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Introduction

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

This unit is from our archive and it is an adapted extract from Understanding Health and Social Care (K100) which is no longer in presentation. if you wish to study formally at The Open University, you may wish to explore the courses we offer in this curriculum area.

This unit looks at the way people identify and become attached to places, buildings and objects. It also analyses how this attachment can impact on personal well-being. Understanding this is important in assessing the care people of all ages need and how this care should be delivered.

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Learning outcomes

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

After studying this unit you should be able to:

demonstrate an understanding of how shared histories of places and spaces could be an important resource to any caring relationship;
identify ways in which the environment can become a resource for caring;
appreciate the importance of personal control over changes of place in relation to how people cope and adjust.

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1 Attachment to place

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

In this unit we are going to consider the way in which people identify and become attached to places, buildings, objects, and how this attachment can contribute to personal well-being or how we feel about ourselves (Low and Altman, 1992). Looking at why places become important provides a basis for asking questions about what happens when people have to move, a common occurrence for people in need of care services.

The purpose of this unit is to focus on the psychological environment, how experiences of places support self-identity, contributing to well-being. Given that the domestic home is a central place for most people it is not surprising that much research has looked at the meaning of home and its importance across the life course, especially during periods of home making and home maintaining which can have different effects for men and women (Sixsmith and Sixsmith, 1990; Rubinstein and Parmelee, 1992; Arias, 1993). I will start this section by considering the meaning of home.

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1.2.1 Positive and negative meanings

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Many people spend a lot of time at home, they invest part of themselves within it, both materially and emotionally. So what does it mean?

Activity 1: What does home mean?

The good news

Read through these comments and write down at least two important meanings of home which you feel emerge.

‘It's family, it's where we live.’
‘It's somewhere I feel safe, I'm always glad to come home.’
‘It's somewhere to shut out the rest of the world.’
‘I can be myself at home, I feel really settled.’
‘It's comfortable, I've got this place just how I want it.’
‘A place where all my things are around me.’
‘It's familiar, I know where everything is.’
‘It's financial security really, it's a place that we own.’

The bad news

Once again, read through these comments and note down two important meanings which you feel emerge here.

‘I can't get upstairs anymore and the roof leaks.’
‘I never really settled here, it always felt temporary – my home was where I used to live.’
‘You couldn't call this home, you can't swing a cat in here it's so small and there's no room to put any of your things.’
‘I don't want to go home, I'm scared.’
‘I've experienced homelessness in the past, so a dream house to me is four walls and a roof over my head. At present I'm stuck in bed-sit land. I've lived in one after another for a number of years. It can be really depressing.’
‘I haven't been out for weeks, just looking at these four walls, it may be home but it feels like a prison.’

Discussion

How did you get on? I thought there were a number of important meanings emerging from these comments. For example home is seen as:

a place where the family live
a secure place
a private place
a familiar or known place
a place for possessions.

These themes tell us something about attachment to place and how the home can engender feelings of belonging, security, safety and permanence – all feelings which can enhance self-esteem.

But is this always the case? Do you recall occasions when you have not liked your home? Have you ever heard people say bad things about their home? Not all experiences of home are positive.

In the second set of comments, you can see a range of negative views which contrast with the positive feelings about home expressed above.

You might have thought about the following:

that the physical environment can affect just how you make yourself at home
that the permanence of the situation affects how settled you may feel
that a poor environment can be depressing
that being alone and not being able to get out can lead to feelings of isolation
that who you live with, and your relationship with them, can make the home a fearful place and make you feel insecure.

So while most people tend to express positive views about their home, the experience of home can be both positive and negative and you will probably have noticed that some of these positives and negatives are opposites. For instance:

security versus insecurity
rich environment versus poor environment
permanence versus impermanence
safety versus fear
belonging versus rootlessness
somewhere that enhances self-esteem versus somewhere that demoralises.

But this does not mean that everything is always this clear cut – people can experience positive and negative feelings at the same time. For example a place may be important psychologically because it has connections with the past but it may offer a poor physical environment which no longer meets a person's physical needs. This can be a common experience for some older people.

Key points

Attachment to home and place is one of the ways people preserve self-identity.
Some service users have to move away from a place to which they are attached in order to receive care.
Home can mean different things to different people.
People can experience positive and negative feelings about their home at the same time.

These themes all tell us something about how people become attached to particular places. The following sections look at three aspects of attachment in more detail. First, how places become personalised. Second, the way attachment to place may relate to group identity as well as personal identity. Third, how the immediate home and its surroundings can become an important practical, social and psychological resource.

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1.2.2 A place for possessions

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Home decorating!

Long description

One of the ways homes come to reflect something of the individual is through the things within them. This personalisation of space, as it is called, is something we all do, though it is done differently in different societies and cultures. Yet many people living in care settings do not have the opportunity to make the environment their own, and moving between places can mean that possessions get lost on the way. We will come back to this issue of loss later on in the unit. First, let's think a bit more about how our attachment to place is reflected in the possessions which surround us.

Activity 2: ‘Which eight things would you take with you?’

The radio programme ‘Desert Island Discs’ asks people to choose which eight records they would take with them to a desert island. I don't want you to think about a desert island, but if you were to move to a place where you could only take a few possessions to make it your own, what would they be, and why? You don't have to come up with eight things but make a note of some items.

Discussion

One of our course testers thought of these things:

pictures of the family to remind me of people
a personal stereo and tapes
a clock that belonged to my grandfather
as many books as I could manage
a collection of little china houses that I've built up over the years - just because they remind me of places
a quilt which I'm still making.

The things on your list probably say something about the people in your life, your interests, places you have been and would like to remember - all things which say something about you and who you are. The importance of making a statement about who you are continues throughout life and occurs in the workplace as well as the home.

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1.2.3 Place and identity

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Home, then, can support your ‘identity’ through the way you ‘personalise’ the space in it with your own belongings – making a statement about who you are. However, if you look back to Activity 1, you can also see other ways identity is supported: ‘I can be myself’. If you say this, it suggests that you don't have to put on an act. You fit ‘naturally’. Home is part of your identity because you are the person who ‘fits’ in that place.

But it is not usually just you alone – 85 per cent of people live with one or more other people: ‘It's family, it's where we live’. If you use the word ‘we’ you are identifying yourself with a group of people. A family is a group to which you ‘belong’ (usually), and which is thereby also a part of your identity.

Then again, home can be 'somewhere to shut out the rest of the world’. What is inside the home is you and people you ‘belong’ with. What is outside is all the rest. These kinds of meanings of home show how it can support a sense not just of your own individual identity but also your group identity. However, not everyone feels a clear cut sense of a home to which they ‘belong’.

Mr E felt strongly that he had no sense of a permanent home:
’… because of my particular personal situation where, being black and being British, in British society, you never truly feel at home. But by the same token if I was to go back to where my parents are from I wouldn't feel truly at home there either. So you get into the situation where home to you doesn't really have the permanence of going to your place of origin because my place of origin is a foreign country. Someone who was born in Australia [for example] but happened to be living in England would say ‘I want to go home’, and home to them is where they were born and raised.
Where I was born and raised I don't necessarily feel at home because I'm an immigrant's son, so to speak, the son of an immigrant, so home for that reason doesn't have the sense of permanence. I can't feel at home in Jamaica because I haven't spent any length of time there, I don't know the place. By the same token I can't feel at home here because I'm not truly British, as it were. So home doesn't really mean anything permanent, I'm afraid.’
(Sommerville, 1994)

Mr E was interviewed as part of a study of African-Caribbean British people living in Manchester. Sommerville, the author of the study, reported that people talked about home in different ways. Sometimes they were referring to their current dwelling and their membership of an immediate household group. Sometimes they were speaking of their area of residence and a sense of membership of a wider group of family and friends. And sometimes they talked about home meaning their country of origin and their sense of sharing an ancestral group. In other words, they talked about home differently according to the group they were identifying with.

Sommerville argues that ‘perception of home cannot be understood in isolation from the issue of group identity’. In particular, he found that perceived ethnic identity affected how people felt about the area they lived in, and whether or not they felt personally secure within Black or mixed neighbourhoods and part of a particular geographical area.

People tend to feel a strong attachment to any place they regard as home – through the support it offers to their sense of identity, as individuals and as members of particular groups. But these are complicated feelings that work in different ways for different people.

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1.2.4 Places and spaces as resources

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Attachment to places can be a resource within care relationships, especially where people have a shared history of attachment to places. An older couple may have experienced the ups and downs of moving between places together for much of their lives. Or a daughter may be caring for her mother in the home where she was born and brought up. A shared understanding of the home environment and the support which may be available locally can be invaluable in developing a care relationship. Such knowledge becomes a resource for care. Take, for example, the case of Mr and Mrs Bright.

Long description

Activity 3: Housing histories

Pauline Bright lives with her husband, Alan, in a semi-detached house on a large estate in Bletchley. They are both in their 70s. In 1994 Mr Bright began to develop a dementing illness and Mrs Bright has been the principal carer, although she now shares the care with a number of different formal carers. Here Mrs Bright is talking about the place and the house they live in.

Read through the extract below. Think about the different ways Mr and Mrs Bright are attached to the place and the house they live in and note down at least two important factors.

We came here in 1956, that's 40 years ago. We were living in a flat in London, in somebody's house, and it was quite comfortable, but it was going to be demolished - you know as part of London being sorted out after the war. Also we had two small children and we were going to have a third, so that was one of the reasons why we needed a bit more room. And also the house was going with the job, my husband is an engineer, and there was a lot of small engineering firms opening up here and there was one particularly good one. All the people in this road were employed in engineering, so we were very much all of a muchness. They said that in this particular road that these 12 houses were reserved for people with breathing problems because it was supposed to be healthy. They came and vetted us first and I had a history of breathing problems. I've always felt very healthy here.
The schools were new, so that's why we knew it so well because we all took our children to school. We were all very much into each other's families although we weren't all the sort of neighbours that pop in and out but we knew each other's failures and successes, particularly the children. It's a good place. It's certainly turned up trumps now because of all our problems. They're all grandparents now and we've seen them come and be carted away in a hearse, you know, and all the grandchildren coming is a wonderful feeling.
I was a secretary before I married and then I was 17 years at home with the children, and then all of a sudden they wanted teachers in the 50s and 60s. There was a teachers’ training college here and they were asking for people who were interested, so off I went to college, which was absolutely superb. My husband was – I asked him first – he was keen and supportive and so, after two years in college, I taught up here for 17 years. Seventeen seems to be in my mind rather a lot, doesn't it.
[Later] When we could buy houses we went around looking for what we could afford and we always came back to this one. It's east and west facing so you get the sun and also the south sun as it comes around. If you can imagine it, it's sunny all the time, all the time. It's convenient, as you can see the furniture hasn't changed much, it's lovely, it's good, everybody loves their home here. They've all left home but they all come back and squash into it somehow and the garden's just about the right size, and it's been good on and off, a few horrible things happening to everybody.

Discussion

For Mrs Bright there is a long association with place and a strong sense of attachment to and familiarity with this particular neighbourhood. As a place they originally came because of employment but they have been a part of the development of a neighbourhood which seems to go beyond just place to engender a sense of belonging and community spirit. It is a place of people, of families where the children all went to school together, and where people continue to offer each other support.

Part of this familiarity is born of the length of time they and many of their neighbours have lived in one place. They have also been of similar ages and part of similar households and this has meant that they have shared common activities. So they have developed social relationships.

Their house itself is also a place to which they are attached. It is talked about with affection – it's lovely, it's good. It has also been a healthy environment. Mrs Bright says ‘everybody loves their home here. They've all left home but they all come back and squash into it somehow’. So the home also means people as well as the physical environment.

Where people live and who people live with are dependent on a myriad of factors. These factors combine personal characteristics and circumstances with the opportunities and choices offered in any locality which themselves will be influenced by national, social and economic policies. There will always be a wider political environment to add to the immediate environment of the individual and their family. Mrs Bright's account is a good example of how the physical, social and psychological environment are all intertwined.

To summarise then, attachment to place is a concept that brings a number of factors together and may involve:

attachments to buildings, spaces, objects
places that vary in scale, specificity and tangibility
people (individuals, groups, and cultures)
social relationships
time.

(Adapted from Low and Altman, 1992, p. 8)

Key points

Personalising space is a way of saying something about self-identity.
Different understandings of group identity can affect the way people think about home and home area.
Understanding more about the shared histories of places and spaces may be important in understanding the resources which are available to any caring relationship.
The environment can become a resource for caring.

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1.3.1 The impact of surroundings

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Thinking about attachment to places leads us to think about just the opposite: how do people feel when they have to change places and move from one situation to another? Some people are always on the move while others seem to stay put for long periods of their lives. For children and adults receiving care services moving between places may be a common occurrence.

These moves may be:

daily, part of a shared pattern of care where a person lives at home but attends a day centre or day hospital
intermittent, such as respite care which may happen for a week or a fortnight every four months
for a limited period of life, such as a young person's move from a children's home to a foster family
permanent, such as moving from home into a residential home or nursing home in later life, or moving out of a long-stay hospital into alternative accommodation.

This section will consider changes in place, looking at some of the issues of space, access and attachment already discussed in the unit. This type of change will also be set alongside other changes in life and those factors which can make change a positive or negative experience will be considered. First, we look at short-term changes of place.

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1.3.2 Change on a daily basis: shared childcare

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Activity 4: Caring for children

We leave our flat at about 8.15 am and go to nursery where Sabrina (who is four) stays for the mornings. I then take Tristan (who is nine) to school and then go on to work. Maureen, who's a registered childminder, fetches Sabrina from nursery after lunch and they go to Maureen's house. Around 3.25 pm Maureen and Sabrina go up to school and, depending what day it is, they fetch Tristan and some other children. Some days Tristan goes home with his friends as they have a swimming lesson or football club. Either I, or Michael, fetch the children home from Maureen's or elsewhere, any time between 5.30 or 6.30 pm depending who's doing what and who's back first.

This was written by one of the mothers whose children go to Maureen's. In this scenario the children spend different parts of their day in different places, so their care is shared.

Make a list of the various places in which the children in this scenario are cared for and how these change with time.
Think about these places and make a note of how they might be different from each other in terms of the spaces they occupy.

Discussion

The children spend different times of the day in different places, so there are changes in both time and space. For Sabrina this includes her own home (a flat), nursery, her childminder's house, and then back to her own home. Her brother, Tristan, goes from home to school and then to Maureen's or someone else's house before coming back home.
Both nursery and school will differ from a domestic home because they are group settings and include a number of children and adult workers occupying the same space. They will have been designed or adapted for the purpose. Maureen lets the children in her care have access to much of the space in her house. The environment is domestic with a few modifications for purposes of safety and to enable the children to have a play space.

Long description

This activity introduces the idea of changes in time and place. The care provided by the childminder is a substitute for parental care given while the parents are working.

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1.3.3 Change on a daily basis: shared care for the elderly

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

In the case of Mr Bright care is shared between his wife and formal carers and changes in the place of care are primarily to give Mrs Bright a break and Mr Bright a change of scene.

Click below to hear an audio clip describing a day in the life of Mr and Mrs Bright.

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Transcript

Click on 'view document' below to read the media notes on the above audio.

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Activity 5: Shared care

Central to this activity are Mr and Mrs Bright. You have just read some of Mrs Bright's feelings about coming to live in Bletchley 40 years ago and living in her community. Mr Bright, a former engineer, has Alzheimer's disease and lives at home with his wife. His illness has affected his short-term memory and as a result he repeats things. Whilst he is quite physically fit and active, he has also lost control over some of his former personal skills such as washing and going to the toilet. Further background details are given in the Media Notes and you might like to read these now (click on "view document" above).

Listen now to the audio clip. This has been arranged to give you a sense of how Mr Bright is cared for during the day. It begins and ends with Mrs Bright. You should listen to the whole sequence, then listen to it again and try to answer the following questions:

How is Mr Bright's care shared and why?
What does this mean for Mr Bright? Does he have any control over the situation? How does he react to changes in time and place?
What does this mean for Mrs Bright – how does she react?

Discussion

Mr Bright's illness places great demands on his wife but they are determined that he should stay at home and so his care is shared between their home and a day unit. Mrs Bright rises early and is in constant attendance on her husband. I don't know about you but I felt quite tired listening to her speak. I could almost hear the relief in her voice when she said ‘By 8 o'clock I know June's going to come’. In this case, even though Mr Bright is seen as the client who June comes to ‘wash and dress’, it is also Mrs Bright's needs that are being met.

June is one of three home carers who assist Mr Bright with getting up and going to bed. June says that she ‘doesn't do anything for Mrs Bright’ – well not in the official sense of the word. But listen to Mrs Bright say ‘It's such a relief. It's lovely to have all this going on in the house’. Here care is shared, June knows that her work only makes a ‘temporary difference’ … ‘you can't make a permanent difference but you improve things for a while’.

Mr Bright also attends a special day unit for older people with dementia. But it seems again that Mrs Bright's needs are central to the provision of this service. Brenda Masters says ‘Alan's been coming here since January. He started off coming here three days a week which very quickly went to five days, the need is very great there for Pauline, his wife, to have some time to herself really, she was getting very tired, very stressed’.
For Mr Bright the consequence of this shared care is that other people attend to him in his own home and he also leaves it for part of the day. His condition has meant that he has had little control over the situation. Care has been provided to support Mrs Bright in her caring. However, this has also meant that Mr Bright has lost some of his personal privacy. He is now assisted in a number of intimate tasks by a formal carer who has access to his own personal space. You will remember how June coped with this invasion of privacy as a care worker.

A bus comes to take Mr Bright to the day unit, so at this point he becomes someone else's responsibility. How does this change of place affect him? Well it's difficult to tell but listening to Brenda Masters at the day unit we do get a sense that he feels disoriented and dislocated. She says that he needs a lot of reassurance. We noted earlier in the unit that many people feel disoriented and anxious in unfamiliar settings; however because of his short-term memory loss, the day unit may seem unfamiliar to Mr Bright every day. Every day he may have to negotiate people, place and spaces as if for the first time. Brenda says:

We welcome Alan as he arrives off the bus. He needs guiding into the unit, he's quite disorientated and he may go off down the drive. We encourage him to sit down and have a cup of tea and calm him down because he's quite anxious, we'll sit with him and try to do something on a one-to-one basis. He does enjoy talking but finds focusing on any sort of topic for a length of time quite trying. He gets lost and confused and his mind blocks. He likes to get up and walk around – he's quite an active person, he has a lot of energy. During the course of the day he requires a lot of reassurance and orientation.
For Mrs Bright, Mr Bright's absence means a breathing space. It gives her some privacy. She attends to herself – moving the main meal of the day to lunch time so that she can cook and eat properly; going out (on this day to the Carers Support Group) and spending time on her hobby, playing the piano.

Chatting in the day room

Mr Bright has to face change on a daily basis, moving between individual and group care. While we do not hear about it here, he also goes for the occasional week's respite care in a nearby residential care home. At the time of the interview Mrs Bright told me that a recent experience of respite care had not gone so well: Alan had been to another home which was unfamiliar and this had unsettled him. Familiarity of place and being able to orient yourself is all part of feeling in control over your everyday life. For Mr Bright, whose illness creates further disorientation, familiarity of place and routine are even more important.

The Brights’ routine now includes shared caring to meet some of their different needs. Yet at the heart of their situation is a determination that Mr Bright should remain living as much as possible in his own home maintaining some continuity in his life and familiar surroundings.

Dementia and Alzheimer's disease

Dementia is a condition characterised by a progressive loss of mental abilities accompanied by changes in behaviour and a gradual decline in the skills needed to carry out ordinary daily activities. The likelihood of developing dementia increases as people get older. It affects less than one person in a thousand of those below the age of 65 and between four and five in a hundred of those over 65.

In the over-65 age group there is a strong increase in the rate with age: about 2 per cent of those aged 65–75 suffer from dementia, rising to over 20 per cent of those over 80. It is estimated that there are 750,100 people with dementia in the UK (Alzheimer's Disease Society, 2001).

There are a number of different types of dementia. Alzheimer's disease is the most common type accounting for 50–60 per cent. The disease was first described by Alois Alzheimer, a German neurologist, in 1907. Symptoms vary from individual to individual. In the early stages the person may be more forgetful of recent events, more likely to repeat themselves in conversation, less concerned with activities or other people, less able to grasp new ideas or adapt to change, more anxious about having to make decisions, or more irritable or upset if they cannot manage a task.

As the disease progresses, loss of short-term memory is likely to become more obvious and people often become confused about time and place. In later stages they may no longer be able to recognise those who are close to them and become increasingly dependent on others for care.

(Adapted from Alzheimer's Disease Society, 1997)

At this point it is worth noting the similarities and differences which exist between the pattern of Mr and Mrs Bright's lives and Sabrina and Tristan, the children who spend parts of their day at the childminder's house. While their needs are very different, both the children and Mr Bright have to make transitions between different people and places.

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1.3.4 Change on a daily basis: Day unit care

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

The importance of maintaining continuity of people and places is important in both cases. Many people attend day care services and find that the change is a stimulating experience, widening their daily contacts and allowing them to become part of another group. The issues of continuity of experience raised here will be familiar to day care workers.

Click below to hear an audio clip describing Redwood Day Unit.

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Activity 6: The Redwood Day Unit

Now listen to the audio clip. In the remaining part of the tape you will hear Brenda Masters and Ceinwen Conroy talking about the Redwood Day Unit. As you listen, think about how the environment of the unit and the way the staff work help to minimise the dislocation someone like Mr Bright might feel.

Make some notes about (a) the ways of working discussed here and (b) the environment.

Discussion

Ways of working. The whole ethos of the Redwood Unit is one of maintaining a calm environment where people can be themselves. Pressure is not put upon people to take part in activities. There is even something rather calming about the way Brenda and Ceinwen speak. Brenda says ‘activities are spontaneous here’ and that ‘levels of ability vary from day to day’. The key to working here is flexibility. Enhancing ability rather than focusing on disability is important, and part of this comes from getting to know people and their past lives. This also involves those at the day unit in reaching out into the community and not seeing themselves as a separate service.
The environment. There are a number of things which are raised about the environment, especially orientation, use of space and safety. The unit was set up partly because another day centre used by older people was felt to be too big for people with dementia. Some settings can produce disorientation or make a condition even worse. Did you notice how Brenda says that there are two lounges and these are used by different groups of people – those who ‘can tolerate small groups’ and those who ‘need more space'?

The open plan nature of part of the unit allows some people to wander in safety. You will have also heard Ceinwen talk about the secure nature of the unit and the way in which they manage wandering. A tension exists here between the needs of people to wander – even to get back home – the needs of carers for respite and the needs of staff to be able to manage how they work in the unit with the resources they have available. How these various interests are balanced becomes crucial in many care settings.

Ceinwen and Mr Bright sharing memories

The design of units for people with dementia has become a particular area of interest in recent years as designers and architects have been concerned to create environments which help people to maintain the abilities that they have, for example colour coding of floors or walls to assist orientation, and to help manage certain kinds of behaviour, for example a wanderer's garden or route layout (Marshall, 1993, 2001; Dunlop, 1994).

In this case we have been able to look at how shared care has implications in terms of time, space and place for all the people involved. Mr Bright's illness has led to decisions being made about the place of care. The aim is to enable him to retain his home base and this means supporting Mrs Bright by giving her some respite from caring. This has meant that Mr Bright has less control over where he spends part of his time and he has to adapt to relocation in time and space and to changes from individual to group settings.

Having home care has also meant allowing other people to have access to their home. For Mrs Bright this level of access has been accepted as it means that Mr Bright can continue to live at home. In this case the change of place has been daily and always involves a return to home, but for other people receiving care the change may be more long term and of greater permanency.

Key points

Receiving care can involve changes of place for different periods of time from daily changes to long-term changes.
Sharing care between informal and formal carers can mean that those on the receiving end of care have to accept changes in time, space and place. This can be disorienting for some people and stimulating for others.

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1.3.5 Coping with relocation

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

We have seen that attachment to place can be important in terms of developing and maintaining feelings of security and a sense of self-identity However, care for some people involves relocation.

Changes of place often involve people in coping with other types of change such as:

changes of role (for example from being a homeowner to being a resident of a home; or from being a hospital resident to being a resident in the community)
changes of status (for example, from being a child to adult, from being unemployed to being employed).

While the focus here is on place, the importance of these other changes needs to be taken into account. They are often interlinked. So for example a change in place may give rise to a change in role.

All change demands some personal or psychological adjustment, although some situations will be experienced as more stressful than others. People facing a move in the research by Hudson et al. saw ‘fears of (and subsequent adjustment to) a major change of environment and living circumstances’ as a major obstacle to moving (1996). How people cope with adjustment is at the heart of change. In terms of changing places this can often relate to their attachment to where they have come from and to the impact which moving may have on their self-identity which we talked about earlier in relation to issues of belonging, permanence and security.

Click on 'view document' below to read Alison Norman's piece on 'Losing your Home'.

View document

Activity 7: Losing your home

Click on the link above to read the piece on 'Losing your Home'. Here Alison Norman talks about what she sees as the devastating effects that moving can have on an older person. As you read the extract try to answer the following questions:

How does the author Peter Marris, who is quoted in the article, describe the experience of losing your home?
What may help people cope with a change in place?
What may be the negative effects for older people of moving into an institutional setting?
How might moving from one care setting to another increase the likelihood that older people may be less in control of the situation?

Discussion

Marris equates losing your home with bereavement or losing a close relative. He comments on the anger, grief and pain experienced by people who have lost their homes through urban renewal schemes, and it is suggested that older people may experience similar feelings when moving into sheltered housing or residential care through losing their home, their neighbourhood and their possessions.
It is suggested that if people can recreate their social status and way of life within a new place then they will work through their loss.
However, older people may find it more difficult to ‘make a positive effort to identify with their new life’ and this is seen as one of the reasons for the high death rate among some older people during the first year after ‘relocation’. It is often those in poor health who do not survive the move.
For some older people moving from hospital back to their own home may be more difficult due to what Alison Norman calls a closing up of their ‘social space’. In other words, the support which they had before going into hospital may break down and this may lead the person to have far less choice over where they are discharged to, often having to move to either a residential care home or a nursing home.

For some older people entering residential or nursing home care means a devaluation of their past lives and a loss of self. In this case relocation may involve enormous loss, especially if the move has been relatively unplanned and from hospital without the opportunity to say goodbye to your home. But it could also be seen as a positive move by some offering less anxiety, more stimulation and engagement.

The research discussed in the chapter linked above suggests that the degree of control which the individual exerts over the moving process is crucial to how they adapt to such change.

Activity 8: The move to residential care

Read through the case study of Mr and Mrs Smith who moved first to a residential home and then later became separated. What are the main differences between the initial move made by the Smiths and the later moves? What factors have affected how they have coped with these changes?

The Smiths

Mr and Mrs Smith were a couple in their 80s who had decided to move into residential care because of the increasing frailty of Mr Smith and the stresses this placed on his wife. They chose the home partly because they already knew people there, and they appeared to settle in well. In the first interview after their move, Mrs Smith expressed relief at having more support and the reassurance of readily available help, and the couple spent some evenings visiting or being visited by other residents. Although Mr Smith complained of having ‘too much leisure’, they both felt that the purpose of their move had been achieved – the stress of caring for Mr Smith had been taken over by the staff.

Two months after their move, Mr Smith had a stroke, and was admitted to the local hospital. From there he was discharged to a nursing home nearby as the residential home did not have the staffing mix appropriate to his nursing needs. This left the couple in two different establishments. Mrs Smith could not follow her husband to the nursing home because the higher cost prohibited this and they were financing their care themselves. If the cost had been affordable, however, there were other objections – the Smiths did not know anyone at the nursing home and the move would mean leaving friends. When visited by the researcher at this time, Mrs Smith recounted the story, sometimes breaking into tears when she thought of her husband, but interspersed her story with rationalisations and justifications which seemed to be partly derived from the discussions she had had with the staff in the home and her family. She showed no anger about the decisions which had been made about her husband's care and her response seemed to be to accept the situation as one over which she had no control: Well you have to go where is suitable, haven't you’.

(Reed and Roskell Payton, 1995)

Discussion

The main point to strike me about this case is the level of control the Smiths were able to exert over their first move and the subsequent loss of control. Their first move appears to have been a conscious decision on their part. They moved into a setting where they had friends and were able to adapt to their new circumstances. It has been Mr Smith's subsequent ill-health which has led to their separation.

This vulnerability has meant that he needs more nursing care and has had to be accommodated in a nursing home. They have also lost financial control over the situation. It is interesting that one of the reasons Mrs Smith did not want to move to the nursing home was because she would lose contact with her friends. So the Smiths demonstrate some attachment to the first residential home which they would lose if they both moved. By staying, Mrs Smith maintains these contacts.

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1.3.6 Relocation: acceptance

The Open University — Fri, 08 Jan 2010 12:40:56 GMT

Of equal importance in terms of adjustment is an acceptance of the new situation and identification with the new life (Lieberman and Tobin, 1983). Reed and Roskell Payton (1995) have shown how ‘adjusting to life in a care home is a complex process, requiring a range of social skills’. They have observed a range of strategies from those people who ‘"push" themselves on strangers’ to those who ‘construct familiarity’ using what little they know about people and places to find common bonds and therefore permit conversation.

They also show how within our present system of long-term care for older people, changes in a person's physical or mental health may lead to further transitions: the most common is from a residential care home to a nursing home. Such additional moves may further unsettle a fragile equilibrium as this case showed.

In many ways this experience is paralleled by others receiving care. Far more young people in care live with foster families than in children's homes. The transitions from children's home to foster care, between foster families, and to independent living involve not only changes of place but enormous changes in status and role from child to adult.

Research has shown that many young people in need of care have experienced multiple moves and that the support offered before, during and after leaving care may be far from adequate (Marsh, 1997; Department of Health, 2001).

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1.3.7 Models of adjustment

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Here we have talked about changes of place as having a particular impact on an individual's sense of well-being or self-esteem. Relocation and separation from familiar places just like separation from loved ones can be experienced as a form of loss which can have devastating effects for some people. Some authors have seen changes in self-esteem as the key to understanding how people cope with change. For example, Hopson and Adams (1976) suggest that any transition, whatever triggers it, sets off a cycle of changes in self-esteem. They provide a model which suggests that individuals may experience similar patterns of feelings and emotions within the process of adjustment.

Figure 1 A model of changes in self-esteem during transitions (Hopson and Adams, 1975, p. 13)

Long description

Here the key to successful adjustment to change is to work through this cycle of reactions. But not everyone will experience all these stages and some people may become stuck along the way, for example experiencing on-going depression. Here are some of the key features of each stage.

Immobilisation. You get a sense of being overwhelmed, unable to act. Unfamiliar transitions, and those of which we have negative expectations, tend to intensify this stage.

Minimisation. As a way of coping with the change it is common to deny that it is happening. This is a frequent reaction to a crisis which is too difficult to face.

Depression. People often get depressed when they face up to the implications of change.

Accepting reality. At this point the person begins to let go of their old state of being, accepting the reality of what is happening to them.

Testing. Having begun to accept the situation, then it becomes possible to test out new behaviours to cope with the new situation.

Seeking meanings. This is a reflective stage where people try to work out how and why things are different.

Internalisation. Finally, understandings of the situation and new meanings become internalised and accepted. They then become part of the person's behaviour.

(Adapted from Hopson and Adams, 1975, pp. 9–12)

You can see that some aspects of this model have already been touched upon in Alison Norman's article and the discussion of Mr and Mrs Smith. For older people ‘accepting the reality’ of residential living and constructing a new sense of self late in life is particularly important but there are obvious parallels for people of all ages who face major life transitions.

There are other models of coping and adjustment which are based on stages. Some consider how people work through losses in their lives, perhaps one of the most well-known being the stages model of grief developed by Parkes (1986) in his work on bereavement. Such models are useful in allowing recognition of the process of adjustment although not everyone conforms rigidly to set patterns (Sidell, 1993).

Key points

Changes of place can involve people in coping with changes in role and status.
All change demands some personal or psychological adjustment. Coping with changes of place can relate to attachment and losing your home can be equated with bereavement.
Personal control over changes of place is important in relation to how people cope and adjust.
Models have been developed to help us to understand the process of change and the effects on self-esteem. However, models can seem prescriptive.

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References

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Alzheimer's Disease Society (1996) Information Sheet 1, Alzheimer's Disease Society, Gordon House, 10 Greencoat Place, London SW1P 1PH.

Arias, E.G. (ed.) (1993) The Meaning and Use of Housing, Avebury, Aldershot.

Department of Health (2001) The Children Act Now: Messages from Research, The Stationery Office, London.

Dunlop, A. (1994) Hard Architecture and Human Scale. Designing Environments for People with Dementia, Dementia Services Development Centre, University of Stirling.

Hopson, B. and Adams, J. (1976) 'Towards an undersanding of transition: defining some boundaries of transition dynamics', in Adams J., Hayes, H. and Hopson, B. (eds) Transition: Understanding and Managing Personal Change, Martin Robertson, London.

Hudson, J., Watson, L. and Allan, G. (1996) Moving Obstacles: Housong Choices and Community Care, The Policy Press, Bristol.

Leiberman, M. A. and Tobin, S. S. (1983) The Experience of Old Age: Stresss, Coping and Survival, Basic Books, New York.

Low, S.M. and Altman, I. (1992) 'Place attachment: a conceptual inquiry' in Altman, I. and Low, S.M. (eds) Place Attachment, Plenum Press, New York.

Marsh, P. (1997) 'Child care', Research Matters, Community Care, Oct. 1996 - April 1997, pp. 60-62.

Marshall, M. (1993) Small Scale, Domestic Style, Longstay Accomodation for People with Dementia, Dementia Services Development Centre, University of Stirling.

Marshall, M. (2001) 'Dementia and technology' in Peace, S., and Holland, C. (eds) Inclusive Housing in an Ageing Society, Policy Press, Bristol.

Parkes, C.M. (1986) Bereavement: Studies of Grief in Adult Life (2nd edn), Tavistock, London.

Reed, J. and Roskell Payton, V. (1995) Settling In and Moving On: The Transition to Care Home, paper given at the Annual Conference of the British Society of Gerontology, University of Keele. Amended version of paper to be published in the journal Social Policy and Administration in 1998.

Rubinstein, R. and Parmelee, P. (1992) 'Attachment to place and the representation of the life course by the elderly', in Altman, I. and Low, S.M. (eds) Place Attachment, Plenum Press, New York.

Sidell, M. (1993) 'Death, dying and bereavement', in Bond, J. Coleman, P. and Peace, S. (eds) Ageing in Society, Sage Publications, London.

Sixsmith, J. and Sixsmith, S. (1990) 'Places in transition: the impact of life events on the experience of home', in Putnam, T. and Newton, C. (eds) Household Choice, Futura, London.

Sommerville, P. (1994) The Meaning of Home for African-Caribbean-British People, paper presented at the conference Ideal Homes? Towards a Sociology of Domestic Architecture and Interior Design, University of Teeside, September 6-8th, 1994.

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Acknowledgements

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Grateful acknowledgement is made to the following sources for permission to reproduce material in this unit:

Text

The information concerning Alzheimer's Disease was extracted from the Alzheimer's Disease Society, Information Sheet 1, May 1996.

Figures

Figure 1 Hopson, B. and Adams, J. 'Towards an undersanding of transition: defining some boundaries of transition dynamics', in Adams J., Hayes, H. and Hopson, B. (eds) (1976) Transition: Understanding and Managing Personal Change, Martin Robertson.

Illustrations

Illusrations 1 and 2: Sally and Richard Greenhill.

Unit Image

vikush

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