Academic journal article Cultural Studies Review

Residential Aged Care Facilities: Places for Living and Dying

Academic journal article Cultural Studies Review

Residential Aged Care Facilities: Places for Living and Dying

Article excerpt

-INTRODUCTION

In modern Western societies such as Australia there is an emerging pattern of population ageing. In 1901 people sixty*five years and over comprised four per cent of the total Australian population, by 2002 this had risen to thirteen per cent and by 2051 it is predicted to reach twenty*four per cent with those over the age of eighty growing the fastest of any age cohort.1 For approximately seven per cent of those who are aged sixty*five and over the final months or years are spent in residential aged care facilities (RACFs).2 In 2007, eighty*eight per cent of permanent separations from RACFs in Australia were from the death of the resident. Of those residents who die in these settings, seventeen per cent have a length of stay less than three months and nineteen per cent less than twelve months.3 From these figures it is clear that RACFs are spaces and places where dying and death occur. Despite this, limited attention has been given to how death is experienced in this setting and how the setting itself impacts upon this experience.4

The terms space and place are often used in geographical gerontology, sometimes interchangeably. Wiles notes that space is a more universal and abstract idea whereas place is more specific, a portion of space, a setting which is experienced and which holds meaning, and which shapes the intimate relations between people.5 Gilmour notes that space, both material and imagined, is produced through action and interaction whereas place is the organisation of space into bounded settings where social relationship and identity take place.6 Here, I explore RACFs as both spaces and places of death and dying. I use the term 'place' as the setting of care; in this instance the RACF is a hybrid place where both living and dying occurs. Space refers to different areas within the RACF where the living and dying intersect. These spaces, far from being fluid, are rigidly defined not by those who live there but by those who define the space as a 'working' space. Together, space and place constitute the scenes of death I explore in this essay.

While institutions play a key role in the care of the dying, there is evidence that within institutions dying patients are sequestered and care is less than optimal. In many cases, this involves an effort to 'screen off' the death scene, to marginalise it within the institution. Sudnow's classic ethnography of death and dying in two American hospitals, conducted in the 1960s, illustrated how work patterns of nursing staff hid the reality of patient's dying.7 He cites examples of patients admitted to the emergency department at night who were expected to die but were not assigned a bed. Rather, they were placed in the supply room until morning. If death had not occurred overnight, a bed was assigned before visitors or medical staff came in. Glaser and Strauss, who studied hospital care in the 1960s, similarly identified a death denial culture in hospitals. They found that dying patients were placed in side rooms, were assigned a room with a comatose patient or, if in a multibed room, were permanently screened off from other patients. 8

Other more recent examples of sequestration of dying in hospices and hospitals has been documented by Lawton and Golander.9 In Lawton's ethnographic study in the United Kingdom during the 1990s, the hospice presented a paradox. On the one hand, hospice promotes openness of death and communal dying, with many patients cared for and dying in four*bed rooms. On the other hand, Lawton noted certain types of patients in the hospice were sequestrated into single rooms. These she classified as having 'unbounded bodies'. That is, a patient for whom there was a breakdown of the physical body boundary which involved fluid or matter that would normally be contained leaking to the outside.10 Golander's ethnographic study of a geriatric nursing ward in Israel found that once a resident's health deteriorated, a transfer was made to a six*bed intensive nursing room in a different building from the nursing ward. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.