Old Age Homes

Roger Clough

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9781032043142
• eBook ISBN: 9781000438260
• Edition: 1
• Topic: Medicine
• Subtopic: Social Work

Originally published in 1981, in Old Age Homes Roger Clough presents a vivid description of the lives and work of residents and staff in an old people's home. His powerful analysis of the realities of residential work would make a major contribution to improved practice, to social work training, and to social policy formation.

Many people, including some social work professionals, still felt that the very existence of residential homes illustrated a failure of society, and that living with their own family or on their own was invariably a more satisfactory experience for old people. Roger Clough questions this assumption. He argues that homes are needed and if they are to be good places in which to live and die there must be a clearer understanding of the interactions that take place within them.

The descriptive parts of the study, based on detailed observation and lengthy interviews, strongly reflect the author's genuine compassion and warmth for old people. His most illuminating perceptions are presented from the perspective of the old people themselves, many of whom were conscious of the double-bind in which residents and staff are caught: there is a prevailing belief that it is best to keep active in old age, yet many of the elderly had little they though worth doing, while the staff saw their role as doing whatever they could for the residents.

Roger Clough uses his material to test two central hypotheses: first that there is a linkage between the attitudes to aging held by staff and the degree of control over their own lives exercised by residents; and secondly that this degree of control is strongly correlated with resident satisfaction. Through an acute analysis of these key variables, he demonstrates the circumstances in which living in a home can be, for certain old people at certain times, the way of life they themselves would choose. His conclusions are of the greatest importance for social work practice and for the changing of staff attitudes in training.

Old Age Homes would challenge anybody who knows or works with a resident in an old people's home. But it would be of outstanding value for the managers, practitioners, trainers and students to whom it was primarily addressed at the time.

Chapter 1 OLD AGE HOMES – MYTHS AND REALITIES

Living in an old age home evokes pictures of apathy, dependence and sadness. This is not the image most of us have about our own life in old age. Attitudes seem crystallised in that of Sir Keith Joseph (1972), addressing a one-day conference on residential work, when he looked down from the platform at a group of staff from old age institutions: ‘Your old people would rather not be in residential homes, wouldn’t they?’ he said. Such assumptions, based on the negative aspects of residential homes in general and of old age establishments in particular, have led to policy statements about the desirability of enabling the elderly to stay in their own homes. In this chapter these assumptions are examined and questioned.

Attitudes to Ageing

The starting point is a consideration of attitudes to ageing. Many of the fears that surround old age establishments are in reality fears about old age itself. Old age homes confront us with conspicuous evidence of problems that may come with ageing – problems such as confusion, senility, severe and multiple handicap, and the resultant dependence on others. Ten individuals may live in their separate homes sitting for hours doing nothing. If those ten people are grouped together and all seen sitting for hours doing nothing, the image is more than ten times as powerful. No wonder a district nurse responded to a questionnaire by writing:

The whole aspect of living in an old people’s home fills me with horror. The patients appear to me like lodgers in a silent hotel, a place with no pulse, fed, slept and sheltered. Armchairs in rooms, round the edge of the wall, just sitting. The sad thing about the whole thing is that patients sit there from choice … I feel they look so pathetic just sitting in silence in armchairs.

Old age is bearable in prospect as long as we can maintain a picture

of contentment and continued interest in the world around, and as long as physical or mental impairment does not hit too hard. It is difficult to maintain a picture of successful ageing when some or all of these factors do not apply. The old age home presents society with the apathy or handicap of residents en masse. It is easy to forget that old age anywhere may be as unpleasant. Similarly by focusing on the poverty of the life of some residents it is easy to put aside our anxieties about our own old age.

Anxiety about old age has two important aspects: physical deterioration which may affect body or mind; and purposelessness resulting from loss of role, death of friends or relatives, poverty and isolation. Both aspects, physical deterioration or purposelessness, may occur inside or outside a residential home.

To ignore this is to fall into the trap of distorting the reality of old age. An American writer, Gubrium (1973), calls this process ‘The myth of the golden years’. A part of this myth concerns the social context of old age. One view of this social context ‘is that of the alleged well-being of old people who continue to maintain their own neighbourhood household … The first of these images … conceives of a self-sufficient couple in an older neighbourhood of homes, who maintain a mutually satisfactory round of daily life. Both are portrayed as actively involved in a variety of crafts and hobby-like activities. Both maintain active local connections in neighbourhoods that are “just as I remember them”.’

Gubrium continues, ‘Not only are social contexts considered felicitous but so are the relationships between old people as well as their activity. Four images of interaction and activity should be noted: (1) the idea of growing old together; (2) the indulgent intergenerational portrayal of the aged; (3) the ideal active “busyness” of the elderly; and (4) the simple advice of planning for retirement.’

Gubrium explodes the myth – many old people are not in their own neighbourhoods or surrounded by a network of relationships. They may have been rehoused, living in lodgings or flats. The myth ignores the movement of neighbours and the crime rate that leaves the old too frightened to leave their homes. Finally, many old are single, do not get on well with their children and do not have the resources of money or health to remain ‘busy’ in old age.

It will be apparent later that most professional workers, when considering their own old age in response to questionnaires, thought in terms of the freedom old age would bring and greater opportunities to pursue interests. This is a very important side of old age, rightly stressed by organisations for the aged. But the other side of the coin is weariness and bitterness.

A part of Gubrium’s attack is directed against what has been termed the activity theory of ageing. This theory, associated particularly with Havighurst (see Havighurst and Albrecht, 1953), proposes that old people age successfully if society accepts the value of the old and ascribes them publicly valued roles. In particular old people should substitute new activities in old age for those which they give up on retirement. An offshoot of this idea is the claim that people need to plan for old age, which has led to the development of pre-retirement classes to encourage such planning.

Gubrium criticises activity theory on the grounds that activity is seen mostly in terms of work-like situations that are active and visible, and stereotypically middle class. The quality of social relationships is ignored. In addition the high degree of physical dependence and the limited roles available to old people are not examined. It became apparent that some people with high morale had low activity.

An alternative understanding of needs in old age was introduced by Cumming and Henry (1961). They suggested, in what has been termed the disengagement theory, that society withdraws from the older person. The individual co-operates in a process of disengagement between himself and society. This is a mutual process. Happiness in old age depends on the individual and society accepting this role for the elderly. While disengagement theory takes into account the needs of society for younger, more active people to replace the older, it may ignore the needs of the elderly. In particular it assumes that this process must take place for all societies and all individuals within that society.

A more recent theme in research work into ageing has been to consider the basis on which one can assess life satisfaction in old age. Havighurst (1968) shows how emphasis has shifted away from the either/or debate surrounding the conflict between the activity and disengagement theories. Citing the Kansas City Study of Adult Life he states (p. 304):

The results of this study indicated that neither the activity nor the disengagement theory was adequate to account for the observed facts. While there was a decrease of engagement in the common social roles related to increasing age, some of the people who remained active and engaged showed a high degree of satisfaction. On the whole those who were most active at the older ages were happier, but there were many exceptions to this rule.

This study carried on the work of others in looking for a personality dimension as a factor that influenced successful ageing. An analysis was produced which was based on three dimensions – personality, role activity and life satisfaction. Havighurst concludes (p. 308):

Of the three dimensions on which we have data – activity, satisfaction and personality – personality seems to be the pivotal dimension in describing patterns of ageing and in predicting relationships between level of activity and life satisfaction.

In contrast Gubrium, in his socio-environmental approach, emphasises the interplay of two factors – activity resources and activity norms. Activity resources are those resources which enable a person to do the things she wishes. They include money, housing, local facilities, social support and health. Activity norms are the norms that an individual has come to accept and share in common with others about what she should be doing.

This theory stresses the importance to old people of expectations about activity. The old will be satisfied when they are able to do what they and others regard as appropriate. Mr Murphy (p. 1 above) found his health worse – he was nearly blind and could move only with difficulty. Yet he did not like having to ask other people to tie his shoe laces. So his resources did not match his norms. Gubrium argues that someone may be said to be coping or have high morale when her resources match the norms set by herself and others. The theory is particularly helpful in explaining why many residents at The Pines found it hard to adjust to their worsening physical state.

Thus attitudes to old age institutions are influenced by fears about old age itself. In addition there is no agreement about what constitutes or results in successful old age. The old may not have the resources to match expectations and, while it is possible to envisage providing the old with more money or better facilities, it is unlikely that much can be done about deterioration in health. Consequently it is necessary to adjust norms as well as to look for better resources.

Attitudes to Residential Living

Old age homes have similarities to organisations like homes for the physically handicapped or long-stay hospitals in which residents are expected to be permanent. Yet all such organisations, along with most other residential establishments, are regarded as second best to living in one’s own home. There are only a few exceptions. In situations where there is a high degree of voluntary entry to establishments (i.e. there are several other living styles available and the residential home is the preferred choice) or where great importance is attached to the purpose for entry (e.g. boarding school) residential living is seen more favourably. Religious establishments, hotels, communes and boarding schools come into this category. Social service type institutions – for children, the mentally or physically ill, the mentally or physically handicapped, the old – fall into the second-best category. The negative aspects of such establishments have been well documented and have become part of the conventional wisdom. Residential institutions have been criticised for almost as long as they have been in existence. Criticism has been intense since the 1950s. Bowlby (1951) cited the dangers for children in institutions from maternal deprivation. Barton (1959) stated that living in institutions could produce a set of problems (which he called institutional neurosis) more difficult to eradicate than the original reason for admission. Goffman, in a series of major essays brought together in Asylums (1961), discussed the totality and pervasiveness of institutional regimes. The more total the regime, the more an institution devised rituals to ensure that physical constraints (such as walls and locked doors) were matched by social pressures to conformity and he illustrated this theme by examining the ‘stripping’ of the person that took place at admission.

With this as background has followed a succession of studies of types of institution – for example, Townsend (1962) on old people’s homes, Morris and Morris (1963) on Pentonville, Morris (1969) on subnormality hospitals, Meacher (1972) about homes for the elderly confused. These have added their weight to the criticism of residential institutions.

Attitudes to Old Age Homes

Today’s elderly have vivid memories of the workhouse, the predecessor of local authority old people’s homes. The workhouse has become a symbol of harsh, unimaginative and regimented living. Whether such a picture is true or not, the tradition lives on. The old consider entering a residential home to be a sign of failure and, on admission, expect to be compliant.

Townsend’s study was a significant landmark in the development of attitudes to old age homes. After the Second World War there were hopes that new and smaller residential homes would lead to more satisfactory living conditions for the elderly. Townsend showed the inadequacy of building programmes but also the inadequacy of life-style within many purpose-built establishments. The view of the old age home as second best was reinforced.

The Williams Committee (1967), set up to examine the training needs of staff in residential homes and acknowledge the importance and the skill of the work, expressed similar sentiments:

One basic fact has to be kept in mind, that even the best residential home is likely to be ranked as second best in the mind of those who come into it. It cannot replace the independence a person enjoys in his own home or give what an affectionate family can provide. Everything is different from what he has been accustomed to for so long. The rooms may be warm and bright and prettily decorated, the chairs comfortable, the food good and plentiful. But they are different and take getting used to. And one’s new companions are not those whom one has known all one’s life, who understand the names that crop up in the conversation or recognise the references to past experiences. It is a sad thing not only to suffer the infirmities of old age but to find oneself among strangers at a time of life when it is difficult to make new friends.

Not surprisingly there have been demands to put resources into ‘community’ and ‘preventive’ work, though I have argued elsewhere that this contrast between ‘residential home’ and ‘community’ is inaccurate and unhelpful, for residential establishments are very much part of the community (see Clough, 1978a).

Townsend (1962) suggests

a number of far-reaching proposals … to reduce progressively the number of communal homes (in the first instance by closing the former workhouses) and ...

Table of contents

• Cover
• Half-Title Page
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Dedication Page
• Foreword
• Acknowledgements
• Introduction
• 1 Old Age Homes – Myths and Realities
• 2 Styles of Old Age Homes
• 3 Participant Observation in Old Age Homes
• 4 Comparative Background Information
• 5 Going into a Home
• 6 Daily Life for Residents in The Pines
• 7 Mr Jepson and Mrs Williams – Pictures of Two Residents
• 8 Departure
• 9 I Hope We Can Make Them Happy
• 10 Norms and Controls
• 11 Ageing in the Institution
• 12 The Function of Old Age Homes
• 13 The Old: Adults with Rights to Services
• Appendix 1: Staff Questionnaire
• Appendix 2: Resident Interview
• Bibliography
• Index