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Home Care and Elderly People: the Experiences of Home Helps and Old People in Salford

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Home Care and Elderly People: the Experiences of Home Helps and Old People in Salford HOME CARE AND ELDERLY PEOPLE: THE EXPERIENCES OF HOME HELPS AND OLD PEOPLE IN SALFORD Lorna Anne Warren Presented for the Degree of PhD University of Salford Department of Socioloqy and Anthropology 1988 SU 0284476 1 Hill Ifl HHlllhull lllhi Hill Ill! Hill Acknowledgements I have lonq anticipated the occasion of sittinq down to write the acknowledgements of my thesis. I find it hard to believe the moment has finally arrived. I wish, then, to acknowledge all the people who made the study possible. Firstly, my supervisor, Lorraine Batic; secondly, the staff involved with Salford Social Services Domiciliary Department— especially the organisers and the home helps - and the old people whose homes I visited. They are this study. No matter what the motivation for undertaking the exercise, the process of completing such a piece of work as this can be a hard slog. I must also acknowledge those who have helped me along the way: Greg, especially for the references and the 'brainfood'; Vic for help with the statistics; Elaine for her reassurance and quiet confidence in me; Sue and Sheila for the mounds of help - including lifts, for listening to me grumble but, above all, for remaining so patient (how?); Helen for watching over me; Maxine for the late-night de-briefing sessions and the use of the dining-room table; Marian for not letting me forget; Karen (with the help of Penelope) for keeping me laughing over the final few weeks and providing me with answers to the crossword; Sandie for always being there and for the hugs; Vicky - you'll know why. 284476 There are all those, too, who I have not named but who are sick of hearing me start every sentence with the promise of 'When I've finished For their special care, I dedicate this thesis to rums, Pips and to Claire. Abstract My study is concerned not simply with the what and the how of hone care for the elderly but also with the I ask about how the domiciliary services operate: what home helps do for elderly people and how they feel about their caring role, and, what the circumstances of elderly people needing care are and how they feel about using help. But I also want to know why home help operates in this way: why home helps care in the way they do and why elderly people feel as they do about using that care? Such an approach cannot fail to take into consideration the wider ecological and structural context within which elderly people and home helps live and work. Part one of my thesis, composed of three chapters, therefore provides this backcloth. I use it to introduce the location of the study, to present a brief history and discussion of the development of domiciliary services for the elderly in Britain, and 10 describe the philosophy and policy shaping domiciliary provision within Salford Social Services Department. As I shall show, current Government economic policy is inextricably woven into the fabric of this backcloth. In Part Two, I detail the findings of my fieldwork, painting a picture of the lives of the frail and impaired elderly people using domiciliary care, and of the work of the home helps providing that care. As far as possible, I have used the interviewees' own words to explain perceptions of (in)dependence and need, of stiqma and taboo, of material and ideological motivations, and of emotional involvements and commitments. A number of writers have argued that dependency - a concept at the centre of inquiries into the care of the elderly - is a socially constructed relationship, both with respect to elderly users and female providers of care. In Part Three, I question whether and in what way the evidence supports or denies this claim. I ask what are the implications of my findings for social policy. I also justify the use of anthropological perspectives in policy-related research. Finally, I present an account of my experience as a researcher which can be approached from a number of different levels., At a'basic level, it represents an immediate account of doing fieldwork. It is also my account, as a post-graduate, of the experience of writing-up a thesis. I consider the effect of the passing of time on context and consciousness and hci this feeds into the analysis and presentation, of work. And I attempt to address concerns with the writer/reader/subject relationship which pose questions to do with communication COE11TS Page INTD UCT ION An Introduction 1 A Qualitative Approach 3 A Feminist Perspective 5 Representation of Research 8 My Own Experiences of Old People and Care 10 A Review of the Literature 13 i. Cross-Cultural Studies of People and Care 13 ii. Surveys of Elderly People and the Domiciliary Services 21 a. Social Surveys of Elderly People 22 b. Studies of Local Authority Services 25 iii. Studies of Carers and Caring 30 Conclusion 41 PAE 1 Chapter 1 Salford: An Introduction to the C 58 A General Outline 58 Industriali sation 60 Post-Industrialisation 62 i. Environment 62 ii. Economy 64 iii. Employment 65 iv. The Elderly Population 67 v. Diversity 68 Chapter 2 Domiciliary Service 71 Development of the Domiciliary Service 71 i. Before 1971 72 ii. A Mandatory Service 75 iii. Post 1971 76 Community Care 80 Conclusion 86 Chapter 3 Domiciliary Services in Salford 88 A Brief History of Welfare Provision 88 Domiciliary Services 89 i. Patch System 90 ii. Frequency and Amount of Services 91 i iii. Home Help Organisers 97 a. Activities 97 b. Training 100 iv. Home Helps 100 a. Activities 100 b. Recruitment 101 c. Employment 102 d. Training 103 e. Clothing 105 v. Old People 105 4 PART 2 Dependence A Framework 110 The Structured Dependency of the Elderly 110 The Structured Dependency of Carers 114 Home Helps Chapter 4 Becoming a Home Help 120 Reasons for Becoming a Home Help 121 i. A desire to help others 122 ii. Income 123 iii. Hours 125 iv. Qualifications 128 Skills and Experience 129 i. Caring for old people 129 ii. Knowledge of the home help service 131 iii. Positions in the home and labour market 132 Summary 136 Chapter 5 The Process of Caring 140 Background 140 Job Expectations 1 141 Activities 143 i. Domestic care 144 ii. Errand care 145 iii. Personal care 145 iv. Emotional care 146 Clients 146 i. Short-term clients 147 ii. Regular clients 147 a. Routine clients 148 b. Handicapped/disabled clients 148 iii. Confused clients 149 iv. Dirty cases 149 Job Expectations 2 151 Unofficial Activities 154 i. 'Doing Favours' 154 ii. 'Breaking the Rules' 159 Caring for Elderly People: A Question of Relationships 163 i. Nature of care 163 ii. Setting for care 167 Caring for the Whole Person: A Question of Time and Responsibility 170 i. Time 170 ii. Responsibility 171 Conclusion 177 1. A Double bind 177 ii. Satisfaction or exploitation? 179 Elderly People Chapter 6 Elderly People as a Survey Sample 186 A Profile 186 i. Household composition 186 ii. Age 188 iii. Accommodation 188 iv. Impairments 190 V. Mobility 190 vi. Sources of help 194 a.' Meals services 194 b. Nursing services 195 c. Chiropodists 195 d. Laundry Service 195 e. Telephones 196 f. Home Help 196 g. Relatives, friends, neighbours and others 199 Pen Portraits 1. Mr Eric Abbott 202 2. Mrs Edith and Mr Frank Harris 206 3. Mrs Kitty Scott 214 4. Mr Roy and Mrs Lily Maguire 219 5. Mrs Doris Wareing 228 Chapter 7 Elderly People and Home Help 239 Reasons for Using Home Help 240 The Context of Old Age and Control 243 Independent Elderly People 246 i. Hobbies and Activities 248 Active Dependent Elderly People 251 i. Economic Resources and Preventive Measures 251 ii. Networks of Care and Settinqs 253 a. Old people's flats and sheltered accornrrodation 254 b. High-rise flats 258 c. Day centres 259 d. At home and alone 260 Passive Dependent Elderly People 261 i. Reluctant Dependents 262 ii. Lone Dependents 266 iii. Passive Dependent Elderly Men 270 Summary 272 Old People's Perspectives on Home Help 274 i. Customers 274 ii. Neighbours and friends 276 Recipients 281 Summary 284 PART 3 Chapter 8 Conclusion 288 Applied Anthropology 288 i. Working With Other Disciplines 289 ii. What Can Anthropology Offer? 289 Policy at the Level of Service Provision 294 i. Old People 295 ii. Home Helps 299 iii. Innovations in the Care of Elderly People 302 The Wider Context of Policy: Community Care and Structured Dependence Re-examined 303 Annex Fieldwork: Doing, Being, Writing 312 Appendix A: A Profile of the Elderly Population 353 Appendix B: Documents on Domiciliary Services and Community Care 360 Appendix C: Salford Social Services Documents 386 Appendix D: Miscellaneous 402 References 413 Tables and Figures LIST OF TABLES AND FIGURES Page Table Title 3.1 Allocation of Home Help Service to Old People by Patch Team - 31 March 1984 92 3.2 Variation in No. of Old People and Average Weekly Allocation of Home Helps Over Three Years 94 3.3 Categories of Person Having Home Help (as DHSS Returns) in the Years From 1974 to 1984 95 3.4 Variation in Home Help Service Over Ten Years 96 3.5 Comparison of Salford Home Help Service Statistics with Averages for Authorities in (a) England and (b) Greater Manchester 98 6.1 Household Composition 187 6.2 Marital Status 187 6.3 Age 188 6.4 Accommodation 189 6.5 Reported Cause of Impairment 190 6.6 Common Impairments in Old People 190 6.7 Mobility of Elderly People (Without Assistance) 194 6.8 Source and Frequency of Outside Help With Some Routine Practical Activities 197 a.1 The Elderly Population: Past, Present and Future 354 a.2 Disability and Dependency 358 Figure Title• Page 1.1 Greater Manchester County and the Metropolitan Districts 57 1.2 The Growth of Salford Persons Over • 75 Years in Salford 61 1.2 Persons Over 75 Years in Salford 68 a.1 The Elderly Population: Past, Present and Future 355 a.2 Who Old People Live With 1980 • 357 a.3 The Increase in Social/Economic Requirements with AQe, England and vales 359 KEY • .• pause in conversation .1/.
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