Domiciliary care, self and older age

Social care funding is reducing in spite of a growing older population. Within this context, domiciliary services are increasingly failing to deliver care that respects the individuality and heterogeneity of older people (Equality and Human Rights Commission, 2011). To date, there has been limited research in the U.K. that explores, from the older person’s perspective, how care practices interact with self. Using biographical narrative methodology, this study takes a constructionist approach to understand the individual’s lived experience of care and how it interacts with sense of self. A three stage model of data collection was used, beginning with a narrative biographic enquiry, exploring with participants (65yrs+, n=17) their journeys into care and any consequential effects on personal identity. Stage 2 involved a two week period of diary completion, with participants recording daily reflections on their care experiences. In stage 3, a semi-structured interview explored the diary entries, linking back to the narrative biographic enquiry to reveal ways in which specific care practices interacted with the sense of self. The findings reveal that a strong relationship between older person and carer, forged through familiarity, regularity and consistency, plays a significant role in promoting feelings of autonomy and dignity. Furthermore such relationship mediates against the loss of executional autonomy that comes with increasing disability. Maintaining autonomy and control was a recurring theme, including in relation to one’s home, one’s privacy and one’s dignity. Findings also reveal increased feelings of autonomy and dignity when carers understand the unique ways in which individuals experience ageing and being in the cared-for relationship. These findings make an important contribution to the body of work concerning best practice in delivery of domiciliary care that respects older people’s sense of self. Furthermore, the narrative approach used within this study, and in particular the three stage data collection method of the narrative biographic enquiry, the diary and the follow-up interview, provides a valuable contribution to methodological knowledge.