?
Participant: they come here to visit as often as we use to visit each other before. I didn`t experience differences.. Yet! (laughing).
Researcher: What are your expectations?
Participant: My expectations are that they love me and check on me keep in touch.
Researcher: What is your input, what do you give in those relationships?
Participant: My input?! I take the initiative to ring them. If I miss them I ring them, I send a card saying it. Some people make their lives very difficult; complaining. if we miss them and they have not said anything, I’ll ring and let them know they I’ve miss them. No need for conflicts.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home?
Participant: Before and after?! (pause) as I said I have not experienced changes, there is no before and after. Maybe because I still spending time at home now and again. Let`s see in the future. you come back next year and I will tell you (smiled).
Researcher: Is there anything else you would like to add, and/or do you have any questions?
Participant: I hope my contribute it`s helpful, my story is not very exciting (laughed). I told you my view.
Researcher: Thank you very much.
Participant: and I wish you the best.
Researcher: please keep the information sheets and let me know if you decide to withdrawn from the study. Many thanks for your participation. it was a pleasure to meet you.
Participant: I have done my best, hope it helps.
Researcher: It does. Everyone has a different experience and that is what we need; different experiences.
Participant: Great. Lovely to meet you.
Researcher: Thank you
Interview 8
Age 81
How long participant has been in a care home – 2 years
Gender____ F
Ethnicity____ White British
What is your name? How would you like me to call you? – (remind participant that, on the study, a different name will be used – However, only for the purpose of the / during the interview, the researcher will be using/calling the participant by their own name or nick name (participant`s choice).
Researcher: Hi. good afternoon. how are you?
Participant: Hello. I am well thank you.
Researcher: So, your telling me that your name is Mrs.B…
Participant: yes. B … S… (smile)
Researcher: So tell me a bit more about yourself?
I am 50 years old, young lady full of energy (laughed) I wish (laughed) I am 80 oh.. 80?! (laughed) 1939.. (thinking and counting) oh 81, 81 (as surprised by it).
I have done all sort of things, and raised 5 children. My father was a police officer, so as you might imagine I’ve had a quite strict education. I have married when I was 21 and got 5 children M.. G… C… M… and J… I have got 10 grandchildren.
Researcher: How did you come about moving to a care home?
Participant: I was a nuisance at home, my children were checking on me daily. My legs, you see (showing the legs with marks and bruises) they very weak.. old lady legs. well I have got old lady legs since ever.. I was 19 and they were already like this.. not very lucky. that is way I have never used those beautiful dresses and skirts, always trousers. my dad did not like a woman in trousers but my mum knew how to keep things calm. I don’t know how she was doing it but she always managed. What was your question dear?
researcher: the reason to move into a care home? Oh yes. And I told you about my my legs yes yes yes. I had a few falls. I have arthritis and a bad knee u see. is useless. I can`t trust my knee, I must walk with a Zimmer frame all the time. We have decided that it would be for the best. I was a nuisance. I’m still one (laughed) but I feel better here. they look after me.
Researcher: How long time ago?
Participant: It was January 2017… about two years, it seems like it was yesterday.
Researcher: How has been your experience living in a care home?
I am happy, I needed care. Someone to keep an eye on me.
Researcher: Can you tell me a bit more about your experience?
Participant: When I came it was a shock. I spent a few days crying. I did not tell anyone, but is hard to see yourself in a small room in a care home. You think that`s it it`s done, our life is over. It will never be the same (pause) you are dependent and you are not the one in-charged. You have to play by the rules (laughed).
Researcher: Tell me more about your sense of home since you came into a residential care home?
I did not feel at home at all, no way. I felt very emotional for a long time, a good couple of weeks, I wasn’t settling. I did want to be here, no one has forced me, let`s say things as they are. But I couldn`t see myself living here for the rest of my life. And you see two years have gone and now I don’t think much about it anymore, I wake up do what I have to do – Nothing (laughing laud) you know what I mean, we must have a routine around the clock, and as the days go by, you don’t think as much anymore. There is always people around, for the good and for the bad (laughed).
Researcher: Can you explain that better?
Participant: You like some quiet sometimes. Here you can`t make it quiet, there are many people. There is always something going on.
Researcher: You said that now you feel better about living here, is it right?
Participant: Yes. I guess I`ve got used to it.
Researcher: Would you say that there is a sense of home now?
Participant: (long pause) Somehow. I know the place, once you know the place, what to expect, also what do not expect, yes. Somehow, I feel at home, but not at home. I believe is like feeling at home in a work place, after a few years you feel at ease around, you know the place you feel confident, less anxious or worried about what you do, you can be yourself.
Researcher: Tell me what would stop you from feeling at home / at ease?
Participant: It`s been 2 years, I don’t think it will change now.
Researcher: In your opinion what would change it. If something could change it?
Participant: If I had to move into another room, it could shake my feelings again, get use to a new space. I don’t know the all rooms, but I have heard that some are quite smaller and I wouldn`t enjoy moving to another room. Dealing with stairs, they must have a lift in the other side I guess, but it would change somehow.
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: I have good relationships with all of them. We share the same space.
Researcher: How would you describe your relationships with other residents?
Participant: Is good (…)
Researcher: do you chat?
Participant: We do chat in the afternoon, we chat before the lunch we have some cherry, we have a laugh. We have good chats, to keep us going (smile).
Researcher: What is for you, the most important thing in those relationships (other residents)?
The most important thing (pause) um… the most important thing maybe the moment when we have meals together, is good to see people around, it cheers me up, have a laugh. Listen to people talking.
Researcher: How your relationships with other residents help you to feel at home?
Having the same faces might help to feel at home, at ease not exactly at home, but in the sense of, what we said to feel at ease, yes it does help.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: Can I change anything? (laughed)
Researcher: If you could?
Participant: Have someone to chat and have a cherry together. Some days I have it on my own, some people have their lunch in the room.
Researcher: What do you expect from those relationships?
Participant: Companionship, when we are together obviously, otherwise I do not expect them to be with me or anything apart of respecting each other`s space, We are all different.
Researcher: What do you give to those relationships/ what is your input?
Participant: What do you mean?
Researcher: When interacting with other residents what do you think you give to them/to
Participant: No much, they may find me a nuisance. Well, we are all old. No many interesting things to discuss.
Researcher: Tell me about your relationships with staff (Names not required)?
Is good, I believe it`s good. I am impressed sometimes, they work hard, the health assistants. I don’t know about others, we don’t get to know the other staff.
Researcher: How would you describe your relationships with staff? The ones you interact.
Participant: Is good. They help me with my shower, dress undress, they are young full of energy. Sometimes you don’t see them around, I wonder where they are, we need them and they take a while to finally com to see us. I never say anything, they apologise and that is it. They might be tired, or hiding somewhere chatting, they love chit chat, I don’t blame them, I am the same.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: What is (pause)
Researcher: the most important thing.
Participant: Yes I understood. They are there for me when I need. When they approach us in a good mood happy to help.
Researcher: How your relationships with staff helps you to feel at home?
Participant: If they make me feel comfortable and respect my privacy, which they do.
Researcher:What would you change in those relationships, to make you feel more at home?
More staff, we have said this many times. I don’t think they have enough staff to assist us promptly. Every day, or almost everyday they say that is short of staff.. I believe that is an issue then. If they assist us better, obviously it will facilitate our life, makes us feel less in need you see, you know what I mean.
Researcher: What do you expect from those relationships?
Participant: Precisely what I said, to have a better help I mean time wise, less waiting. What If I have a fall, they need to think about it. The manager. the management whoever is responsible for personal.
Researcher: What do you give to those relationships/ what is your input?
I don’t know. I am sorry. Am I meant to give them anything?
Researcher: No, we just mean to ask if you think that you give something of yourself when interacting with staff.
Participant: I talk to them, we are never quiet, they always have something to say and I am the same, I like to chat. We speak about trivial things, have a laugh.
Researcher: Tell me about your relationships with family & friends?
Participant: I have a good relationships with my 5 children. My two girls live locally, they visit me when they can. We speak on the phone.
Researcher: How would you describe your relationships s family & friends?
Participant: Is good. I don’t have many friends coming to see me. We have lost contact, we keep sending cards over the Christmas. I keep them all, we know each other very well and have many memories together, we don’t need many words to understand each other (smiling).
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: When they come to see me and stay for a couple of hours, when they bring my grandchildren. When they remember special dates and take me out to celebrate all together. When the 5 of them are around and we do a big dinner with everyone.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: Come to visit me and staying with me for a couple of hours. Is good because I remember them around and I can look forward the next week.
Researcher: Their next visit?
Participant: Exactly.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: Nothing to change on the relationships. Nothing in the relationship would make me feel more at home. It helps when they come to see me here and stay for a while, it feels a bit more like home when they around obviously.
Researcher: What do you expect from those relationships? (with family and friends)
Participant: I expect them to come to see me and love me, remember me when they are in their lives so they can share things with me as part of their life.
Researcher: What do you give to those relationships/ what is your input?
Participant: I worry about them, I take part of their decisions, my children value my opinion, I help them financially as well, not much now.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participant: Well, with friends I see them even less now. With my family, is very different. We try to keep the same contact, but it is different. They cannot stay overnight, which makes things hard for them, they have to stay in a hotel or go all the way back to D**** with little children.
Researcher: Grand grandchildren? Participant: Yes the little ones, is too tiring for them.
Researcher: Is there anything else you would like to add, and/or do you have any questions?
I wanted to say. I don’t know if you can do anything about it, but this place should have a guest room, for families to stay, or allow them to stay with us in our room. That would help me to feel more at home, If they had to pay a fee something, that would not be a problem.
Researcher: I will not be able to make any changes in the home, but your views will be noted on the study.Thank you very much for your time and participation.
Participant: It is okay, if at least it help to change things for better.
Thank you for your participation.
Thank you
Interview 9
Age 81
How long participant has been in a care home 8 months
Gender – F
Ethnicity – White British
Hi, we can start our interview now.
Participant: Okay, ready when you`re ready.
Researcher: So, What is your name?
Participant: My name is R. But I would rather remain anonymous.
Researcher: Yes. As I`ve told you no names will be used or mentioned on the study itself, just for myself.
Participant: Right.
Researcher: How are you?
Participant: I am good thank you. Curious about your questions.
Researcher: Oh okay. Let`s get started then. Tell me a bit about yourself?
Participant: I am an 81 years old, who has come into this care home 8 months ago. It was a hard decision to make. I was in hospital; for a while after a hip operation and have realised that I would not be safe at home. I have a lovely son who made all he could to stop me, but I am a stubborn old lady, all his efforts were unsuccessful.
Researcher: which somehow answer my next question; How did you come about moving to a care home? Would you like to tell me more about your decision?
Participant: I had to, basically I needed help during my recover, and eventually I have decided to stay. It make sense. I feel safer.
Researcher: In here, in the care home?
Participant: Absolutely.
Researcher: How has been your experience living in a care home?
Participant: It`s been good. I feel safer knowing I can request for assistance at any time.
Researcher: Do you want to tell me a bit more?
Participant: Is hard to say, I am in need of care. Is not that I prefer to be here, but I do need it and I must look after myself and seek for help if in need. So is a conscious decision. I miss my place, but this is the situation and I must be fair and conscious of my physical needs.
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participant: There is no sense of home. I feel that I needed help .. to be in a place where I can be assisted and this is the place. No room for nostalgy. Need help seek for help, that is how I see it. I don’t think about how it would be staying at home, or what is missing in this place or how it should be so I could feel more comfortable, no. I don’t see the point, it would disturb me I presume. I am here, I had a lovely happy life, now I need help because physically I am old, I have a young spirit (smiled), and that is it. This place, in my opinion, must be comfortable, welcoming, warm and homelike, but no one can expect it to be their home. We may live here but is not our place, if somebody has such expectations will perhaps struggle … (pause) because you see they will face the truth and feel disappointed and in a place like this all we need is peace, not frustrations.
Researcher: Tell me what would make you to feel at home?
Participant: My own home. My own home will make me feel at home. Here I just expect warmth, clean environment where I feel safe and well looked after. Professionalism. I cannot ask a care home to be my home. I can live here, and don’t get it wrong I got your point and what you are studying, I am an educated woman, I can see your point. what I am telling you is a truth no one will tell you, there is no sense of home away from home, you will get use to a place and feel comfortable in there but it won`t be like home. Listen to what I am saying. Each place has it`s own purpose, a care home is a care home, a hospital is a hotel is a hotel, it might make you feel comfortable but that is all.
Researcher: Thank you. Tell me about your relationships with other residents (Names not required)?
Participant: I don’t spend time with other residents, I have my dinner in quiet dinning room, only 2 other people eat in there, a couple who seat in a separate table and D from room xx. I enjoy her company, but we don’t talk much she is a quiet person so am I. We barely know each other, I know her name and that is all, I don’t think I have ever mentioned much about myself.
Researcher: How would you describe your relationships with other residents?
Participant: I don’t know. I don’t go around … perhaps something I could change. Who knows.
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: (pause) I will tell what would be important, once I have no much contact. If in the future I decide to be part of in house activities, I would love to find friendly faces, kind souls and open minds. It`s all we need to have healthy interactions and feel safe, safe by all means, safe to share, to be, to engage and take part.
Researcher: Thank you. My next question is: How your relationships with other residents help you to feel at home?
Participant: I think I have just answer to that question.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: Not to feel at home, I won`t change my idea of what home means to me, But I understand, so, to feel more comfortable, safer in these space, note: comfortable and safer, I believe it would help to have great relationships. Yes, talk, share take part. You have touched a very important point, which I have never thought about indeed, I believe that.
Researcher: What do you expect from those relationships?
Participant: At the moment, nothing, In the future It will probably has have changed. I need to feel it, come back in a few months (smiled).
Researcher: What do you give to those relationships/ what is your input?
Participant: The same. So far I have been focused on myself not thinking to much other people, thinking of it makes me feel like I want to go downstairs now.
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: Staff, the nurses?
Researcher: All staff, nurses, carers, cleaners anyone you interact with.
Participant: It is good. They are professional, kind, helpful. They always appear happy most of them, I remember when I came I use to think “they must like their job”, the nurses. The housing, they do a good job nothing to complain, they`re professional, fast, they clean it well and quite fast, I couldn’t do it so well.
Researcher: How would you describe your relationships with staff?
Participant: You know what, I have never thought, I have never seen it has a relationship, but it is you are right. There is an interaction yes there is (pause). Is good it is a good relationship, they listen, they take care. They are in and out all the time, we see each other quite often. It is good, they are good workers, they seem passionate about their job. There is just a small complain, well, the waiting, they take long time to respond to my call, sometimes for half a hour.
Research: What is for you, the most important thing in those relationships (staff)?
Participant: You make very difficult questions I must say. Important … their good skills to look after me, being polite and pleasant.
Researcher: How your relationships with staff helps you to feel at home?
Participant: Safer (smiled), respond to my call faster.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: The same. Would change whatever is stopping them from responding to my call.
Researcher: What do you expect from those relationships?
Participant: Good skills to look after me, politeness kindness. Yes.
Researcher: What do you give to those relationships/ what is your input?
You must ask them.
Researcher: What would you say?
Participant: Not much, I receive care and.. so they are the givers. Is an interesting point. But I am not sure of what to tell you.
Researcher: Tell me about your relationships with family & friends?
Participant: I have a good relationship with all my family and friends. My son comes here every other day, he works for *** (near by place) so it is handy for him and I love it. My friends (looking at the phone) are in there, is all over the telephone. It is okay It has been like this since I have moved from L****. I have one tablet (pointed at the tablet on the table) and he also send emails, thanks to technology we can keep in touch.
Research: How would you describe your relationships s family & friends?
Participant: Is good, modern I would say.
Research: What is for you, the most important thing in those relationships (family & friends)?
Participant: Keep in touch. When my son comes to see me.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: It helps me to feel loved and when we feel loved everything appears easier so, I think I have answered your question.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: To feel safer and more at ease I would love if my son could stay a bit longer, my friends could visit me. I believe that the more you feel loved the better you feel – wherever. It does not matter.
Researcher: What do you expect from those relationships?
Participant: Love and care. No need for more.
Researcher: What do you give to those relationships/ what is your input?
Participant: I am always here …available. I have been always available to talk, to listen to be there for them.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participant: Is different, at home family and friends can stay over, since I`m here they had to stay in hotel so they can see me. It makes things more difficult. How was the question again?
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Yes. I don’t see them as often. But we talk, is not the same. Now we don’t see each other as often that is the difference.
Participant: Is there anything else you would like to add, and/or do you have any questions?
Yes. Thank you, some of these questions were an eye opener. I`ll certainly make a few changed on my routines. Thanks for that.
Researcher: Thank you for your participation.
Interview 10
Age 83
How long participant has been in a care home 1 year and 2 months
Gender F
Ethnicity- White British
What is your name? A
Researcher: How are you?
Participant: I am very well, thank you.
Researcher: Tell me a bit about yourself?
Participant: (…) where shall I start? (smiled) I must start from … well. . No lets make it simple, isn`t better? I am a curious, (long pause) brave and skilled woman who has had a marvellous life of her dreams. I was a piano teacher all my life, many of my pupils have become very important musicians. Had 2 children a boy and a girl, my son has graduated in music in P*** and is now a famous theatre actor/singer. What else could I ask for?!
Researcher: Impressive.
Participant: I know. I am proud. I was a single mum! Yes … You were not expecting it. Yes.
Researcher: How did you come about moving to a care home?
Participant: So, I have become very frail and my children have decided that it will be better for me to move here. They both live in France, it takes them 5 hours to come and visit me. Is far, they think I am dying (laugh) if something happened “mama we cannot be there” (referring to what children say). So, after a period of reflection considering pros and cons, I have agreed. They`ve convinced me (smiled) It`s okay.
Researcher: How has been your experience living in a care home?
Participant: How can I put it in words? (pause) It has been a roller coaster.
Researcher: Can you tell me a bit more about it?
Participant: Ups and downs until they finally adapt to me. I have my own way for everything, they can`t came here and tell me how to do things, when.. or how to do my own life. They have tried, but they lost the battle, I am not easy.
Researcher: When you say they. Who are you talking about?
Participant: The managers the people in-charge of this place.
Researcher: Tell me more about your sense of home since you came into a residential care home?
Participant: It did not exist. Nothing. When I told them how things would be, they said “no”. No?? No, that is not an answer for A. (said her name) No. This is my room (emphasis on the word “my”) I pay for it, this is my life, no one comes and tell me what I do or don’t. No. I gave them a hard time, I did. I know, but they don’t tell me how I live my life. So, when they eventually get to know A (said her own name) things eventually fell into place and I could feel at home. It takes time, but you get there. If… wait a second, if and only if they adapt to you.
Researcher: Home adapt to the resident?
Participant: (nodding) and not the resident to the home. The key (wicked and smiled).
Researcher: Tell me what would stop you from feeling at home?
Participant: That is not an option. I will not stay here, living here, if I would not feel at home. So, my answer is, in case things are not in my way, my room, my times respected (pause) my meal times, my medication when I need it not when they decide that is meds time, meds time? I am not ruled by timings, I take it when I am used to and suits my routine, not when it suits them. No. Have I answer your question?
Researcher: Yes. Thank you.
Researcher: Tell me about your relationships with other residents (Names not required)?
Participant: It`s difficult. We don`t know each other. At this age, I have found myself explaining myself. I don’t want it. People don’t believe in who I am. I was a wealthy woman, people can`t stand it. What can I do. I won`t tell them stories to please them, I am who I am. But it disturbs their peace. Some have money to be here because they have had rich husbands. I did not get anything from a husband. My father was a famous violinist in France we all had very good education. Is not my fault. It`s their frustrations. They have never travelled, gone on a cruise, seen beautiful ballets and classical concerts with the best orchestras in the world. I went all the way to Buenos Aires to learn tango. All those privileges (pause) but I won`t be hiding who I am to make them feel better. No.
So, I use to have my dinner with M and F but M started to question everything I say. I have decided that is better for me to avoid her. F is a good girl, if she is by herself I would have my dinner with her. She does not feel jealous. Yeah.. I thought I did not know what the problem is. I know, I know .. It hurts when you can`t be yourself (long pause – appeared sad).
Researcher: How would you describe your relationships with other residents?
Participant: Unfair. I accept them as they are. They don’t accept me.
Researcher: What is for you, the most important thing in those relationships (other residents)?
Participant: Acceptance. I need to be myself. I cant be with people thinking about what I can and cannot say about myself.
I told M that I had a Steinway, she laughed. What she knows. Who is she? Se is jealous of me, it hurts.
Researcher: How your relationships with other residents help you to feel at home?
Participant: Without those incidents with M, I would, I would feel better. Is positive to have someone to talk, but if those people have nothing positive to say, I would rather stay in my room or spend time only, only with the ones who accept me for who I am.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: People to believe me and accept me for who I am. Not laugh when I share my past.. No.
Researcher: What do you expect from those relationships?
Participant: I expect respect and acceptance. People need to understand that everybody is different, and some people have had the chance to enjoy life, it shouldn`t disturb or annoy, annoy them. Is frustration, but it hurts (touching on the chest).
Researcher: What do you give to those relationships/ what is your input?
Participant: I was giving everything, myself. I am a genuine, passionate woman. Is not pleasant when you can`t be yourself, and that was the problem.
Researcher: Tell me about your relationships with staff (Names not required)?
Participant: The girls are lovely, but they must follow the rules, and to get them on my side I have had to bend the rules. So now we speak the same language (smiling). Now they know me and can help me when and how I need. So we get along well.
Researcher: How would you describe your relationships with staff?
Participant: Good. They know me well. I make sure I tell them who I am, how I like things. I love a good chat, the mangers don’t like it, they want the girls on their toes … I always tell them, breath… seat down. One thing at the time. We talk I like to share some stories, to inspire them. These girls need to dream more, they can`t spend their life serving cups of tea, assisting old ladies to use the loo.
Researcher: What is for you, the most important thing in those relationships (staff)?
Participant: When they allow themselves to slow down and seat in that little stool, you see there under that chair (pointing at a small stool), and we talk, no age, no social status, just talk. The girls are good, better than the old ones my comrades (laugh).
Researcher: How your relationships with staff helps you to feel at home?
Participant: Helps very much. When they stay for a minute to chat with an old lady, it means the world to me.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I would change the managers and those stupid rules. They should be allowed to spend time with us, stay for a chat, is good for them to learn things from us and we need them to be there listening to us. Bring cups of teas is not enough. Not for me I need more, I need somebody who brings the tea and seats for a minute, talk to me, listen to me getting to know each other.
Researcher: What do you expect from those relationships?
Participant: I expect kindness, acceptance and care, by all means, not only to bring me a cup of tea.
Researcher: What do you give to those relationships/ what is your input?
Participant: My room door is always open. I can tell when they are not well, I am here for them, we should be here for each other, we give and receive. We are people, forget ages, staff, resident it does not matter, we need to be genuine.
Researcher: Tell me about your relationships with family & friends?
Participant: They are far away from here. My son visits me monthly, My daughter comes often, she works from home, so it`s easier for her. But she comes all the way from France, is not easy. Friends (pause) I know so many people, so many. Sometimes we send a card, give them a phone call.
Researcher: How would you describe your relationships with family & friends?
Participant: Is good. Could be better. My daughter is a complicated woman. She has divorced recently, she is not well, and she loses patience with her old mother. We have had better days. I love her dearly, but I have to admit that is hard for me to deal with her issues, sometimes I have to switch off the phone, because she upsets me.
Researcher: What is for you, the most important thing in those relationships (family & friends)?
Participant: Being close, being happy and spending quality time together.
Researcher: How your relationships with family and friends helps you to feel at home?
Participant: If I am well, happy everything else is good. It helps when you have a good relationship with your beloved ones.
Researcher: What would you change in those relationships, to make you feel more at home?
Participant: I would make my daughter less emotional, more grounded more mature when solving her issues. So, she would not drag me into it. It stresses me.
Researcher: What do you expect from those relationships?
Participant: I expect my children to be mature, to be conscious of their decisions and attitudes so I don’t need to worry or get involved in their issues.
Researcher: What do you give to those relationships/ what is your input?
Participant: They know me. They know they can come to me and offload, but there is a limit I can take, they must know when is too much. I am here for them, but I can`t get caught on those vicious circles of suffering. They need to know how to solve their own issues. I can listen but there is a limit.
Researcher: Tell me about your relationships with family and friends before and after coming to leave in a care home.
Participant: It has been the same since ever. I am the mummy they run to me all the time, and here I am for them. Maybe I`ve spoiled them… maybe I was not a good example not showing how to handle things… many questions.
Researcher: No differences at all .. between before and after moving here?
Participant: The differences are purely me being in a home. The relationships itself (pause) I can`t find any difference, same arguments, same trust, same struggles, same distance, they were not closer before I moved. No.
Researcher: Is there anything else you would like to add and/or do you have any questions?
Participant: No questions. You can stay longer I can show you some of my photographs, when I was younger. I was an elegant young lady (smiled).
Researcher: I really would love to, but unfortunately, I have booked another interview with somebody else in a different care home and is far 30m driving… So, I am sorry.
Participant: Call them say you will be late. (laughed) Go my dear go, where is it?
Researcher: Towards North.
Participant: Oh.. right. So don’t be late. Drive safe. And come and visit me one day.
Researcher: Thank you. Have a lovely day. Many thanks for your participation.
Thank you