Conversations within a nursing home: An ethnographic study of the lived experience of residents, visitors and staff

This thesis uses an ethnographic study to explore the lived experience of those living, working and visiting a nursing home. This tripartite has traditionally been hidden from view, given no forum to voice experiences in a meaningful way within a sector which is seriously underfunded. By using the work of Erving Goffman as a foundation I utilise a therapeutic reflective Marxist lens to explore the lived experience of the tripartite and examine the neo-liberal practices that abound within health services. I relate the tripartite voices through a series of narratives that underline that care, in and of itself, is significant and that it is emphasised through the everyday-ness of their experiences that cuts through the institutional practices and power imbalances inherent within the social care arena. There are complexities that arise when attempting to understand the messiness of the nursing home and wider social care arena but, as a nurse that has spent the majority of their working life within it, I have been able to navigate and draw some conclusions around what it is to live, work and visit this marginalized sector. I have explored what it means to age in today’s society and the inherent ageism, discrimination and stigma that accompanies the ageing process. I have reviewed what ‘home’ is and that an individual’s personal history of ‘home’ supports an individual’s sense of belonging and continuity which is integral to well-being and thus a literal place and an ideal. However, the legislation and regulation that wraps itself around elderly care inexorably leads to a sense of surveillance which provides a power imbalance. This power imbalance is reviewed against Goffman’s work around Total Institutions (1961). By thematically analysing my data I have realised that the conversations and observations were part of a greater map which, due to its subject matter, was complex but interconnected. Ultimately, there were three themes that took precedence: Death (of self; social death and of life as we know it); Personalization of care and expectations and; Environment and business policy. All the statistical evidence points to a future where there is an ageing population with increasingly complex co-morbidities which will be situated within the reality of a decreasing younger population. I conclude that there is a need to reframe sickness to health-care within the rhetoric around older people and their requirements from a healthcare system, coupled with a necessity of educating the wider population on societal prejudice and discriminations to an ageing population. There is also a need to engage further with the current conceptualizations of care at a deeper and philosophical level