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.

Le vieillissement de la population est un défi en termes d’accompagnement de la dépendance physique et/ou psychique du sujet âgé.Une étude épidémiologique dont l’approche est pluridisciplinaire, et qui utilise les outils de l’anthropologie en insistant sur l’approche qualitative menée sur dix EHPAD (Limousin et Ile de La Réunion) a eu pour objectif de contribuer à l’amélioration des connaissances sur les expériences vécues par les personnes âgées et les familles de résidents Alzheimer, les étudiants et les professionnels de santé. Pour cela, les représentations socio-culturelles/expérience vécue de la population de l’étude ont été explorées ainsi que la décision d’entrée, la vie quotidienne et la prise en soins prescrite, perçue et réelle en EHPAD.Ainsi, les résultats montrent que l’entrée en EHPAD est multifactorielle et influence les stratégies d’adaptation des résidents. Le contexte de vie contraint, encadré par des règles de fonctionnement renvoyant à la vie en collectivité, collectivité de « vieux », impacte le processus de socialisation de la personne âgée. Vivre en maison de retraite, c’est un changement socio-culturel radical. D’ailleurs, exercer en maison de retraite pour les professionnels de santé relève d’un travail sur la posture et l’identité professionnelles en raison du conflit entre les représentations de la vieillesse et les expériences vécues. Cela implique le développement de compétences liées aux savoirs relationnels. En outre, pour les étudiants en santé, faire son stage en EHPAD, c’est découvrir une institution qui est un véritable lieu de vie et de travail envisageable. Pour finir, l’EHPAD bouleverse les représentations de la vieillesse, ce qui questionne l’accompagnement de l’entrée en EHPAD discuté dans ce travail. / The ageing of the population is a challenge in terms of accompanying physical and / or psychic dependence of the elderly subject.An epidemiological study whose approach is multidisciplinary, and which uses the tools of anthropology by emphasizing the qualitative approach, conducted on ten retirement homes in France (Limousin and Reunion Island) was intended to improve knowledge about experiences of seniors and families of Alzheimer’s residents, students and healthcare professionals.To achieve this goal, socio-cultural representations / lived experiences of the study population were explored as well as the entry decision, daily life and care taken prescribed, perceived and actual in EHPAD (acronym for nursing home in French).Thus, the results show that the entry into accommodations structures is multifactorial and influences the adaptation strategies of residents. The forced living context, framed by operating rules referring to community life, the “old” community, has an impact on the process of socializing the elderly person. Living in a retirement home is a radical socio-cultural change. Besides, practicing in a retirement home for health professionals is a work on professional posture and identity because of the conflict between representations of old age and lived experiences. This involves development of skills related to relational knowledge. In addition, for health students, doing an internship in EHPAD means discovering an institution that is a real place to live and potentially work.Finally, the EHPAD upsets the representations of old age, which questions the support of the entry into EHPAD discussed in this work.

In Jordan, residential care institutions (RCIs) for children in conflict with the law are identified as various specialised state institutions which constitute a state formal response to youth crime, and specialise in taking care of children. This thesis examines the objectives of RCIs’ programmes for children in conflict with the law in Jordan, as they attempt to reduce offending by convicted children, and whether these objectives meet children’s needs, according to the view and experiences of children themselves (12-17 years). This study is based on qualitative methods, using data from individual and focus group interviews with institutional staff, and participant observation and individual interviews with children. Exploring the divergent claims made within childhood and youth crime theoretical perspectives, this thesis develops a nuanced understanding of institutions’ crime-reduction programmes by drawing upon key theoretical concepts from these frameworks: children as ‘socially becoming’ and ‘social beings’. RCIs provide four rehabilitative programmes to help reduce children’s problematic and offending behaviour; namely, a family guidance programme (FGP), a poverty reduction programme (PRP), an educational programme (EP) and a child behaviour modification programme (CBMP). To a large extent, these programmes tended to provide polices of crime prevention which focus on re-socialising children according to the normative and cultural system of behaviour in which children were generally perceived as incompetent social actors, and where their best interest was not always acknowledged. To a large extent, children’s own perspectives and experiences of institutional rehabilitative programmes revealed the institutional failure to treat their familial, economical, educational and behavioural problems. Overall, children thought such failure happened either because the institutional aims were not actually implemented, or because the methods of delivering the institutional programmes per se were ineffective. This finding reflects a contradictory picture between the RCIs’ objectives and their actual practices, reflecting the institutional departure from a set of theoretical ideas regarding the prevention of youth crime. Focus group discussion with key informant staff referred to a variety of obstacles that contribute to their inability to address children’s wider needs within the existing institutional aims. Parental refusal to participate in child abuse and supervisory neglect interventional sessions, short-term intervention for chronically abused children and institutional reliance on talking methods in promoting parental supervision over children’s behaviour were all issues hindering effective institutional intervention within the familial environment. The institutional failure to meet children’s educational and career training needs occurred because these programmes are scheduled at the same time. The seriousness of some children’s crimes and the inability of some families to accompany their children to school were other issues preventing children from attending school. The lack of staff motivation, along with staff’s interrelated roles, prevented child monitoring staff from fully carrying out the intended intervention of modifying children’s negative behaviours. Ultimately, the findings from this study indicate the inconsistency between RCIs’ principles of rehabilitating children in conflict with the law and their actual practices, including the lack of policies in place to meet the institutional objectives. This in turn meant that RCIs do not actually operate to rehabilitate children in order to reduce reoffending, but are largely punitive and operate to criminalise children and separate them from society.

Care transition, the process of moving from community care to residential care, is one of the biggest changes that older people can experience in their later life. Evidence from the literature suggests that older people's experiences of care transition tend to be negative and traumatic, with most of them being little involved in the process of care transition. How older people exercise choice during the period of care transition is important for understanding their experiences of care transition for the following two reasons: first, choice has been referred to in the literature as the key to less stressful care transition experiences, which can subsequently lead to a better quality of life in residential homes; second, the introduction of choice in public services has been the key plank of British social policy in recent decades and there has been a movement towards extending choice in residential care. This research aims to study older people's care transition experiences and their exercise of choice during the process of care transition, to explore the meaning and the perceived effects of choice and to identify the role of choice in promoting a positive care transition. This thesis presents findings from 48 in-depth interviews with older people who became new residents in one of the ten participating residential homes in London and had their care paid for by the local authority. This research identified four groups of older people who showed marked differences in terms of their needs, their exercise of choice during the care transition process and their adaptation to residential care: Active Planners, Conformists, the Unsettled and Shelter-Seekers. The findings from this research suggest that the older people's care transition experiences varied and that they stretch beyond the prevailing evidence emphasising the stressfulness of the care transition. The cases of Active Planners and Shelter-Seekers show the potential for positive roles for care homes in the case of users with genuine needs for residential care. An overwhelming majority of the older people who were interviewed were great proponents of choice and many of them actively exercised choice in the course of their care transition. This challenges the claim of the passivity of older people which has been argued in the literature. However, the cases of some Conformists who did not want to exercise choice also highlight that having no choice can be a choice for some older people. On the whole, older people’s exercise of choice played an important role in facilitating a positive transition, despite it not being a precondition for such a transition. However, there were administrative issues limiting the level and the extent of choice that were available to the older people and the Unsettled experienced an undesired move into a care home, having their choices denied or rejected. This thesis also questions the working of choice and competition in residential care, as the older people did not seem to enjoy the expected benefits of choice relating to service improvements which have been argued for in the literature.

This thesis is an examination of the definition and implementation of ‘good practice’ in residential care for senior citizens. The central contention is that ‘good practice’ is a term that has been variously defined. Different groups define it in different ways, and their definitions have changed over time. This reflexive qualitative study explores ‘good practice’ in local authority, voluntary and private residential care homes in Scotland from the perspective of policy, practice and the experience of senior citizens who live in them. The study is based on analysis of policy documents, historical studies, and reanalysed interview and survey data from two earlier studies conducted by the author and colleagues. The thesis shows that the notion of ‘good practice’ that emerges in policy and practice documents is a confused and often conflicting set of ideas. Historically, the earliest were driven by concerns over cost. In more modern times, statements about ‘good practice’ have had a more benevolent intent but are frequently flawed by paternalistic and ageist assumptions. It is shown that staff in residential homes typically adopt a different set of attitudes: their preoccupation is with safety and the avoidance of risk. Although benevolent in intention, these interpretations of ‘good practice’ are also at variance with what residents themselves actually want. Two particular models or styles of care are examined in detail. One of these is the use of ‘keyworkers’, often implemented in ways that fail to realise its potential. The other is the ‘hotel’ model of care. The potential of this model as an alternative to the statutory model is explored. The thesis concludes that it is a model that can realise the goal of enabling residents to exercise independence, choice and privacy while meeting their needs in residential care.