More than a visitor? Rethinking metaphors for family care in long-term care homes

Abstract

Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members

“…This interpretation moves beyond existing characterizations of video as a tool for social connectedness [ 27 ] to one in which video calls are used to continue care practices when physical visits are restricted. Many of the activities conducted by participants in this study, including relational maintenance and health monitoring, align with the findings of ethnographic studies on the coordinated work of families in care homes [ 67 ]. Our analysis suggests that, when video calls were used to replace in-person visits, they became a modality for families to continue these contributions to care.…”

“…Many people in aged care are living with profound health challenges, some of which precipitate their move into care [ 66 , 67 ]. Participants reported that residents’ health problems affected their ability to participate in video calls, often because commercial systems are ill-suited to the aged care setting [ 35 ] and require adaptation to be successful [ 61 ].…”

“…Finally, our analysis identified that the continuation of care through video calling was impeded by multiple challenges. One problem relates to the constraints of the aged care context, where homes are often underresourced and understaffed [ 67 ]. This was especially challenging during the pandemic [ 65 ] and influenced the quality, reliability, and length of video calls.…”

Problematizing Dominant Assumptions about Unpaid Support through Exploring Case Study Profiles of Older Home Care Clients

“…Our fndings contribute to a body of scholarship, which highlights important complexities of care provision, including reciprocal exchanges of support in care relationships, reluctance to self-identify as a caregiver, situations of violence or a lack of love, and structural forces shaping the capacities of unpaid carers (e.g., [10,21,30]). Findings from the present study further expand, nuance, and problematize existing conceptual, methodological, and institutionalized perceptions and assumptions of caregivers, and should also prompt refexivity about assumptions about older adults' access to fully capacitated and involved sources of unpaid support, both in Canada and beyond.…”

“…Research has also explored the intersecting contributions of these kinds of demographic or categorical indicators of diversity to diferential outcomes or correlates of care provision (e.g., [9]). Other sources of variation between caregivers that are less easily addressed through quantitative and demographic measurement remain less visible (or not formally diagnosed); this can include variation in orientations toward or identifcation with the caregiving role, for instance, [10][11][12].…”