“Becoming people to each other”: How practice and meaning intersect in the delivery of aged care and disability support Susan Banks (BFA) A thesis submitted in fulfilment of the requirements for the degree of doctor of philosophy School of Social Sciences University of Tasmania August, 2016 Contents Contents .............................................................................................................. i List of figures, tables and photo-voice images ................................................. vi Declaration of originality .................................................................................. vii Authority of access ............................................................................................ ix Publication related to this thesis ...................................................................... xi Statement of ethical conduct .......................................................................... xiii Abstract ..................................................................................................... xvii Acknowledgements ................................................................................... xix Chapter 1. Introduction ............................................................................... 1 Background ........................................................................................................ 1 Labels .................................................................................................................. 4 The thesis structure ........................................................................................... 5 Chapter 2. The literature ............................................................................. 7 Introduction ....................................................................................................... 7 The political environment .................................................................................. 8 Demographic change and care and support ................................................ 10 The recipients of disability and aged care services .......................................... 13 Defining disability ......................................................................................... 13 Demography of disability ............................................................................. 15 Socio-economic conditions .......................................................................... 15 The nature of care and support work .............................................................. 18 The workers who deliver ‘hands-on’ care and support ................................... 20 Pay and conditions ....................................................................................... 21 Worker demographics .................................................................................. 23 What studies have focused on these workers? ........................................... 25 How care is discussed in the literature ............................................................ 32 Conclusions ...................................................................................................... 45 Chapter 3. Methodology and methods: Using an ethnographic approach to explore meaning and practice ................................................................... 49 Introduction ..................................................................................................... 49 Methodological approach—Goffman’s dramaturgical analogy ...................... 50 i Performances in aged care and disability support ...................................... 52 Using ethnographic methods to see the performance ................................ 53 Three ‘stages’ and an ethnographic methodology ...................................... 58 Methods ........................................................................................................... 59 Recruiting the participants ........................................................................... 59 Participants. The cast of the play ..................................................................... 60 Getting in: Recruitment, organisations and researcher status .................... 60 The participants ........................................................................................... 66 The data........................................................................................................ 69 The reflective researcher: Fieldnotes, transcribing and reflection ............. 82 Interpreting the data ........................................................................................ 87 Data analysis ................................................................................................ 87 In search of meaning in the data ................................................................. 90 Conclusions ...................................................................................................... 91 Chapter 4. Findings: Setting the scene—Introducing the workers, the clients and where the work happens ........................................................ 93 Depictions of aged care and disability support................................................ 94 Gathering the stories ................................................................................... 94 Southern Tasmania ........................................................................................ 100 The actors—and the theatres ........................................................................ 101 Workers ...................................................................................................... 101 Workers not in research dyads .................................................................. 103 Clients ......................................................................................................... 106 Clients not in research dyads ..................................................................... 107 People in research dyads ........................................................................... 109 Conclusions .................................................................................................... 124 Chapter 5. Findings: Working to deliver care and support ..................... 127 Introduction ................................................................................................... 127 Theme 1. Workers’ presentation of self ........................................................ 128 Care and support workers presenting a compassionate self .................... 129 Workers’ identity by comparison ............................................................... 131 Summary .................................................................................................... 135 Theme 2. Workers’ performance ................................................................... 135 ii “Supporting people in their everyday lives” .............................................. 136 (Re)Creating the competent performance—presentation of clients’ self . 138 Risky work .................................................................................................. 147 What shapes practice: Agency, rules, boundaries and provider organisations .............................................................................................. 161 Summary—Workers’ performances .......................................................... 171 Theme 3. How workers talk about clients ..................................................... 172 Resentment and othering: Disabling verbal statements ........................... 173 Conclusions .................................................................................................... 178 Chapter 6. Findings: Working to accept care and support ...................... 181 Introduction ................................................................................................... 181 Theme 1. Clients’ presentation of self ........................................................... 182 Clients presenting a competent, independent and capable self ............... 182 This precarious life—managing, resisting or rejecting difficulties ............. 186 Summary .................................................................................................... 193 Theme 2. Clients’ performance ...................................................................... 194 Instrumental tasks ...................................................................................... 194 Preparing the worker (training) ................................................................. 195 Preparing for the worker: Emotional and intrinsic .................................... 197 Summary .................................................................................................... 206 Theme 3. How clients talk about workers ..................................................... 207 The unaccepted worker: Reasons to say no .............................................. 208 The embraced worker ................................................................................ 216 The role of provider organisations ............................................................. 217 Summary .................................................................................................... 223 Conclusions and reflection on clients’ perspectives ...................................... 224 Chapter 7. Findings—The self in interaction ..........................................