~ Written in memory of my PhD supervisor, Dr. Robert (Bob) Rubinstein ~
Ascribing meaning to one’s home has been considered integral to the development of a sense of self and personhood. Developing a positive sense of home is particularly important in later life (Rubinstein, 1989; Rubinstein & de Medeiros, 2005). The home has been described as a place of freedom, where we can be ourselves, where we have some control over our belongings and our time. Consider this: When you’re sick and not feeling well, where do you want to be while you recover? My guess would be your home, in your bed, or on your couch—somewhere where you’re comfortable with maybe a loved one nearby making soup.
In residential care, there has been a slow, yet vocal movement to augment the sense of ‘home’ that residents feel in these settings. There are initiatives to make residential care home-like by allowing residents to bring in personal belongings, hang photos and artwork that is familiar, and giving residents more control over how their meals and activities are structured throughout the day (Cooney, 2012). The importance of relationships in creating a home-like environment within institutional settings was emphasized in interviews with residential care staff that my colleagues and I conducted (Canham et al., 2017). A sense of home was felt when interpersonal relationships developed between residents and staff who cared for them day-in and day-out. However, against the backdrop of a highly regulated managed care paradigm, attempts to make residential settings more home-like have not been without challenge.
While there are challenges in creating home-like residential care settings, it is being acknowledged–which is light years ahead of discussions surrounding older adults experiencing homelessness. What, can we estimate, is the meaning of home for older persons who are living in precarious housing situations or who are experiencing homelessness? What sense of freedom and control do older adults living in vulnerable situations experience? Burns (2016) has rightly asked the question of what ‘place’ means to older adults who are staying in shelters and, similar to research in residential care and elsewhere, has found that control, comfort, privacy, and security are key to a sense of place. These data beg the question of how different the experience of staying in homeless shelters from the experience of living in residential care is; can either setting truly fulfill an older adult’s needs for meaning and personhood? How can these disparate settings and bodies of work lean on one another to better serve our most vulnerable older adults?
In partnership with the Homelessness Services Association of British Columbia and Providence Health Care, I am involved in research that is examining the health and psychosocial support needs of older adults who are experiencing homelessness. We’re finding that there are unique vulnerabilities for older people experiencing homelessness; that general population shelters are inappropriate for older adults following hospital discharge; that there is limited availability of shelter or housing settings for older adults who have complex health and social needs; that shelters and housing need to be tailored to older adults experiencing both first-time and chronic homelessness; and that community supports are needed for older adults upon discharge from hospital (Canham et al., 2018). These findings, again, point to the importance of relationships in meeting the needs of older adults, though described in homelessness sector jargon as ‘case managers.’
Arguably, relationships are key to both a sense of home (Sixsmith, 1986) and to successful service engagement; therefore, should we not be advocating for increased supports (e.g., appropriate education and pay) for a workforce—of both case managers and care staff—who can walk alongside our elders as they navigate their later years? Have we asked what role case management could have for older adults in residential care? Or, conversely, what role healthcare staff could have for older adults in homeless shelters?
At the crux of what all older adults need is a place to call home—a place where they feel safe and comfortable, where they can express their true identity, where they can rest and recover from illness, where they can attach meaning and build a sense of place. This freedom has largely been stripped from older adults who are living in precarious housing situations, who are experiencing homelessness, and those who have moved into residential care settings that are not focused on person-centered care. As we continue to build person-centered ideologies into our institutional settings, we should also be promoting culture change in the treatment of older persons experiencing homelessness. One avenue for moving forward could be in the building of a workforce that respects and dignifies the lived experience of older adults regardless of their housing status.
Burns, V. F. (2016). Oscillating in and out of place: Experiences of older adults residing in homeless shelters in Montreal, Quebec. Journal of aging studies, 39, 11-20.
Cooney, A. (2012). “Finding home”: A grounded theory on how older people “find home” in long-term care settings. International Journal of Older People Nursing, 7, 188-199. doi:10.1111/j.1748-3743.2011.00278.x
Canham, S. L., Battersby, L., Fang, M. L., Sixsmith, J., Woolrych, R., & Sixsmith, A. (2017). From familiar faces to family: Staff and resident relationships in long-term care. Journal of Aging & Health, 29(5), 842-857. doi: 10.1177/0898264316645550
Canham, S. L., Davidson, S., Custodio, K., Mauboules, C., Good, C., & Bosma, H. Health and psychosocial needs of older adults who are experiencing homelessness and being discharged from the hospital. Manuscript in preparation.
Rubinstein, R. L. (1989). The home environments of older people: A description of the psychosocial processes linking person to place. Journal of Gerontology, 44(2), S45-S53.
Rubinstein, R.L., & de Medeiros, K. (2005). Home, self, and identity. In G.D. Rowles & H. Chaudhury (Eds.), Home and identity in late life: International perspectives (pp. 47-62). New York: Springer.
Sixsmith, J. (1986). The meaning of home: An exploratory study of environmental experience. Journal of Environmental Psychology, 6, 281-298. doi:10.1016/ S0272-4944(86)80002-0