The impact of the transition to a care home on residents' sense of identity

Paddock, Katie ORCID: https://orcid.org/0000-0003-1264-5845 (2015) The impact of the transition to a care home on residents' sense of identity. Doctoral thesis (PhD), University of Manchester.

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Abstract

The transition to a care home can be a difficult experience for older people, with various changes and losses, which can impact an older person's sense of identity. However, it is not clear how older people perceive and manage their sense of identity within a care home, particularly in the United Kingdom. This study aimed to explore how the transition to a care home impacted on the identities of care home residents, and how they addressed this impact. Findings were interpreted using the Social Identity Perspective (SIP), which postulates that people strive to maintain a positive identity. Identities are composed of a personal identity (relating to personality traits), and a social identity (relating to group membership). SIP can help to interpret the symbolic nature of interactions and experiences, although to date has been infrequently used in care home based research.This study used a case study approach with qualitative methods. Cases of three care homes were purposefully sampled within Greater Manchester. Residents, relatives, and care home staff were asked to participate. Semi-structured interviews with 18 participants (nine residents; four relatives; five staff), and approximately 260 hours of observations were conducted over one year. Data were analysed using Framework Analysis.Results revealed five overlapping themes: 1) Social comparison; 2) Frustration; 3) Independence and autonomy; 4) Personal identity vs. Care home; 5) Ageing and Changing. Overall, the transition to a care home had a negative effect on residents' identities, due to organisational restrictions and associations with cognitively impaired older people. In order to forge a positive identity, residents without dementia aimed to distance themselves from residents with dementia, whom they perceived negatively. To achieve this distance, residents without dementia engaged in social comparison, by emphasising their comparatively superior cognitive abilities and physical independence. Symptomatic behaviours of residents with dementia also caused frustrations amongst staff and other residents. Furthermore, differing expectations of the care environment caused frustrations between residents, relatives, and staff. Most routines and restrictions made it difficult for residents to express their personalities. Although staff aimed to incorporate residents' individuality into care, they often reported feeling restricted by a lack of staffing and resources. Additionally, residents considered the physical impact of ageing to alter their established sense of identity. However, the care home further undermined residents' identities, particularly in relation to their independence and autonomy, which were important elements of their personal identities. Residents' perceptions of what counted as independence changed in light of their declining physical abilities and what they were allowed to do within the care home, in order to maintain this element of their identities.Findings indicated that the care homes would benefit from more resources to organise more meaningful activities for residents. However, small changes to routines, such as allowing 'duvet days', also helped to support residents' identities. Recommendations for practice include the introduction of an 'identity champion' to provide guidance and support on how care home staff could make identity-relevant changes.