A long-term residential care facility is a complex socio-political milieu where people from diverse backgrounds come to live, visit the residents and work together. Changes in the basic local support networks of the elderly suggest that there will be a growing number of elderly people seeking entry to long-term residential care facilities in Hong Kong. The quality of life for such residents has been shown to be related to the quality of the relationship they maintain with family members and with the staff. The purpose of this research is to provide empirical data and theoretical understanding of this “care triad” in the context of residential care facilities in Hong Kong. The study will describe and analyse the pattern and dynamics of the interaction between the elderly residents, their family and the staff with a view to informing professional practice and enhancing quality of care for residents.
The theoretical perspective guiding the study was informed by post-colonialism, post-colonial feminism, symbolic interactionism, intersectionalities and Foucauldian epistemology. The method of inquiry adopted was Charmaz’s strategy of grounded theory, which allowed for a constructionist inquiry of the taken-for-granted triadic relationship that exists between residents, family and staff.
Following eight months of observation conducted in a facility for 294 elderly residents with varying levels of dependency in Hong Kong, a purposive sample of seven triads was identified on one floor accommodating ambulant independent and frail aged residents. Field work consisted of approximately 218 hours of participant observation and 31 interviews with administrators, family members, residents and staff conducted by the researcher.
The findings from this study are discussed under three key themes. First, an empowered citizenship emerged in this setting that generated three distinctive care triads, namely the resident-driven triad, the family-driven triad and the staff-driven triad. In the resident-driven triad, the elderly residents expect family and staff to conform to their opinions and ways of doing things. In this type of triad, the residents struggle with their desire to retain acknowledgement of their identity and maintain their own independence in the face of institutional expectations of conformity and their own failing abilities. In the family-driven triad, family members reconstruct their sense of identity as a consequence of role changes and taking on new tasks formerly not performed by them. In the staff-driven triad, the residents’ individual preferences and needs are subordinated to the rules of the institution. The residents appear to be willing participants, believing that the staff should be in charge and will help them to meet their needs. The residents are obedient and compliant, while the staff member enacts a traditional hierarchical relationship. Second, the impact of a tripartite engagement in care had important consequences for the relationships between residents, family and staff. Third, conscious alliances emerged in the relationship, fostering the development of a “third space” in the dynamic care triad. All of these themes were underscored in the situational reality by external factors, such as medicalisation of care, relations of power, and discourses being influenced by the perceived frailty and vulnerability of the elderly, which are ultimately played out in day-to-day interactions between those who live in the facility, visit the residents there and work there. The study recommends that a constructionist inquiry of the triadic relationship needs to be continued to further examine the issues raised in this research. Scholars in the field of gerontology, particularly modern gerontology, are positioned to continue to challenge the discourse of the ageing identity and the threat this constitutes for those who live, visit and work in long-term residential care settings and in society more generally. Fostering consciousness about this discourse requires fundamental changes in the way ageing is viewed. Furthermore, all stakeholders of the care triad need to reorient themselves towards relational care. In a setting such as long-term residential care, relational care occurs in the form of a conscious alliance. The development of the “third space” that is fostered in these triadic interactions provides opportunities for the development of participatory, inclusive communities for the diverse populations that live, visit and work in the long-term residential care facility.