Increasingly, old people in India are moving into institutional settings. There is a paucity of qualitative research examining the condition of residents in care homes. This thesis addresses this gap through a detailed qualitative study of three such homes in Goa, India. It explores the care processes and practices in the care homes and how far they are attuned to the needs, lives and identities of their residents. An understanding of the experiences of residents as they have been undergoing different stages of entering and settling into a residential care setting has been the main focus of the research, which illuminates the context in which resident experiences were embedded. The thesis explores the process of institutional living: the conditions (losses and changes) that lead older people to enter institutional care; the losses and changes incurred while entering institutional care; the paradox between induced dependencies created by institutional control and structures resulting in passive compliance; and the struggles of the residents to resist these power structures. In documenting life for the resident in the care homes the thesis shows that their subtle daily forms of resistance exist within a framework of power. The final empirical chapter discusses how residents experience different forms of departure, whether as ending this struggle or beginning a new one. Data were collected through a combined ethnographic methodology of participant observation and semi-structured interviews with residents, staff and management over an eight-month period, in addition to a scoping survey of 37 care homes in the State. The study retrospectively examines residents’ experiences during various stages – pre-entry, entry, post-entry and exit – of their residential career, the drivers and constraints during these stages, and the role of staff and management in contributing to these experiences. These are presented as narratives – interleaved stories highlighting (some) important aspects of life in care homes in Goa. I have included the various responses made by residents to the different stages of their residential career – their ambivalences as well as their certainties, their anger as well as their passive acceptance, their dependence as well as their agency – and to interpret residents as sometimes vulnerable, sometimes invincible, and sometimes struggling. In doing so, I have provided insights into the ups and downs of life in care homes in Goa, through exploring paradigms that were crucial to residents’ lives in my study. These insights reveal that the dismantling of residents’ individual autonomy and control occurred prior to their coming into the institution. Once inside the care home, their lives were further altered by rules, routines and practices of staff and management. The resident’s identities thus were increasingly being defined by the institution. The findings further revealed that residents do not always accept passive dependency but instead struggle to carve their own identity within the institutional settings and controls they are subjected to. Finally, my findings reveal how perceptions and preparations for departure from the institution are coping mechanisms used by the residents and the staff alike, as extensions of their struggle for survival, freedom, and control. These findings lead to a greater understanding of how different processes are intertwined in residential careers for residents in care homes in Goa. The findings invite a rethinking of conceptions of autonomy and ageing, passive compliance and agency, and departure and coping, particularly within the context of institutional living in Goa. This study has thus illustrated the mechanisms in place for older people entering, settling and leaving care homes in Goa and demonstrated whether these mechanisms are adequately suited to their needs. The hope is that this understanding will contribute to the development of improved policy and practice that better reflects the needs and wellbeing of older people.

No description available.

Thesis (Ph.D.)--Wayne State University, 2007. / Adviser: Gail A. Jensen. Includes bibliographical references.

Thesis (Ph.D.)--University of Texas at Arlington, 2009.

Thesis--University of California, San Francisco. / On spine: The Status passage of elderly persons. eContent provider-neutral record in process. Description based on print version record.

Thesis (Ph.D.)--University of Delaware, 2008. / Principal faculty advisor: Robert Warren, School of Urban Affairs & Public Policy. Includes bibliographical references.

Thesis--University of California, San Francisco. / On spine: The Status passage of elderly persons. eContent provider-neutral record in process. Description based on print version record.

In Scotland, as in many other welfare states, the organisation of care homes for older people takes place in a highly contested space where debates about demographics, limited financing and changing expectations of the state compete with questions about choice, rights, equality and models of care. These services intersect the formal boundaries of the public and private sectors as well as the lines between public and private life. The production of care home services crosses several policy spheres, including local governments, the devolved Scottish administration and the UK government and includes numerous organisational bodies, such as care home providers, the care regulator and the voluntary sector. At the centre of this intersection lies the work of contracting and the production of a national framework agreement for care home services in Scotland called the National Care Homes Contract (NCHC). This contract is both the bridge between the public and private sector and a formalised link between the individual and the institution. In this thesis, I depict the NCHC document as an artefact which links these spheres and the work of contracting as the practice of maintaining that relationship. I take up the concept of boundary objects and suggest that the NCHC functions as a bridge between multiple fields of practice and is a useful tool for understanding the competing perspectives of people who plan and deliver care home services in Scotland. In this thesis, I reveal the different, and at times competing, perspectives which surround care home services for older people and the stabilising work that is undertaken to manage these differences. This research utilises an interpretive approach to examine the creation and ongoing implementation of the NCHC. Fieldwork for this research was conducted over 12 months and includes interviews with local authority planners and contract managers as well as care home owners and managers from the independent and third sector, each of whom do particular kinds of work to create, implement and use the text. A textual analysis of the framework agreement is also used to support this research. I examine the work of making, re-­‐making and using the NCHC at three levels: national policy actors, local government contract managers, and managers of local care homes. Each group undertakes a kind of policy work: first to create the NCHC, then to implement it in local jurisdictions and finally to use it within local service delivery. Stabilising work takes three primary forms: text work designed to stabilise meaning, relational work designed to translate meaning across boundaries of practice, and ethical work, a value-­‐ based emotional work that underpins the first two kinds of everyday labour. I suggest that this work is first and foremost driven by a need to stabilise the care home sector and that it is deliberative in nature and conflict ridden such that the use of the contract in practice is often resisted. In working to stabilise this system, the values of this work come into conflict – triggering both caring and resistance responses within the sector. In giving an account of stabilisation, I provide a micro-­‐sociology of the meaning making, relationship-­‐building and conflict which underpins policy work. I draw conclusions from this about the discretion of policy actors at all levels of the system, the rational-­‐technical and emotional nature of their work, and the unexpectedly deliberative policy space of contracting in Scotland.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.

The purpose of this study is to explore the eldercare managers' descriptions of their work situation, and through our research, reach a comprehesive view of the managers discretion in the municipational eldercare system in Sweden. Our questions in focus are: In what sense do the managers feel that laws, guidelines and objectives control their decisions? In what sense do the magangers feel that colleagues influence their decisions? How do the managers experince that superior managers and politicians influence their decisions? The essay is based on semi-structured interviews, with six different managers in the eldercare, from three different municipalities. We have made a questionnaire as a tool for our interviews, so that no questions were forgotten during the interview sessions, (with a few additional follow up questions). We analyze our results by using DiMaggio and Powell theory; we have chosen to work with two of the isomorphisms, in order to show how the managers relate to the organisations. We are also using Lipsky’s theory of street-level bureaucrats and their professional discretion, to see the manger from the other perspective; as an individual person in the organisation. Our results and analysis indicates that managers in the eldercare have a wide ability to control and shape their discretion. The factors, which control how the managers form their discretion, are laws, guidelines, goals, colleagues and superior management levels. These factors are largely interpretable, which gives the managers a wider possibility to shape decisions based on the existing guidelines and framework. The study shows that the most limiting factor to constrain the discretion is the financial resources.