Living in a State Residential Home: A phenomenological exploration

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Living in a State Residential Home A
phenomenological exploration
Christian Borg Xuereb
School of Life and Health Sciences, Aston
University, Birmingham UK
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Introduction

• In 2002, this age group accounted for 17 of
  Maltese population
• Expected to increase to 22 by 2010
• This figure is expected to increase to around
  100,000 elderly persons by the year 2050

National audit Office, 2005 Galea, 2008
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Background

• Increase in life expectancy
• Greater concern about the quality of life
• Change in independency, daily life patterns,
  social networks and support.
• Older residents' experiences towards residential
  care identifies more negative than positive
  experiences.

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Background

• A residential care home is a long-term care
  facility for elders from the full range of
  socio-economic, educational, professional,
  religious and geographical backgrounds.
• The dramatic change in both physical and social
  demands as a result of residential care placement
  is certainly a life condition that requires major
  adjustment by older people.

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Aim

• To understand and describe the lived-experiences
  of elderly men living in a state residential home
  and how this affected their health.

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Methodological design

• Qualitative study- phenomenological approach
• Semi-structured interviews were tape-recorded,
  wherever the participant felt most comfortable
  (either in his room, or quiet part of the hall)
• Sample
• Purposive sampling
• 6 elderly Maltese males, without cognitive
  impairment between 60-90 years old were
  interviewed
• Ethical issues were prioritized

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Demographic data

• Age ranged from 79 to 87 years old.
• Five of the participants were practising Roman
  Catholics, while one of them stated that he was
  not very religious.
• All of the participants lived through the Second
  World War, and this had an impact on their lives
  in some way or another.
• One of the participants was wheelchair bound and
  could not move because of arthritis through his
  whole body, while the other five participants
  walked independently without help.
• Five of the participants were widowers, and four
  of them had children. However, only three of them
  received visits from their children as for the
  other participant his children lived abroad.

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Analysis

• Deciding to enter the residential home
• Decision taken by the individual and his partner
  / or by relevant others for him
• Not to be a burden on their children
• Loneliness and solitude

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Analysis

• Experiences embrace emotional physical social and
  spiritual gains and/or losses
• Social support from their family, staff, friends,
  other elderly residents
• Spiritual support
• Loss of independence - becoming dependent on
  staff and relevant others institutionalization
• Loss of self-image powerlessness, privacy and
  personal space loneliness and isolation
  Boredom, life became a routine
• Feelings of oppression - material losses like
  house and hobby

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Analysis

• A safer environment in which reminiscence is an
  essential part of everyday life, a life without
  future
• Gains security concerning health care and support
• Reminiscence
• A future void of any purpose

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Deciding to enter the residential home

• Decision taken by the individual and/or partner
• It was my decision... my children said nothing
  for my children, they were at least they would
  not feel guilty that I wanted something and they
  did not give it to me... ...you understand I
  took the decision (Frank)
• Decision taken by relevant others
• They just brought me here how can I say it one
  moment I was sleeping, and I woke up finding
  myself here it was a shock for me wasnt it
  they told me that I was in an unconscious state
  for 3 to 4 weeks so I do not know what happened.
  I found myself here (James).

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Deciding to enter the residential home

• They did not want to be a burden on their
  children
• They his children never told me anything, I
  cannot I dont have anything to say about them
  they never grumbled or said anything its just
  that I feel that I should not bother them with
  extra burdens no had some tears in his eyes as
  long as I am fine here emm its ok (Paul).

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Deciding to enter the residential home

• They did not want to be a burden on their
  children
• Maltese culture - strong family cohesion (Tabone,
  1994, 1995 Troisi 1994 Abela 1998).
• This may have pushed the elderly to choose to
  live in a residential home rather than with their
  children, so that their children can live their
  own separate life

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Deciding to enter the residential home

• Loneliness and Solitude
• At home I was on my own, I was sad most of the
  time I used to sleep on my own at night I was
  fed up sleeping alone and waking up alone again
  I was always alone... I used to be afraid being
  alone at night, at home (Mark).
• Sense of relief at no longer being alone.
• Older persons living alone were more likely to
  look for residential placement as a strategy to
  gain social contact with others.

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Experiences embrace emotional physical social and
spiritual gains and/or losses

• Support from family, friends and other residents
• I have a sister who comes to see me regularly
  every alternate day I am happy when she comes
  You feel you are not forgotten they remember you
  youre still alive (Mark).
• Spiritual support
• If possible I do not miss the mass isnt it God
  that guides you in the evening we say the
  rosary, because there is the rosary as well at
  4.00pm (Paul).

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Experiences embrace emotional physical social and
spiritual gains and/or losses

• Several feelings of losses, like loss of
  independence, loss of self-image, loss of
  privacy, loss of house and hobbies, were
  expressed by participants of this study.
• I think at home I used to live better because
  its like, I used to do the things that I wanted
  true I used to eat when and what I liked. I am
  not complaining on food you know but before you
  used to decide on everything your independence
  changes a bit doesnt it(Paul).

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Experiences embrace emotional physical social and
spiritual gains and/or losses

• We need our personal space it is enough of an
  encumbrance if youll have a wheelchair near your
  bed without inserting another bed! that is the
  most important thing I feel suffocated thats
  it I do not have that sensation of freedom
  anymore lets face it because in a wheelchair
  you are not free to do what you want anyway so
  even that little bit of space, that I want, is
  being taken away from me now it does not make
  any sense at all (Frank).
• Stress and anxiety - led to a number of other
  feelings such as powerlessness, sadness,
  isolation, depression, and feeling of betrayal.

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• Boredom
• How would you feel? If you did nothing except
  from sleeping, walking, eating and sleeping
  again and sometimes you just watch TV (Steve).
• Feelings of oppression material losses (house
  and hobbies)
• What I miss is a bird thats what Im missing
  right now apart from that Im okay I love
  birds I relax a lot when they sing its my
  hobby e for how long will you do nothing but
  stare or watch the TV a birds song goes
  straight to my heart it helps me remember times
  when I was younger and I used to run outside and
  stuff like that I always had birds since I was
  young in the other ward, I had 3 or 4 birds you
  know but over here, he told me for now dont
  bring any (Steve).

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A safe environment in which reminiscence is an
essential part of everyday life, a life without
future

• Gains security concerning health care and support
• Your mind is at rest that you will always find
  help and support. If you say it is painful
  here you see the doctor coming to see you you
  always find the help you need Once I had a heart
  attack, of course I had pain here, and God
  knows, they took me to hospital I found the
  doctor immediately, and they helped me
  immediately. Thank God it happened here rather
  than at home. When the doctor saw me, he
  immediately said... Hospital now (Mark).

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A safe environment in which reminiscence is an
essential part of everyday life, a life without
future

• Reminiscence
• I was a jack of all trades I used to go fishing,
  play some music, I used to play the cello I even
  played at the Manuel Theatre and anyways I had
  20 or 21, I used to play the cello very well
  then quit at 34 years of age emm I studied cello
  quite in-depth and since I like music, here I
  switch on the radio on the Classic FM, and
  listen to it from Monday to Friday

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A safe environment in which reminiscence is an
essential part of everyday life, a life without
future

• A future void of any purpose
• The future now I do not have a future I wish I
  am still young, only then I would have a future
  laughs now there is nothing e we live what we
  can as happy as possible isnt it I do not
  bother anyone and that is it (Jon).
• I got used to it seeing people dying death is
  something natural... and everyone has to face it
  (Mark).
• Were 5 in a room, if one of us dies, they told
  us that they would not add another one well
  stay as 4. Thats what he said well see
  anyways we get along well (Steve).

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Practical Recommendations

• Caregivers need to be sensitised to value
  residents independence, privacy, autonomy and
  the need for personal space.
• Pet therapy could be of invaluable help in
  countering boredom and increasing attendance to
  general activities and therapies.
• Older people that have applied for a placement in
  a residential care should be contacted and
  prepared for relocation. Thus an outreach program
  is recommended to provide relevant information
  about the residential care to elderly who are
  interested in entering the home.
• Family involvement should be encouraged as much
  as possible, especially during the transition
  period.

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Future research

• There is a need for a large scale quantitative
  and qualitative study to explore and compare the
  quality of life of elderly men and women living
  in residential care with those living in the
  community.
• Researchers need to study if living with
  cognitively impaired elderly in residential homes
  has an effect on mentally fit elders.
• A longitudinal research of the effect of
  placement to a residential care on physical and
  psychosocial health could be conducted, choosing
  participants from amongst those that have
  recently applied for placement in a nursing home
  and follow their journey till after placement.

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Conclusions

• Elderly leaving their private homes to go to live
  in residential care face a myriad of losses.
• Felt more secure and safe knowing that medical
  health is always present.
• Although they face so many losses, they still
  prefer the safety, care and company one finds in
  residential homes.
• Ultimately, the sense of security that elders
  feel in the residential home is a critical reason
  why most residents apply for such relocation.

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Acknowledgments

• Dr. Rachel Shaw, School of Life and Health
  Sciences, Aston University
• Participants in this study
• The management and staff of the Residential Home

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• Thank you for listening
• Any questions?