Increasingly, old people in India are moving into institutional settings. There is a paucity of qualitative research examining the condition of residents in care homes. This thesis addresses this gap through a detailed qualitative study of three such homes in Goa, India. It explores the care processes and practices in the care homes and how far they are attuned to the needs, lives and identities of their residents. An understanding of the experiences of residents as they have been undergoing different stages of entering and settling into a residential care setting has been the main focus of the research, which illuminates the context in which resident experiences were embedded. The thesis explores the process of institutional living: the conditions (losses and changes) that lead older people to enter institutional care; the losses and changes incurred while entering institutional care; the paradox between induced dependencies created by institutional control and structures resulting in passive compliance; and the struggles of the residents to resist these power structures. In documenting life for the resident in the care homes the thesis shows that their subtle daily forms of resistance exist within a framework of power. The final empirical chapter discusses how residents experience different forms of departure, whether as ending this struggle or beginning a new one. Data were collected through a combined ethnographic methodology of participant observation and semi-structured interviews with residents, staff and management over an eight-month period, in addition to a scoping survey of 37 care homes in the State. The study retrospectively examines residents’ experiences during various stages – pre-entry, entry, post-entry and exit – of their residential career, the drivers and constraints during these stages, and the role of staff and management in contributing to these experiences. These are presented as narratives – interleaved stories highlighting (some) important aspects of life in care homes in Goa. I have included the various responses made by residents to the different stages of their residential career – their ambivalences as well as their certainties, their anger as well as their passive acceptance, their dependence as well as their agency – and to interpret residents as sometimes vulnerable, sometimes invincible, and sometimes struggling. In doing so, I have provided insights into the ups and downs of life in care homes in Goa, through exploring paradigms that were crucial to residents’ lives in my study. These insights reveal that the dismantling of residents’ individual autonomy and control occurred prior to their coming into the institution. Once inside the care home, their lives were further altered by rules, routines and practices of staff and management. The resident’s identities thus were increasingly being defined by the institution. The findings further revealed that residents do not always accept passive dependency but instead struggle to carve their own identity within the institutional settings and controls they are subjected to. Finally, my findings reveal how perceptions and preparations for departure from the institution are coping mechanisms used by the residents and the staff alike, as extensions of their struggle for survival, freedom, and control. These findings lead to a greater understanding of how different processes are intertwined in residential careers for residents in care homes in Goa. The findings invite a rethinking of conceptions of autonomy and ageing, passive compliance and agency, and departure and coping, particularly within the context of institutional living in Goa. This study has thus illustrated the mechanisms in place for older people entering, settling and leaving care homes in Goa and demonstrated whether these mechanisms are adequately suited to their needs. The hope is that this understanding will contribute to the development of improved policy and practice that better reflects the needs and wellbeing of older people.
|Award date||1 Jul 2014|
|Publication status||Published - 2014|