At home in a nursing home: on movement and care

Abstract

This thesis follows the everyday movements of a group of elderly Australians, to critically examine how they came to experience a sense of home while living with bodily and cognitive impairments in a nursing home. In tracing their steps and the minutiae of their day-to-day activities, this research illustrates how nursing home residents experience ‘home’ as a sense of ‘rightness’ of being through doing the most mundane activities of walking, transferring position and eating. Examining care through the lens of home, I analyse how home, bodies and movement are reconfigured through multiple contexts of care. I argue that it is only in constellations of care that produce movements that residents attempt to make, but are unable to make on their own, that the potential to become at home is made possible. Based on 12 months of fieldwork in two nursing homes in metropolitan Adelaide, South Australia, this research attends closely to the sensory extensions (Dennis 2007) and restrictions of residents’ bodies vis-à-vis their engagements with other people and things. From the taste of a home cooked meal, to the touch of staff and family members, medications, handrails, carpeted floors and walking aids, residents’ ageing and declining bodies respond to, and may resist, assistance to walk, stand or eat. Care plans, staff and equipment, as this thesis will show, can also restrain residents’ bodies, inhibiting their movements and their becoming at home. This thesis draws on Deleuze and Guattari’s (1977, 1988) theories of becoming and desiring production to expand Jackson’s notion of home (1995, 2002) and ‘existential imperative’ (2002, p. 14) to propose that home is a matter of becoming-at-home-in-the-world. Key to my argument is how residents experience an innermost drive to move, and in examining how their urge to move is responded to, I demonstrate the multiple and at times contested forces that can propel residents to sit, to stand, or to put one foot ahead of the other. It is through this Deleuzian approach that I detail the multiple persons and things that enact and produce assemblages (Deleuze & Guattari 1988) of care. In so doing, I demonstrate that an ethically responsive care, or the care that was communicated and experienced as ‘right’ by residents, requires tinkering (Mol, Moser & Pols 2010) to achieve a balance between inclusion and autonomy (Rapport 2018). From moment to moment, and day-to-day, as bodies age, decline and eventually die, each resident requires different assemblages of care to move and to become at home. Examining the varieties of experience for nursing home residents through the theoretical lens of becoming at-home-in-the-world, this thesis provides new knowledge about the interrelations between movement and care, and the generative and productive affects of walking, standing and eating in residents’ lives. I argue that this ethnographically informed understanding of the sensibilities and potentialities of movement presents a challenge to clinical constructions of bodily and cognitive impairment and is at odds with aged care discourses and practices that may render the lives of nursing home residents inactive or meaningless and thus further constrain their existential and bodily potentials.