The impact of the transition to a care home on residents' sense of identity

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Abstract

The transition to a care home can be a difficult experience for older people, with various changes and losses, which can impact an older person’s sense of identity. However, it is not clear how older people perceive and manage their sense of identity within a care home, particularly in the United Kingdom. This study aimed to explore how the transition to a care home impacted on the identities of care home residents, and how they addressed this impact. Findings were interpreted using the Social Identity Perspective (SIP), which postulates that people strive to maintain a positive identity. Identities are composed of a personal identity (relating to personality traits), and a social identity (relating to group membership). SIP can help to interpret the symbolic nature of interactions and experiences, although to date has been infrequently used in care home based research.This study used a case study approach with qualitative methods. Cases of three care homes were purposefully sampled within Greater Manchester. Residents, relatives, and care home staff were asked to participate. Semi-structured interviews with 18 participants (nine residents; four relatives; five staff), and approximately 260 hours of observations were conducted over one year. Data were analysed using Framework Analysis.Results revealed five overlapping themes: 1) Social comparison; 2) Frustration; 3) Independence and autonomy; 4) Personal identity vs. Care home; 5) Ageing and Changing. Overall, the transition to a care home had a negative effect on residents’ identities, due to organisational restrictions and associations with cognitively impaired older people. In order to forge a positive identity, residents without dementia aimed to distance themselves from residents with dementia, whom they perceived negatively. To achieve this distance, residents without dementia engaged in social comparison, by emphasising their comparatively superior cognitive abilities and physical independence. Symptomatic behaviours of residents with dementia also caused frustrations amongst staff and other residents. Furthermore, differing expectations of the care environment caused frustrations between residents, relatives, and staff. Most routines and restrictions made it difficult for residents to express their personalities. Although staff aimed to incorporate residents’ individuality into care, they often reported feeling restricted by a lack of staffing and resources. Additionally, residents considered the physical impact of ageing to alter their established sense of identity. However, the care home further undermined residents’ identities, particularly in relation to their independence and autonomy, which were important elements of their personal identities. Residents’ perceptions of what counted as independence changed in light of their declining physical abilities and what they were allowed to do within the care home, in order to maintain this element of their identities.Findings indicated that the care homes would benefit from more resources to organise more meaningful activities for residents. However, small changes to routines, such as allowing ‘duvet days’, also helped to support residents’ identities. Recommendations for practice include the introduction of an ‘identity champion’ to provide guidance and support on how care home staff could make identity-relevant changes.

Layman's Abstract

The move to a care home can be a difficult time for older people. There can be lots of changes, which can effect an older person’s sense of identity. But, it is not clear how older people think about their identity in a care home. This study aimed to explore how the move to a care home changed the identities of care home residents. To understand the findings, we used the Social Identity Perspective (SIP), which argues that people aim to have a positive identity. SIP can help us to understand identity in a care home, but to date has not been used in much research that is based in care homes.Three care homes in Greater Manchester were sampled. Residents, their relatives, and care home staff were asked to take part. Interviews with 18 people (nine residents; four relatives; five staff), and 260 hours of observations were conducted over one year. Data were analysed using Framework Analysis.Results revealed five themes: 1) Social comparison; 2) Frustration; 3) Independence and autonomy; 4) Personal identity vs. Care home; 5) Ageing and Changing. Overall, the move to a care home had a negative effect on residents’ identities. The rules of the care homes, as well as living with people with dementia, made it difficult for residents to think positively about themselves. Residents who did not have dementia disliked other people thinking of them as being ‘as bad’ as residents who did have dementia. So, to help make a better identity for themselves, residents without dementia highlighted their mental skills, which they felt were superior to those of residents who had dementia. Residents who have dementia can sometimes behave in an unusual way. These behaviours sometimes frustrated staff and other residents. The residents and their relatives would sometimes get frustrated with the staff, because they felt they were not being cared for properly, and were not helping residents to express their identities. On the other hand, staff would sometimes get frustrated with relatives and residents, because the staff felt that the relatives and residents expected too much from them. The rules of the care homes made it difficult for residents to express their identities. Staff tried to treat each resident as an individual, but they found this difficult due to a lack of staff and funding.Residents felt that getting older and feeling weaker made them change how they thought of themselves. Being independent was an important part of the residents’ identities, but moving to a care home made residents feel less independent. To make themselves feel more independent, the residents tended to complete small tasks in the care home.Findings showed that the care homes might need more staff and funding to organise better activities for residents. Small changes to the routines of the care homes also helped residents to develop positive identities. An ‘identity champion’ could teach staff how to support residents’ identities in the care home.

Keyword(s)

Care homes; Identity; Older people; Qualitative; Social Identity Theory; Transition

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