Spheres of the Elderly: Interpreting the Lives of NRC Residents
by Laurie Moberg
St. Olaf College, Northfield, Minnesota
Abstract
In gerontological studies, many have investigated aspects that
contribute to quality of life in elderly constituents. Living
environments are reorganized according to suggestions from these past
studies and the needs and desires of the elderly population. Yet
fewer studies exist as analyses of how people negotiate their lives in
these new frames. This study strives to understand elderly
residents’ perceptions and construction of quality of life manifested
in the interplay of social, physical, personal, and spatial spheres of
their lives in a facility providing a continuum of care. This
particular research reflects these perceptions as interpreted by
residents at the Northfield Retirement Community. Using a
semiformal interview schedule with questions referenced to explore
quality of life, this study reflects the insights interpreted from
fifteen interviews with sixteen people in the Northfield Manor,
Northfield Parkview West, and Northfield Parkview East
residences. All in one complex, the Northfield Retirement
Community, I interpret that residents from the independent and assisted
living organize their lives in concentric spheres of influence from
their core personal sphere to interaction with the greater community
beyond the retirement community.
Setting
The sample population included current residents of the Parkview East,
Parkview West, and Northfield Manor sections of the Northfield
Retirement Community (NRC). The NRC is a retirement facility
offering a continuum of care from independent living in Parkview West
and the Northfield Manor, to assisted living in Parkview East, to
nursing care in the Care Center.
Problem
As people live longer lives in greater health, the composition of
retirement communities has altered. Now accommodating more
independent lifestyles, these locations intentionally bring an age
cohort into physical proximity. In the new symbolic social spaces these
residences create, they help determine how residents reframe their
experiences.
Methodology
Using a semi-formal interview schedule, the researcher asked residents
to reflect on aspects of quality of life in the NRC to gain an
understanding of how the residents interpret their lives in this
retirement community.
Observations
§ NRC residents organize their experiences as a
dynamic interplay with the social constructs of the symbolic
environments into concentric social spheres
o The core sphere situates largely within residents apartments
o The secondary sphere involves interaction with people within their wing of the NRC
o In the tertiary sphere, residents explore the symbolic frame of the NRC as a whole
o The fourth sphere integrates the elderly residents with the larger community
§ In this framework, each sphere is bounded and
semi-permeable. Movement between spheres is not merely dependent
on the will of the resident, but shares a dependency on the social
structures that either obstruct or encourage flow.
§ Individually, interactions in each sphere stem
from a series of choices. Residents enact control over their
lives and contribute to the construction of their symbolic space
through these choices
§ Each of these spheres fosters distinct
patterns of interaction and nourishes the elderly in different
ways. In this way, the spheres are all uniquely useful and
beneficial to the well-being of the elderly constituents.
Synopsis
Amidst the dynamic organization of life experiences in a retirement
community, variations in care, individual choices, and social
interactions connote more than simply the quality of life, but provide
a framework for the process of aging.
Spheres of the Elderly: Interpreting the Lives of NRC Residents
Abstract
In gerontological studies, many have investigated aspects that
contribute to quality of life in elderly constituents. Living
environments are reorganized according to suggestions from these past
studies and the needs and desires of the elderly population. Yet
fewer studies exist as analyses of how people negotiate their lives in
these new frames. This study strives to understand elderly
residents’ perceptions and construction of quality of life manifested
in the interplay of social, physical, personal, and spatial spheres of
their lives in a facility providing a continuum of care. This
particular research reflects these perceptions as interpreted by
residents at the Northfield Retirement Community. Using a
semiformal interview schedule with questions referenced to explore
quality of life, this study reflects the insights interpreted from
fifteen interviews with sixteen people in the Northfield Manor,
Northfield Parkview West, and Northfield Parkview East
residences. All in one complex, the Northfield Retirement
Community, I interpret that residents from the independent and assisted
living organize their lives in concentric spheres of influence from
their core personal sphere to interaction with the greater community
beyond the retirement community.
Introduction
The promise or trepidation of life in a retirement
community comes to mind as people age. As physical capacity
declines or mental health falters, elderly people begin to assess these
facilities as an option for security as promoted by American
society. Yet “the nature of a communal experience represents a
significant change for most people” (Powers 1995: 191). Whether
illuminated or shadowed on the horizon, these communities exist to
serve the needs of potential residents.
Yet the character associated with each different
facility stems from the symbolic environment cultivated through social
structures and social interactions. Often retirement communities
endure the negative societal stigma of “institutionalizing”
inhabitants. Bethel Ann Powers suggests “it is the homogenizing
effect of institutions that belies the heterogeneity of residents by
dealing with them in a fairly uniform manner” (1995:192). Through
the community practices, this sense of institutionalization
persists.
Aware of these connotations, the Northfield
Retirement Community actively resists this label. From physical
design to social structures, this facility strives to foster an
environment of homey comfort on the opposite end of the spectrum from
the “institutional” model. Organizing their lives amidst these
unconventional frames, residents contribute to the social spaces that
promote a soothing sense of comfort and contentedness. Unwavering
in the pursuit of a facility the antithesis of “institutional,” the NRC
has created a space of pleased residents unchallenging of
organizational structures. Instead, the residents immerse
themselves in the symbolic spaces and frames that provide them
happiness in the heart of Northfield.
Setting
A town of over 17,000, Northfield occupies a space somewhere between a
suburb and a rural township. Thirty-five miles south of the Twin
Cities metro area, the town becomes a revolving door for many commuters
in and out to a wide variety of white and blue-collar work.
Providing opportunities for both managerial positions and manual labor
employment, Northfield is home to the Malt-O-Meal Cereal Company and
McLane Minnesota distribution center. These corporations employ
over 1000 workers combined from Northfield and the surrounding
area. Sheldahl, a company that used to thrive in the industrial
engineering and innovation market, is steadying its place in the
Northfield economy, shifting its niche in the market primarily to
communications technology and small circuitry products. Even
amidst these product changes, Sheldahl employs 450 people locally.
So close to the Twin Cities, Northfield’s connection to corporate
franchises also provides many service and management positions.
South of town, Northfield annexed property to allow Target, Cub Foods,
and suburban strip mall facilities to build and increase the town’s tax
revenue base. Bringing these facilities in stirred heated debate
and a polarization of perspectives between those interested in moving
forward with such investments and a second sector striving to maintain
a thriving downtown filled with independent merchants that might suffer
with the presence of these corporate chains.
The main business district has suffered from these influences.
Amidst these large employers, Northfield also boasts a tradition of
entrepreneurs with independently owned small businesses lining the
streets of downtown. From the Cocoa Bean, a local candy store, to
the Tavern Restaurant, to the Rare Pair Inc. clothing store, to the
Scandinavian Marketplace, small business owners nestle their shops into
the historic buildings of Division Street, Northfield’s business
epicenter. Recently, two long-term businesses folded under the
weight of this competition – Petricka’s, a locally owned and operated
grocery story, and Jabobsen’s, a 20th century version of a general
store. Yet others continue to thrive.
While the businesses have adjusted to fit the needs and wants of the
modern public, the buildings profess the quaint charm of the
past. The Northfield Chamber of Commerce website boasts that the
town is “a unique blend of the historic, the progressive and the
creative.” Northfield upholds its historicity as an emblematic
value without denying the contemporary. Buildings are remodeled
and refurbished rather than demolished. Northfield even
capitalizes on the allure of the past with the annual Defeat of Jesse
James Days town celebration honoring local Joseph Lee Heywood killed in
the attempted raid of Northfield’s First National Bank in 1876; the
original bank building is now a museum operated by the Northfield
Historical Society. The four days of festivities draw crowds from
around the nation to see reenactments of this famous last raid for the
James-Younger gang.
Amidst this historical richness, three of the town’s largest employers
are educational facilities each with their own continuing
histories. With over 2000 employment opportunities in
Northfield’s educational institution, the emphasis on learning is
apparent. The Northfield School District offers 500 of these
positions and it is growing. In 2001, a school bond referendum
passed, raising property taxes to allow the city to build a new middle
school. Carleton College, a four-year liberal arts college on the
East side of the river, boasts wide national acclaim as an institution
of distinguished academic rigor. St. Olaf College, while drawing
more heavily from a regional pool of students, is similarly a four-year
liberal arts college is highly regarded for its music program as well
as its organization of travel abroad experiences. St. Olaf
provides “an education committed to the liberal arts, rooted in the
Christian gospel, and incorporating a global perspective” according to
the institution’s mission statement (“President’s Office”).
As a long-term resident of the Northfield community and as a student of
this college, the background of St. Olaf bears great importance to my
research. A residential campus of nearly 3000 students
representing 49 states and 20 countries, St. Olaf employs 860
people. The size of a small community itself, St. Olaf began over
125 years ago and has since left a lasting impression on the community
and its inhabitants. I became an ambassador of the college as I
visited the Northfield Retirement Community to conduct my
research.
Coming into Northfield on Cedar Avenue, a driver may scarcely notice
the Northfield Retirement Community (NRC) concealed in its own cove of
woods on the outskirts of town, just down the hill behind St. Olaf
College. In its neutral beiges and brick, the four-sectioned
campus is scarcely visible from this angle. Yet since 1969 this
facility tucked into the landscape has housed hundreds of elderly
people with varying abilities and health related needs. To
provide for these needs, the NRC is woven into a nonprofit corporate
sphere. The parent corporation, Lutheran Home of the Cannon
Valley, consists of nineteen member churches. Fifteen of these
churches have members who serve on the board. This corporation is
a non-revenue producing entity that owns the undeveloped land
surrounding the NRC including the wooded areas that shelter it.
Furthermore, they are responsible for the Northfield Retirement
Community – the actual building facility. Under this umbrella are
the five main sections – Northfield Care Center, Northfield Manor,
Northfield Parkview East and West, and as of May 1, 2004, the Cannon
Valley Suites. The campus is arranged so that all these sections
are connected through enclosed hallways, but each is a distinct spatial
entity. In a convoluted “I” formation, Parkview East and West are
at the south end of the “I” with a long hallway linking them to the
Care Center and the Manor at the northeast and northwest corners,
respectively. The Manor is five floors of single hallways.
The other three sections are large circuits; by following the internal
wall of any space, one can wrap and wind through back to the starting
point. In the Care Center, this is especially confusing as it is
broken into three smaller sections – the Bluebird Unit, the Cardinal
Unit, and the now restructured Cannon Valley Suites. Still, the
circular nature is similar in each. Below is a map to clarify the
floor plan. Each section is spatially distinct and serves
different needs. The only spaces that are overtly shared are the
administrative office space and the chapel, which doubles as a
community room.
Combined, the sections of the NRC offer a continuum of care. The
Care Center is a skilled nursing care facility certified under the
state plan for medical assistance and serving people since 1969.
As such, it provides twenty-four-hour nursing services, medication
administered by licensed staff as prescribed, three meals according to
dietary needs, housekeeping, laundry and linen services, and activities
to encourage social interactions. According to the Minnesota
Department of Human Services, the Care Center meets these criteria in
providing quality care designed for “the physical, social, and
psychological needs of elderly and handicapped persons”(“Northfield
Retirement Community”). This area of the NRC is for those least
able to function independently in the larger society and least able to
care for their own daily needs.
In recent years, however, people have become increasingly aware that
many elderly people do not require this much care and may actually feel
demeaned by these services based on a medical model of care. In
response, there has been a rise in Assisted Living Facilities (ALF) and
Continuing Care Retirement Communities (CCRC) as alternative residences
for the elderly. These tend to be modeled on social care (Kahana
2000: 1663). The NRC aspires to both of these standards.
Beginning with the Manor 1981, and the subsequent additions of Parkview
in 1994, 1997, and 2001, the NRC added both independent and assisted
living to its offerings. Each area has its own dining room
providing meals for the section residents and any guests they register
in advance. Parkview West and the Manor also each have a coffee
shop/convenience store. While both are open to all residents, the
Manor is further away for most people and has more limited hours and
products. As such, the West store is used by residents from to
all sections of the building. The salon and barbershop in East
are also available to everyone as the only sites for this on
campus.
Parkview East is an assisted living facility (“Northfield Retirement
Community”). ALFs feature an apartment environment allowing
privacy and independence. Simultaneously, they offer varied
services such as housekeeping, transportation, and meals as well as the
promise of at least minimal access to medical care if necessary
(Johnson 2003: 428). Parkview East, specifically, offers
independent apartments with kitchen and bath as well as community
activities and events, three-meal service provided as part of the
renter’s monthly payment; additional services include a convenience
store/coffee shop in West, beauty salon and barbershop, van service
into Northfield, and the option of licensed home-care services for
housekeeping, laundry and personal care (“Northfield Retirement
Community”). Each of the additional services requires some
payment just as if going to a salon or grocery store in town.
East, as staff and residents abbreviate it, is staffed with at least
one aid twenty-four hours a day as well as an RN forty hours a
week. These staff members help ensure that residents take the
right medications, come to meals, and are aware of activities happening
each day. The RN in particular can offer some assistance with
illnesses and regularly offers blood pressure screening.
Parkview West is a two-story independent living facility offering one-
and two-bedroom apartments designed for self-sufficiency and
comfort. The residents pay for the rent of the apartment, with
the cost varying by the size, a storage unit in the building, and five
meals a month in the common dining room. Other services are
available for a fee including a garage, van service, salon and
barbershop, convenience store/coffee shop, and options for cleaning and
laundry service (“Northfield Retirement Community”). Equipped
with an elevator for handicapped accessibility, this wing of the NRC
also has several gathering spaces including a community room with two
internet-access computers.
The Manor is also an independent living facility, a five-story
apartment building designed for self-sufficiency. Recent
attention has been given to updating the facility – changing the
windows, painting, replacing the flooring as apartment occupants change
– to ensure that this section of the building matches the high quality
and fresh appearance of the other wings. This setting differs
from West not only in the age, but in the particular audience it
targets; Manor housing extends the option of rent subsidies through HUD
thus drawing a lower income crowd than West apartments. Through
HUD, rent is based on a tenant’s income rather than an inflexible flat
rate. Still, it is equipped with most of the same
amenities. In the first year of living in the Manor, residents
are required to eat meals in the Manor Dining Room. Other
services include the coffee shop in the Manor basement, salon and
barbershop services in East, van services, community spaces, and
options for cleaning, laundry and personal care services.
While both independent living facilities, Parkview West and the Manor
both also have access to nursing staff and care if necessary.
Apartments in all three wings and the nursing care area are equipped
with two urgency call cords in the bathroom and bedroom. Since
the campus has staff on duty at all times, these cords help ensure that
residents will be taken care of should they need assistance. This
offers a primary difference between living in a continuing care
retirement community and living independently. In a CCRC,
residents are offered tiers of care according to their functional
needs.
As a CCRC, the NRC is responsible for providing this tiered system of
care from independent to assisted to nursing care living as
promised. These “life-care facilities” are retirement campuses;
depending on the policy, residents enter a life-care contract and live
in housing ranging from independent living to nursing homes (Johnson
2003: 428). As residents’ mental or physical health declines,
they transfer to different on-campus housing that provides a greater
level of care (Johnson 2003: 428). These options strive to ease
the transition to alternative housing. At the NRC this is not
facilitated through a designated contract but moves are made according
to needs. Housing and Social Services staff for the three areas
coordinate applications and movements so that in-house needs are met
before new residents from the outside are offered housing.
Each of these housing and care distinctions follows the guidelines of
government policies. At the state level, retirement communities
like the NRC are facing massive budget cuts and policy demands.
As a result, the NRC has re-labeled the care provisions for one section
of the Care Center. The Cannon Valley Suites section used to be
another branch of nursing home beds, but under the most recent policy
guidelines, the NRC could not afford to provide skilled nursing service
to this area. They therefore decreased the number of nursing home
beds in the facility and added the Suites as a fourth tier of care,
somewhere between nursing care and assisted living. According to
legislation, this reconfiguration is irreversible; the beds can never
again be nursing home beds unless the policies change once again.
The effects of this alteration are at present undetermined.
While the arrangement of the NRC contributes to residents’
interpretation and appreciation of their social environment, my
research emphasizes only residents in ALF and independent living spaces
– Parkview East, Parkview West, and the Manor. The design of each
space offers similarities. The hallways of each have plushy
carpeting in shades of blue, teal, deep rose, and deep purple. In
contrast to the tile floors, this alleviates the sense of being in an
institution. The walls are painted in neutral tones of beige and
cream. Darker patches frame the doorways, the paint in shades
complimenting the carpet tones. Each doorway has a small alcove
of color and a small shelf beside the door. In Parkview East and
West, these alcoves are larger and the shelves durable as a planned
part of the Parkview design. In the Manor, the shelves are classy
wood, but certainly additions made after the original design
intent. Outside every apartment, these shelves are decorated with
items that offer insight into the characteristics of the
inhabitant. Often the doors also have hangings making these
spaces outlets for personal expression. Inside, each apartment is
guaranteed a couple of outside windows. In Parkview, many face an
enclosed courtyard. In the Manor, the view overlooks either St.
Olaf or Bethel Lutheran Church.
Inside, however, the apartments differ drastically. East
apartments are the smallest. While they offer the amenities of a
kitchen, bed, bath, and living space, they are compacted into two rooms
and a bath. The kitchen and living area are sectioned off only by
the change in flooring in the main apartment space– from linoleum to
carpeting. The bathroom is accessible only through the
bedroom. The kitchen is fairly complete, often with a
nonfunctioning, half-width stove and oven, a kitchen sink, and a
refrigerator of varying sizes. Still, the space has multiple
rooms, two closets, kitchen cupboards, and plenty of open space for the
residents to arrange their own parcels of furniture and
decorations.
Manor spaces are a bit larger one-bedroom apartments. Like all
the apartments, the Manor is unfurnished, but with plenty of
opportunity for residents to bring their own favorite pieces to
function in the space. In these apartments, the fully equipped
kitchen is separated from the large living area by walls on all
sides. One wall has a doorway off the entryway, though no actual
door. The other wall has a slot opening between the counter and
upper cupboards. The window between the two spaces is useful but
prevents the kitchen from getting much daylight. The bed and bath
are down a short hallway opposite the kitchen.
Parkview West apartments are the largest and most varied. Two
bedroom apartments are the most sizable, with a long hallway, large
bathroom and pantry. One-bedroom apartments have two
styles. The first is simply a short hallway to the bedroom one
way and bathroom the other. Alternatively, these apartments may
have another den/dining space off from the central living space.
Demarcated by a corner pillar, the space opens on two sides but is a
distinct room. The fully equipped kitchen is similarly
partitioned with a half-wall on two sides and pillars to the ceiling at
the corners.
These dissimilarities may seem minor, but the residents occupy these
spaces much of the day and the spatial configuration contributes to
their sense of their environment and their perception of quality of
life.
These perceptions are further influenced by the presence and
configuration of social spaces. Each facility designates areas
for social interaction by providing tables and chairs, televisions,
computers, coffee break snacks, cards, games, and other amusements, as
well as sponsored activities. In my meandering through the
facility, the community spaces seemed mostly used for coordinated
events though occasional sociability occurs spontaneously.
These spaces become the living environment for these residents every
day. The qualities of their spaces, inside and outside the walls
of the NRC shape and organize their experience; they become the key
features that allow residents to identify their place, from apartment
2220 to the Milky Way. In so doing, these spaces become central
to how they understand and perceive their quality of life.
The Problem
Throughout the world, people view the elderly with
diverse perceptions. For some, they are wise sages; for others,
the support and care of elderly relatives becomes a social
burden. Across the spectrum, the care extended to the elderly
population varies. Communities and relatives can offer housing
and physical care in exchange for wisdom, teaching, and
connection. Alternatively, some elderly try to provide for
themselves without any dependency. While these options exist, one
of the most prevalent ideas spreading across the American landscape is
the establishment of nursing homes or retirement communities. As
“post-World War II phenomena,” these long-term care facilities function
as enclosed, age-specific institutions (Vesperi 1995: 10). With
this modern option available, American families and communities
struggle with the utilitarian decision: what living arrangement for the
elderly satisfies the most people involved? Yet beyond the family
situation, the elderly person faces a personal question: what
arrangement is best, most satisfying, least trying for me?
In light of the exponentially growing population of elderly, this
question is especially viable. According to the 2000 United
States Census, 12.4% of the American population is over age 65.
With the baby-boomer generation entering the age of retirement, senior
citizen discounts, and social security checks, the question looms: what
happens to Grandma and Grandpa if and when they become unable to care
for themselves? Whose responsibility is it to ensure them a
quality life? This question becomes increasingly prevalent as the
age of life expectancy rises; many people live long after retirement,
even long after they feel comfortable or can safely care for
themselves.
Often, responsibility for caring for the elderly rests on the next
generation of family members: children now grown and with families of
their own. This creates a complicated family dynamic.
According to Nagy’s theory, families operate through a generational
flow of giving: parents give to their children who willingly
take. When these children become parents themselves, they then
provide the same generous attentiveness to their offspring as an
“effective form of gratitude” to their parents (Plantinga 1995:
55). While Nagy’s intergenerational theory may seem like a simple
progression, it does not accommodate the climate of society.
Parents do not simply vanish with the presence of a third generation;
the roles simply adapt. When children incur responsibility for
tending to their parents as they age, this generational system of
giving and gratitude must alter. Nagy may consider this a
distortion of his pattern. Regardless, this reality illuminates
several new dimensions of interaction and concern. The question
of “how do we care for Grandma?” involves many parties.
It must also include a financial perspective. As these differing
viewpoints come forth, they must evaluate the cost of upkeep in an
independent home, the financial needs inflicted on family, or the price
of living in a retirement community. Each of these imposes
different monetary demands at different increments. Retirement
communities tend to have more predictable, regular expenses in contrast
to the surprise charges of maintenance living outside these
provisions. Yet the fee that enables this care and maintenance
may be extensive. These facilities also often provide channels
for government assistance that may not be available in other
forums. However, money is not the only facet directing this
complex decision. Instead, it is a balance of the needs and wants
and interests of all parties, most of all the elderly person
involved.
Weighing the possibilities, families, communities, and individuals
differ in determining what option serves their common objective to
provide quality care and living arrangements for their loved
ones. Many older people strive to stay in their own residences as
long as possible, accepting the kindness of community care. If
they live alone, this can isolate an aging person as much as a nursing
home; without adequate means and opportunities to exercise their
independence, they are merely housebound. Some elderly people
accept the provision of care and connection offered by their children
and move in with family. However, this can place an added strain
on relations as family members adopt the added role of exclusive
caretakers.
An alternative is to find facilities with paid caretakers: retirement
communities. Increasingly, the standard “nursing home” receives
an unfavorable public assessment. Staffed by licensed nursing
personnel, these facilities advocate a medical model of care.
While this study does not explore the dimensions of legislation
involved in the development of nursing homes, “Social Security,
Medicare, and Medicaid have not just enabled but actually promoted the
medicalization of old age” through the past decades by promoting
nursing home care through their economic channels of influence (Vesperi
1995: 10). Contrary to the pervasive negative views disseminated
in public discourse, these facilities are often “viewed as key
achievements of national social welfare policy” (Vesperi 1995:
10). Yet from an uninformed outsider’s perspective, retirement
communities become residences for frail and dependent populations, and
the presumably rigid routine of daily life in a small, shared room and
bath, induces a waning human spirit and the phenomenon of “learned
helplessness” (Kane 2001: 295). Nursing homes also often
incorporate special care units to meet the needs of mentally impaired
patients suffering from Alzheimer’s disease or other forms of dementia;
for those with sound mental capacities, this type of treatment is
unwanted (Johnson 2003: 430). Under the confines of this
legislation, care for the aged has “less to do with what old people
require to sustain their lives than with what society requires to
manage them, both physically and socially” (Vesperi 1995: 11). As
attention is drawn to this, older people and their families alike often
prefer to avoid this degrading environment (Kane 2001: 295).
In response, legislation is now shifting. Since the cost and
services of residency in a nursing home are predetermined by state
policies, legislation has the authority to dictate a price-freeze of
sorts: nursing homes are not allowed to charge residents more, but the
facility accrues extra costs simply to meet government standards for
provisions of care. In this way, the new policies discourage the
implementation of “nursing home beds” that require more staff and
services without money to pay for them. Indirectly, policymakers
then endorse alternative types of retirement communities by legislating
fewer economic and care restrictions on them.
These policies have created a rise in Assisted Living Facilities (ALF)
and Community Care Retirement Communities (CCRC) as alternative
residences for the elderly modeled on social care (Kahana 2000:
1663). CCRCs offer everything from independent living to full
nursing care on one campus. ALFs are often part of larger CCRC
campuses; they include minimal care provided by a series of aids and
access to a nurse. These types of facilities offer alternatives
for people striving to promote their own successful aging according to
their needs.
This study arises out of my interest for understanding how elderly
people understand and organize their experience as part of a continuing
care facility. More specifically, it strives to understand
elderly residents’ perceptions and construction of quality of life
manifested in the interplay of social, physical, personal, and spatial
spheres of their lives in a facility providing a continuum of
care. This particular research reflects these perceptions as
interpreted by residents at the Northfield Retirement
Community.
For the elderly as for most people, evaluations of aging relate to
interpretation of quality of life. Quality of Life (QOL) is both
an objective and subjective assessment gauged, interpreted, and
constructed by individual and community interactions with spatial,
social, and internal environments. QOL refers to both natural and
created environmental cues such as economic resources, water and air
quality, and housing. Simultaneously, QOL indicates the measure
of intangible personal resources including the capacity to sustain
friendships or value nature (Albert 2002: 1158). The WHO Quality
of Life Group offers a comprehensive, qualitative definition: based on
the perceptions of individuals, evaluations of QOL stem from the
“context of the culture and value systems” existing in the surrounding
community (Markides 2000: 2302). It evolves in “relation to [the]
goals, expectations, standards, and concerns” prevalent for an
individual and community and is “affected in a complex way by a
person’s physical health, psychological state, and level of
independence and their relationships to salient features of their
environment” (Markides 2000: 2302).
To understand these extensive strands of QOL, I turn to a framework
proposed by Rosalie Kane (2001). Offering eleven dimensions of
QOL, Kane’s (2001) suggestions extend and elaborate Maslow’s Hierarchy,
and they became the foundation for my interview questions. Kane’s
conceptual criteria for QOL begin with a “sense of safety, security,
and order…a benign environment where people are well intended and where
the ordinary ground rules of life are understood” (2001: 297).
Feeling one’s world is not in chaos, people secondarily like to be
physically comfortable, free of pain and suffering, and
well-tended. Furthermore, elderly people deserve enjoyment in
their daily existence. They also deserve to choose and
participate in those pursuits that are meaningful to them.
Elderly people also perceive quality of life through “reciprocal
relationships where [the resident] is able to give as well as receive
support, advice, and confidences” with people in and out of the
retirement community. As a reflection on their lifestyle outside
the care community, elderly people deserve to have their dignity
respected. Extending this theme, elderly people should be allowed
the privacy to care for themselves, their possessions, and to interact
with other people. Residents also deserve a “sense of being known
as a person and being able to continue to experience and express his or
her identity and to have desired continuity with the past” (Kane 2001:
298). Quality of life is also perceived in relation to how
autonomous someone is and how active he or she is in “making decisions
and choices and directing one’s own life” (Kane 2001: 298). Part
of this access to choice is the ability to experience and maintain a
sense of spiritual well-being. Finally, QOL has a physical
dimension in functional competence, that is, how capable people are of
tending to themselves and their instrumental and non-instrumental
activities of daily living (Kane 2001: 297-298). These dimensions
offer a broad scope of interrelated ideas I used to create questions to
begin to interpret the complex perceptions of QOL among
residents.
Kane’s (2001) reconfiguration of QOL targeted long-term care, a status
not exactly comparable to the three locations I researched in the
NRC. Despite the difference in provision of care, Kane’s (2001)
dimensions offer parallel and prevalent insights into perceptions of
QOL in the NRC communities. For the final dimension, functional
competence, I presented individuals with no questions, yet their
ability to pursue an interview with me offered insight into the
prevalence of illness and disabilities in their sphere of perceived
QOL.
Amidst these divergent influences and aspects, quality of life can be
understood as a dynamic interpretation of personal, social, and spatial
interactions. As such, perceptions of QOL are constantly
constructed and reconstructed by residents’ understanding of their
symbolic environment. Employing Herbert Blumer’s theory of
symbolic interactionism, perceived QOL becomes a facet of each person
or community’s subjective understanding of a symbolically defined
environment (Strykes 2000: 3095). In a retirement community, the
residents become actors shaping and reshaping their understanding of
social interactions and social spaces. Based on their
interpretations, they attribute subjective meaning to behaviors.
Attributing meaning to symbolic behaviors, language, and other
communication systems reflects a need to organize and understand
society at a personal, micro level. The ascription of meaning to
interactions allows classification of symbols. This organization
of symbols and their ascribed meaning serves social interactions in two
primary ways: they create a sense of social organization and a sense of
self.
Concretely, the elderly population offers insights into the character
of this symbolic space and how their living environments organize their
life experience. Ultimately, this study explores how elderly
people in a retirement community experience quality of life and
organize their perceptions in broadening spheres of control.
Methodology
To investigate the interpretation of social,
personal, and spatial constructions of quality of life, I conducted
research at the Northfield Retirement Community. This site for
anthropological study may be considered “among the most pedestrian and
familiar, hence among the least credible” fieldwork sites (Vesperi
1995: 8). However, this space is among the most unique and
challenging for anthropological fieldwork as it “combines the
traditional challenges of cultural discovery and description with the
inescapable questions…. [and] perplexing issues of identity,
perception, and experience” (Vesperi 1995:8). Amidst these
complexities, my research and methodology reflect my efforts to
interpret the experiences of residents at the Northfield Retirement
Community.
I completed my field research at the NRC based on my
personal connection to the facility. My father began working at
the establishment in 1981, just as the Manor began its inaugural
year. Born in 1983, I had the privilege of spending quality time
with the residents in my youth. In that period, the facility
centered on the long-term care nursing home section. Joining my
dad for noon meals and traipsing after him in his duties, I became
accustomed to the social and spatial organization of the NRC. I
joined residents in playing games and listening to music
performances. I came to expect to see Frank at his loom outside
the dining room, two Hershey’s Kisses from Fred each time I saw him,
and little trinkets of kindness from Betty and Ella. At such a
young age, I was swathed in the kindness and joyful hearts of the
people in the facility without fully understanding their long-term
residency or even their passing. Similarly, I was unaware of the
burgeoning voices against nursing home care for elderly people. I
never witnessed the mistreatment, depression, learned helplessness, or
disillusionment that befell so many nursing home residents throughout
the country. This is not necessarily to say it did not happen,
simply to admit that I was enveloped only in the living spirit of the
NRC emanating through the residents.
With this positive history, the negative perceptions
surrounding retirement communities caused me to question my own
experience as a phase of indiscriminate naïveté.
Despite these connotations, the NRC always seemed filled to capacity
and thriving, thus inducing the construction of Parkview East and
West. With the facility now twice as large as I knew it and still
thriving, I wanted to critically evaluate how residents of the facility
truly understand and interpret their experience at the NRC and how
these features and patterns contribute to their perceived quality of
life. Despite this objective to investigate their lives
critically, I come with a history connected to the NRC. A few
years ago, my grandparents became the residents of Parkview West
deepening my connection to the place and the people. Being family
of both management and residents, my study carries the weight of these
connections in the responses of interviewees. Nonetheless, the
NRC offered a fascinating site for research.
The process began with a project proposal to the St. Olaf Institutional
Review Board. The proposal included a recruitment letter for
potential interviewees, postcard to contact me, telephone protocol for
setting up appointments, an informed consent form, and a list of my
interview questions delineated according to the dimensions cited by
Kane (2001) (attached – Appendices A-E). After IRB approval, I
contacted the Housing Director for Parkview and the Manor for her
approval. Once both parties accepted the parameters and protocol
of the study to ensure confidentiality, privacy, and preserve general
well-being, I began recruiting.
In a letter, I explained my study to residents and invited their
participation. My dad delivered over 150 letters on his morning
route leaving one envelope outside each door of Parkview East, Parkview
West, and the Manor. Offering a thorough explanation of the
study, I asked residents interested in allowing me to interview them to
contact me by phone, email, or a postcard tucked in with the
explanatory letter. By contacting me, this ensured competency for
participation in the interview. Further, their responsibility to
connect directly with me ensured that no one in the NRC was aware of
their participation unless they explicitly shared the
information. This protected their right to confidentiality, a
guarantee I extended for the study. This method of sampling
required voluntary response and thus cannot ensure a random sample of
the population of NRC residents in these three sections.
From this set of self-selected respondents, I chose to evenly disperse
my interview schedule to try to gather a comprehensive and equivalent
view of each location. I opted to converse with four Manor
residents, four Parkview East residents, four single Parkview West
residents, and two married couples in Parkview West. To gather
these volunteers, I took the first four people to respond from each
section thus avoiding the complication of how to randomize the
self-selected set. While I had not intended to include married
couples, one of my first contacts involved a couple so I extended the
research to allow two couples for a more thorough exploration of this
dimension of NRC life. For each category, if I received too many
responses at once to cover the number of interviews I could conduct, I
turned the postcards face down, shuffled, and randomly selected
participants to eliminate bias.
Using the IRB approved telephone protocol (attached – Appendix C), I
contacted these respondents to set up interviews. From this first
list of interviewees, I had three that did not respond after three
calls. Setting three attempts as my parameter, I selected
alternative interviewees from the long list of respondents and arranged
appointments with them.
In the end, I conducted fifteen interviews (I interviewed one married
couple together and one independently by their convenience). I
met residents in their apartments and began each interview by having
the resident sign an informed consent sheet (attached – Appendix D)
required, as they comprise an “at-risk” group. For those unable
to sign because of visual impairment, I read the informed consent
information and accepted their verbal agreement as satisfactory.
I followed a semi-formal interview schedule and conducted interview
that each lasted about an hour. I created extensive written
fieldnotes based on my scrawling during each interview. These
fieldnotes are integrated into the paper as sections offset. Any
expressions verbatim from residents are denoted by quotations in these
sections.
Conducting fifteen interviews out of a population of over 150
residents, the sample seems small for generalizability. Despite
this, themes appear throughout the information shared by these
residents. While four seems an inadequate number to shape a
general understanding of how people organize their lives in each
section of the NRC, each story offers an insight into the overall
construction of the social sphere as well as insight into the overall
design of the community. While the specific stories cannot apply
to all residents, the themes of interaction often involve a larger
social sphere than just the people interviewed.
While the conclusions in the paper may not offer a complete
interpretation of the complexities of experiences and quality of life
at the NRC, the paper offers a critical exploration of some of the
prevalent themes that organize experiences there. The broader
ideas may relate to other facilities, although the NRC is a unique
place as a church-supported retirement community with extensive
attention to security and care. Residents construct and organize
their understanding of reality “from the pertinent categories and
vocabularies of the settings. Participants construct their lives,
but not completely on their own terms” (Gubrium 1991: 25). As
such, the conclusions presented here should only act to enlighten
potential frames of understanding for the dynamic and unique processes
of constructing and interpreting reality in this and every social
location.
Findings
Imagining our lives, few people can lay a faultless track and intend to
follow it without deviation. Changes are inevitable and even
potentially cherished parts of our lives as we age. Yet changes,
whether predictable or not, manifested in physical, mental, emotional,
or spiritual realms, can also be trying. Most devastatingly, some
dimensions of change can challenge our inner sense of identity.
In response, people cling to familiar frameworks. As Vesperi
asserts, “late adult life is marked by efforts to defend and maintain a
core identity in the face of repeated challenges” (1995:15).
These challenges often induce people to reorganize their experiences in
light of a new symbolic environment and new symbolic cues. Shaped
by these changes, this reorganization strives to help them balance the
defining features of their past and the facets of their new symbolic
environment.
The NRC represents a site of this negotiation of past and present
symbolic environments. Residents orient themselves to the shape
of this social space through channels I began to interpret as
concentric spheres of interaction and influence. The basic
structure of a spherical framework involves the capacities of
influences moving in and out. Each sphere has defining yet
permeable boundaries largely defined by spatial dimensions. Each
of these bounded spaces evokes a specific symbolic space and therefore
social atmosphere. Therefore, the spatially defined spheres have
parallel social spheres in which residents organize their
experiences. Yet studying the actual spaces of these social
spheres is only one dimension. These borders of this
concentricity become a site of further exploration. The frame
surrounding a sphere, both socially and spatially, does not eliminate
interaction with other symbolic spaces and other people. Instead,
these borders are selectively permeable and malleable. How people
organize their experience within a sphere often revolves around who and
what symbolic cues are allowed to move in and out of a sphere.
Several features contribute to the type of inflow and outflow between
spheres. I propose that these flows across borders reflect the
dynamic capacity of a resident to influence the symbolic environment of
a sphere and be influenced by it. These influences stem from a
variety of social cues involving residents’ physical needs, social
abilities and connections, integration of past patterns, exertion of
control, capacity for adaptation, and ultimately, choice. The
ability to assert a modicum of control through choices helps residents
define the social boundaries of the various concentric spheres as well
as to move in them according to their own discretion and needs.
Movement and conduct in and between these spheres is not explicitly
controlled by their choice, but is a dynamic interplay between the
resident and the dimension of the social sphere itself, including its
participants and symbolic space.
Using the sphere as a basic conceptual framework involves exploring
residents’ lives through this lens. This spherical conception
includes four tiers of interaction that intersect with others at
various levels. Beginning with the internal, personal, primary
sphere as a zone of significant control, the patterns emanate outward
to a secondary sphere of interaction within a site-specific wing of the
NRC, the tertiary sphere organized by the symbolic community of the NRC
as a whole, and a fourth sphere of interaction with the larger
community beyond the NRC. These dimensions then illuminate one
organizing conception of the complexities shaping residents’
experiences of life in the NRC.
The Move: Shifting Spheres
As people age, their spheres shift and reorganize with the changing
patterns and abilities of their lives. Amidst these movements of
malleable spheres, the intimate sphere of the home in the community
becomes a treasured space. Without the time constraints of
external employment and the expression of proficiency in the workplace,
with deteriorating social ties to friends adjusting differently to the
new dimensions of their intersecting spheres, with family grown and
only able to visit, and with society devaluing the contributions of
elders to our culture, the home offers a space where an aging person
can still effect a modicum of control. Rooted in this sphere, an
elderly person shapes his/her own temporal, spatial, and personal space
according to their own discretion and needs. They become the
primary actors shaping their own symbolic environment. If this
space effectively allows social movement in and out, the elderly person
eliminates the sensation of isolation. Yet what happens when this
space becomes too extensive for the elder to manage?
For many, the result is a move into a retirement
community. The external home in the community acts as a central,
intimate, and symbolic sphere for all people, especially the
aged. It grows increasingly significant as other dimensions of
their lives alter – employment, health, household. They define
and understand this space amidst the unsteady currents of change in
external social and spatial spheres. Leaving their home - this
tightly knit, self-reliant space - proves a challenge. One
resident, Rolf, said he “decided to give up [his] home,” relinquishing
control to his family. Similarly, for Bonnie, the move became an
imperative change:
As her husband’s health deteriorated, Bonnie became increasingly aware
that she could not care for both her home and her husband. She
had always managed the home, but the combination of responsibilities
became overwhelming. To be able to focus all her attention on her
husband’s care, she opted to leave the large home where she had raised
her children to move to the NRC.
In each story, the language is indicative of the sentiment shared by
many; while willingly moving, the process of leaving requires a
sacrifice of this space called home. Power’s study affirms the
“difficulty of the decision…where one becomes separated from the
familiarities of home” as a common theme despite variations (1995:
180). Still, for others like Rachel, this “home” and its
interactions with larger social spheres became overpowering:
After her husband died, Rachel says she could not stand to be in the
house alone anymore. In a residential area, she could not keep
track of the neighbors and felt overwhelmed by all that was around
her.
Rachel had already begun to feel that her home was not a controlled
center, but a challenged space. She was unable to control the
influx of external issues flowing into her personal sphere; this sphere
was being constricted and tightened as external forces minimized her
control. Her willingness to move reflected a desire to regain
control already being lost by investing herself in a new organization
of spheres.
While these sentiments offer indications of themes prevalent in the
motivations of many retirement community residents, the move stems from
the interplay of a variety of different purposes, needs, and intentions
unique to each resident. For example, Dennis preached to people
for years that they should “plan ahead.” Living this philosophy,
he and his wife knew they would “make a move when [they could].”
Therefore, they began looking at the NRC long before functional ability
required it; they looked simply to prepare for an inevitable
course. While Molly, another resident, had already left her house
for a different type of retirement community, she decided to move to
the NRC because she wanted to be nearer her children. Marie moved
impart to force her husband to relinquish his homecare activities and
responsibilities. In his waning age and health, she feared for
his safety.
Each of these transitions explores a seemingly logical path toward an
alternative living arrangement. However, this move is not just a
geographical change but a process of reorganizing one’s spheres of
influence and control. According to Barbara Hornum’s assessment
of the social aspects of living arrangements for the elderly, each
change in residential accommodation brings “decreasing independence,
both physical and psychological” (1995: 151). These ramifications
are abundant and a move away from home has the potential to threaten an
elderly person’s sense of control. Pressed to redefine their
spheres of existence without the home locus, people lose a centering
space. Movement into a retirement community necessitates
interpretations of an unfamiliar symbolic environment with new
parameters.
To illustrate their maintenance of control, most of the residents
present themselves as proactive in the decision to move to the
NRC. Molly embraces her decision to move nearer to her
children. “If something is your choice, you feel better about
it,” she says. Certainly family played an integral role in her
desire to move, but ultimately she claims the decision as her
own. Similarly, Norah participated in measuring the value of
moving to the NRC:
Anticipating the need for more extensive care in the indeterminable
future, Norah posed a question: how much weight would fall on her
children should she and her husband stay in the condominium where they
previously lived? In such an arrangement, they would need
constant assistance with transportation and health care. They
resolved that it would be best to be in a facility that offered a
continuum of care, to be fair to their kids and ease the strain on
themselves. “We’ll do it ourselves,” they decided.
These experiences illustrate personal agency as a dimension of
control. As Hornum argues, “in instances where the choice to move
has been made voluntarily…the trade-off of such independence has been
perceived as bringing worthwhile rewards” (1995:151). In this
study, the reward emanating from this active decision is more than the
services and opportunities provided by the NRC but is also an assertion
of influence and agency in a move that unsettles the core sphere of
control for these aged people: the home.
The New “Home”: The Apartment
Yet leaving the home does not eliminate all sense of control. In
the absence of ritual cues for aging, Hornum contends that “moving into
age-segregated housing actually facilitates and clarifies steps
necessary” to transition into a new configuration of spheres of
influence (1995:153).
Vesperi argues that life care facilities like the NRC, offering a
continuum of care beginning with independent living, “are specifically
designed to bridge this transition” into alternative living
(1995:16). Part of easing this shift away from home and into a
care facility is achieved by providing spaces that allow personal
expression and definition. In retirement communities like the
NRC, the house as the central sphere of control is replaced by the
apartment as the site of this expression. Each section at the NRC
offers residents a personal apartment or one that can be shared with a
spouse. Within this space, residents essentially have the liberty
to shape their own realities. Often studies in life care
facilities emphasize “comparisons of new social institutions with the
ones that individuals have left behind” (Vesperi 1995: 16). At
the NRC, these continuities are apparent within the tight spatial
sphere of the apartment. The physical space of an individual
apartment facilitates opportunities to define the space with materials
that resonate with previous home sphere of control. A comparative
newcomer, Lydia is still in the process of creating a spatial
orientation in her apartment that adequately expresses her control in
this sphere by reflecting aspects of her past:
Lydia’s departure from her house was the circumstance of troublesome,
unmanageable health. When she left her house, she left
unwillingly but at the requirement of a medical disposition that could
render her helpless without warning. To prevent any serious
failings without attention, Lydia accepted an apartment in the
NRC. With this sudden and unwanted change of social spheres,
Lydia has incorporated features of her home into her apartment.
She says she “ransacked” the rooms of her old house to provide the
furnishings for her current apartment. Various pieces come from
different rooms. These things help her feel that her space is her
home. From pictures of her recently deceased spouse to familiar
furniture, lamps, and books, Lydia has created a space that she says
even her friends find welcoming and she can hold as reminiscent of her
own home. She says the space is “homey” to her because it has
“[her] own furnishings.”
Lydia’s defines her space through familiar features of her past.
She tries to recreate patterns of home to establish a sense of
stability and continuity. As she responds to the circumstances of
failing health and changing living arrangements, she ultimately
recognizes her diminishing ability to manage these dimensions of her
life. Under these auspices, Lydia’s apartment becomes a central
sphere of current control emblematic of her past extensions of
influence.
Yet Lydia expresses clear limits to her ability to
recreate this spatial sphere of her home. Namely, she remarks
that she “ransacked” her home to find pieces suitable for her
apartment. The conglomeration of furniture in her apartment never
explicitly shared the same space prior to the move to this space; she
does not replicate the interior designing of a room from home, but
melds divergent strands of her home life into one space. Lydia’s
ability to shape her own spatial sphere is bounded by the dimensions of
the apartment.
The limitations of coordinating a space resonate in
the voices of other residents as well. Moving from a large house
to a smaller Parkview West apartment than she intended, Bonnie had to
condense and minimize the possessions that oriented her previous
spatial sphere:
Due to the size of her apartment, Bonnie has downsized. She had
to sort through and get rid of fifty yeas worth of things from trinkets
to furniture. Some things she truly valued she is only able to
keep in memory.
Yet Bonnie strategically selected at least some of the things that came
to the NRC with her. For her husband, they kept the cat, one of
the key components to provide him comfort in the midst of declining
health.
In Bonnie’s experience, many items had to be expendable while others,
like a pet, are invaluable. Of all the things gathered in fifty
years in one house, only specific pieces presumably carry special
significance and therefore deserve the prominent appellation of
belonging in the limited apartment space. Some items in the rooms
are present more for their functionality – tables, chairs, dishes, and
others. Still, the selected objects are symbolic of each
resident’s past life and memories. They do more than simply fill
space, but symbolically orient a resident to their past. The
selectivity of items to keep and those to relinquish inspire a spatial
sphere of reference inspired from past constructions, yet subject to
new configurations.
These new configurations included the limitations
imposed not only by the size and shape of apartments provided by the
NRC, but also the unalterable aspects of décor. All NRC
apartments are in neutral, light beige tones from floor to ceiling
except older manor apartments, which have darker flooring.
Although none of the residents explicitly mentioned this facet of their
apartment, residents seem to have responded to these inflexible spatial
features through their own interior designing. For example, in
the main living space of her apartment, Lydia covered the plain
flooring with an extravagant rug in a myriad of colors. Several
residents masked the plainness of their walls by hanging artwork.
These features indicate both items of value to the residents as well as
décor preferences. Both objectives offer opportunities for
residents to shape their personal spheres, yet limit them to the
predisposed conditions.
Perhaps in part because of these constraints to a complete
self-regulation of a personal sphere, Doris has found the space only
tolerable:
I ask Doris about her enjoyment of her own apartment space and she
responds thoughtfully. “Sure, sometimes I see what others have
and I think ‘Oh gee, I wish I had it as nice.’ But overall, the space
is adequate to my needs” she tells me.
This comparative perspective affirms that Doris is aware of limitations
in her own environment. This reference suggests that her
apartment is constantly a space she negotiates and balances as an
imperfect representation of her center of control. Without
specifying the exact features that invoke this, Doris identifies
parameters to her apartment as a sphere of spatial control.
Flow across the Boundaries
As each resident constructs a spatial sphere unique to them, these
individual apartments become a personal sphere of control amidst a more
intensely social atmosphere outside the apartment parameters. In
a facility designed to draw people into close spatial proximity,
maintaining a private sphere becomes a crucial facet of control.
This personal realm is especially evident for Emma:
In her nineties, Emma is still a thriving woman. Despite
extensive macular degeneration, she navigates her apartment
deftly. Since her sight is minimal, the things in her apartment
seem almost irrelevant to her. She does not comment on “goods” as
defining her enjoyment of her apartment, but rather the patterns she is
able to enact within the space. “I still care for myself,
bathing, getting in and out of bed, and all,” she reports. Her
sense of independence comes from not being given orders or directions
from others, but setting her own schedule and maintaining her own
course of activities. Her apartment is so familiar that she is
able to interact with the space to adequately care for herself and
provide for her personal needs.
Emma experiences her apartment as a space concretely and personally
defined according to her needs. As her eyesight continues to
deteriorate, she maintains her ability to control and navigate this
space. It becomes an increasingly significant spatially defined
sphere of control as she begins to lose her ability to navigate social
circles outside the apartment:
Engaging in Manor activities, Emma is increasingly reliant on the
kindness of other residents. For example, Emma recently attended
the monthly Manor birthday party in the Manor dining room at the
invitation of another resident. Her companion had to assist her
in getting cake, coffee, and finding a place to sit as Emma is unable
to see well enough to serve herself. Emma is not used to being
served; in fact, she would prefer to be the one serving others but her
visual limitations make this impossible. “Most people aren’t here
because they can’t do,” she says, but admits that she truly
can’t.
Recently, Emma has also accepted the strong recommendation of the NRC
that she not walk alone outside. She likes to use the path
surrounding the NRC but is now required to find someone to walk with
her. While she recognizes the value of their concern, she also
finds it difficult to ask people. She wishes other residents
would extend the offer. “Why can’t people just ask ‘would you
like me to walk with you’ so I wouldn’t have to feel like I am
bothering?” she questions aloud.
These examples illustrate Emma’s dependence outside her
apartment. Her sphere of control is sharply bounded, delineated
by the parameters of her apartment. Her locus of control exists
only in her apartment because she is physically unable to extend
control into the wider circle of social interactions. Outside her
apartment, her experiences are not self-directed but dependent a
constant current of assistance from other residents. Mobility, or
lack thereof, determines her functional abilities in social
settings. This drastic reduction in independence and agency
outside her apartment augments the value of her assertion of control
within. As Scheidt and Norris-Baker argue from Lawton’s work,
residents gain “increased security and control by restricting their
range of physical and behavior space” (2003: 58). More and more,
Emma organizes her experiences around her apartment, reflecting this
pattern. Her choices for conducting herself are reduced to the
key meanings embedded for her in each sphere: she can choose to be
dependent in an increasingly complicated social sphere or she can
participate in her own sphere of control exclusively maintained in her
apartment.
While Emma often chooses to remain in her apartment,
within the boundaries of a self-controlled, self-defined sphere, this
does not mean the sphere is impermeable:
Emma admits she is withdrawing from social activities offered by the
Manor, becoming “inactive” because of the complications posed by
participation. Simultaneously, she is growing progressively
dependent on the influx of caregivers. She has a housekeeper tend
to her apartment, Meals-on-Wheels delivers one meal a day that lasts
her all three, her children come to sort through her mail, and
community members and college students come in to read to her.
The osmotic flow in and out of Emma’s tight, personal sphere of control
increasingly transitions away from an equal exchange. As Emma
bolsters the boundaries to limit her own passage outward, the borders
become increasingly permeable to people entering her sphere to offer
assistance. This penetration of people into her center of
influence is not necessarily a challenge to this stronghold.
Instead, Emma actually enacts her control through these selective
admittances. She determines who may and may not be permitted into
the sphere. She admits those who are genuine in their extension
of care and attention thus minimizing the sense that she is “bothering”
them with her needs. While the entrants are largely present to
extend some type of care Emma cannot provide for herself, Emma still
screens the members thus executing a measure of control.
As a Manor resident, she can extend control over the
movements of people into her space. In Parkview East, these
penetrations are not determined by residents and are primarily
expected; they are essentially the premise of living in Parkview East,
the assisted living facility. Residents in this area have
extenuating health circumstances that incline them to need added
attention, hence they live in this particular wing of the
facility. For them, the influx of people into their private
sphere is not chosen but mandated by their living experience. For
them, the permeation of aid is part of daily life. This is
apparent in Rolf’s response to an interruption during our interview:
As Rolf and I sit in his apartment there is a knock on the door.
Before either of us has processed the knock and can formulate a
response, the door opens and an aid comes into the entryway. “Oh,
I didn’t realize you had company Rolf,” she says staying hear the
door. “I just wanted to remind you about the birthday party in
the dining room.” Rolf doesn’t flinch or miss a beat but responds
as though he expected the announcement. “Oh yes, when’s that
again?” She mentions the time then excuses herself as he looks at
his calendar. Rolf has a problem with short-term memory.
Although he has already mentioned the time and date of the birthday
party to me twice, he looks at the calendar as though once again
surprised to see it written there in heavy ink. Because of this
struggle with memory, he is used to the aids coming in and out.
“They also give me my medication,” he tells me, pointing to a locked
black box on the corner of his table with a chart on top covered with
dates and initials. “I had a problem once with taking too many so
they do it for me.”
These interactions with aids and nurses help Rolf to survive physically
and socially. He does not predict nor prevent their entrances and
exits into his private sphere as it is only through their assistance
that he can maintain his own sphere and move into wider circles of
provided social interaction. They bring necessary supplements to
his perception of the world into his apartment. This allows him
to retain control through their assistance and therefore be ready to
engage in external social interactions.
External aid for daily living, however, only
resonates with those who require assistance. For others, these
knocks and attentions may impede their construction of a sphere of
control. Initially, this was the case for Rachel:
When Rachel first came to the NRC, she did not appreciate the extra
measures of care extended to Parkview East residents. “I hated it
to begin with,” she says referring to the nurses stopping constantly
and all the attention she was getting. After spending some time
in the Care Center after an illness, Rachel began to accept that she
“had to give up some privacy to be taken care of. You can’t exist
in this world without help.” To ease into this, Rachel has two
outside nurses that come in to offer her assistance on a regular basis.
Rachel’s early introductions to the level of care in Parkview East
upset her because they assumed a lower level of competence than she
professed. As her health deteriorated, these care routines became
more valued and acceptable. She recognized the trade-off: she
could sacrifice a modicum of privacy to receive needed care. In
return, she is able to stay in this facility rather than live in the
even more regulated and attended Care Center. She maintains a
dimension of control over her personal apartment sphere, however, by
dictating which nurses she allows to extend this care.
The physical care is not the only way that staff members enter into
residents’ personal spheres. In Parkview East, staff and
management also permeate the private sphere through some time
structures. To ease meals and to follow prescription directions,
staff creates a common schedule. Delineating such rigid routines
has the potential to be a negative influence on assertions of
independence. By the same token, it has the potential to
intentionally and unintentionally inspire new venues of aid or
choice. Only through time did Rachel begin to understand the
value of the schedule for her. In the beginning, she struggled
with these parameters determined by staff and management:
Rachel was also opposed to the schedule imposed by Parkview East.
Mostly, the schedule revolved around meal times. Since East
residents are provided with three meals a day in the common dining
room, the aids knock on doors and try to bring absentee residents to
mealtime. Rachel was bothered by the early hour of breakfast,
which did not allow her to sleep in. After living there for a few
years, she has realized the value of having these meals provided and
having someone care enough to come find her. When she didn’t go,
she found she ended up “all by [herself]” quite often. Now, she
concedes and says, “I always do what they want me to do.” She now
says the scheduling is one of the best facets of life in the NRC.
Familiar with the flow of activities in East, Rachel now embraces the
schedule. While it restricts her ability to define the time
dimension of her sphere, it provides her with needed opportunities to
move out of her central sphere and into spheres of greater social
interaction. She appreciates their assistance to ensure this
transition. In this way, Rachel understands the symbolic
behaviors of the NRC as intended to assist her.
Doris understands this same scheduling as a form of security and a structure she can challenge to assert her own authority:
Each day, as the aids make their rounds to gather people for meals,
Doris feels the confines of such a strict schedule. If she
doesn’t join them, she will surely get a visit as the aids want to be
sure she is doing well. Since she feels no threat to her current
state of health, she finds their constant check-ups unnecessary.
Most of the time she acquiesces to the preordained schedule, but Doris
says, ““I don’t have to get up. They don’t like it, but I don’t
have to.”
Through her defiance, whether she acts on it or not, Doris asserts
control. Ultimately, it becomes a situation where she has a
choice of whether to accept the schedule or defy it. While the
schedule seems to be an impediment to personal control of time, for
Doris, it enables an assertion of control through choices.
Choices become a potential backbone to asserting and defining
control. Once the ultimate choice of where to live has removed
them from their home, residents face the dimensions of a new symbolic
environment. This new space diminishes many of the patterns and
roles of their previous life orientation and requires
adaptability. Lydia’s experience is emblematic of some of these
tensions:
Looking despondently out the window of her apartment into the
courtyard, Lydia says she feels trapped here by her health and other
life changes, including her husband’s death. In contrast, she
calls her friends “free.” This sense of restrictions is what she
likes least about being here. It coerces her to reestablish
herself and develop new patterns conducive to this life, space, and
these conditions. She feels like she must “start a new life, but
this can’t be changed. All I can do is just recognize the good of
my past and the good of what I have now, and ask God for guidance
amidst all these changes.”
Lydia’s new home has required her to adjust her regular patterns,
alterations she views as diminishing her agency. Despite the
purpose for the move, or how active each person is in deciding to move,
negotiating life in a retirement community obligates people to adapt
and appreciate this symbolic space. As Lydia reorganizes her
experiences within the NRC, however, she respects the spaces in which
she has the liberty to define her own environment. These spaces
allow for choices, individual decisions to determine what best suits
each person. In making these choices, residents are defining
their sphere of control and its boundaries.
Defining Self in the Core Sphere
These decisions include adaptability of individual
roles; the boundaries of the sphere of control stem from understanding
which roles people relinquish and which they try to retain in this new
environment. In her move to the NRC, Julie has retained many
domestic care roles in her apartment:
Julie moved to the NRC with her husband. Due to an ensuing
illness, the move turned out to be “exactly the right place at exactly
the right time.” While her husband’s medical needs make this
true, Julie’s behaviors parallel the activities she lived outside the
NRC. Her daily pattern seems to have only minimally
changed. They get up by six in the morning and regularly walk
even in the winter. She takes care of their cat, a pet they have
had for fifteen or sixteen years. Julie is responsible for their
meals and cleans their own apartment. While these services could
be provided by NRC staff, Julie is used to taking care of a house and
has chosen to continue these habits.
For so long, these familiar domestic roles defined Julie’s experience
outside the NRC. While it might be more convenient to have others
provide these services, Julie prefers to do the tasks herself.
The NRC offers this choice; expressing her agency to choose, she
maintains familiar roles, implanting external patterns into this
symbolic environment. These behaviors may reflect gender
dimensions. With her husband still living and active in their new
home, there may be an expectation that she continue to fulfill these
tasks as a symbol of her role as a wife. However, she seems to
choose the roles rather than having them imposed upon her.
Perhaps more likely from her interview, these actions are symbolic of a
conflict in adapting to this new space. She is one of the few
people who does not accede to the assistance of housekeepers and only
three others in independent living mention that they make many of their
own meals. Through the act of choosing to perform these tasks,
residents establish boundaries around their private sphere, delineating
which behaviors they control and which they relinquish to others.
Further, the conduct defines the permeability of this border: the more
residents do for themselves, the less they allow others to impinge on
and enter their sphere, invading their privacy to complete these menial
tasks. Finally, continuing these behaviors situates these
residents in a sphere mimicking their previous lives.
Within a new symbolic environment, however,
residents are allowed to choose which activities from their previous
patterns they will retain and which they will relinquish. The
nature of some makes them unfeasible and inappropriate for the confined
spaces of a retirement community. Others, however, are easily
implemented in this new space. Julie, for example, chooses to
continue her domestic patterns because they are reminiscent of her
past, symbols of her identity, and easily controvertible in this new
space. For others, these are the first activities to go.
Without the responsibility of caring for a home and yard, residents
have more free time. This free time has the potential to
metamorphose into loneliness as it did for Rachel before she adjusted
to the East schedule. Simultaneously, it may also provide
opportunities for residents to pursue leisure activities with greater
time and zeal. This increased free time becomes a facet of life
that each resident controls and shapes independently. Even
following the East schedule guidelines, residents have much of the day
to pursue their own agendas.
With this temporal freedom, other residents choose
to exert control by incorporating meaningful activities from their past
into their present. Edna typifies this integration of external
activities into her internal sphere of control:
When I come into Edna’s apartment, she is knitting. When Edna
first moved here and no longer had to take care of a house, she “almost
felt guilty for doing her own things.” Yet Edna likes to be busy
so she fills her days with activities she enjoys. Besides
knitting, she does other needlework, volunteer activities, participates
in council activities and more. Despite a variety of options,
Edna still feels some activities are missing. She points to a
couple of paintings on her walls, landscapes of beautiful colors,
vibrant. She painted them. When she moved in here, into
this small space, she had to give up her painting because space did not
allow it. She also gave up her weaving loom and a keyboard in
storage downstairs. She had to prioritize to fit into the limited
space. Still, when she moved in, she knew and realized that
“you’ll give up space and stuff. You learn to balance.” She
summarizes her complaints by saying “the conveniences outweigh the
limited space.”
By continuing activities she enjoyed in her past, but actually
increasing their value in her daily patterns, Edna creates the shape of
her symbolic environment. These activities become a bridge
between the two spheres of life experiences, the intersection of
circles on a Venn diagram. Through them, Edna exerts control: she
chooses which activities to pursue, how, and when. However,
Edna’s sentiments also demarcate the boundaries of her control of these
activities. The borders derive from the limited space of her
apartment. Because of the physical dimensions, Edna loses her
opportunity to engage in some desired activities, conditions that
require some adaptation. These particular patterns of meaning too
large for her space are relegated to storage or live as memories posted
on her walls.
Yet choosing these activities is not the only
expression of control. Instead, dimensions of control are
manifested in the products of these activities. These objects
offer character cues about the resident. Whether created or
purchased by their hand, American culture emphasizes the value of
material things as symbols of personality and identity. As such,
these material objects position people within their social
sphere. For elderly people in a retirement community, these goods
act as a bridge between a past social sphere and the current symbolic
environment. They cross over with the resident, artifacts chosen
to shape a resident’s inner sphere. For example, Edna openly
shares with me that the paintings on her wall are her own
handiwork. This admission confirms that she sees herself as
creative and still wishes to be productive in this way. She
exerts control by shaping at least her own private sphere and directly
shares these identity cues with me. This shape and the identity
cues reflect her past. She incorporates these cues into her
private sphere at the NRC to situate herself in both the symbolic
atmosphere of her past and present.
These connections from past to present are also enacted by people
situating themselves in reference to their past. In the symbolic
environment prior the retirement community, people are able to position
themselves through patterns of conduct. Particular behaviors and
roles suggest related operative values, experiences, and even social
location. Within the retirement community, many of these
behavioral cues are diminished as people learn to negotiate a new
symbolic space. For example, it is more difficult for residents
to convey contributions made through past employment when people are
unaware of their careers. Yet these histories contribute to the
shape of an individual’s present. In his study of nursing home
residents, Jaber Gubrium (1995) began to explore the value of these
past environments as key contributors to residents’ current
organization of their experience. He challenged his own research
methods by posing these questions
What can be learned about the meaning of the resident’s nursing home
experience when it is examined in connection with his or her life
story? How does a life story inform interpretations of these
qualities? The questions lead to an alternative sense of the
story, one less centered in the present… than broadened to make meaning
in relation to life as a whole. (Gubrium 1995: 30)
These ideas demand attention to the stories of the past conveyed by residents.
In the NRC, residents use these stories to situate themselves in their
past in ways that cannot be conveyed in their present setting.
Julie and Rolf offer explicit examples of how the story of one’s past
becomes a central feature in defining their symbolic environment:
Before Julie and I even begin the questions, she begins to tell me of
her past. She begins with her connection to my grandparents many
years ago, so long past that she did not remember it without their
coaxing. She progresses, discussing the jobs she held as a social
worker and her moves across the country and even abroad, to serve this
role. She says “there were just so many openings when I returned
from the war, I could have worked anywhere. It wasn’t that I was
especially good, there were just so many openings and I had my
masters.” For the 1940-50s, a woman with a master’s degree is an
impressive legacy. She begins to hesitate somewhere after her
first job and before she has her degree, but I encourage her to
continue as she is providing an avenue for us to have an open path of
communication. Still, she has very humble, delicate ways about
her, her hands tracing the air, then lying over her arms. She
blushes a little after she has shared all the information, then says,
“Well, should we begin with your questions?”
There is modesty in her words, yet she extends this biographical
information at the outset of our engagement as though wanting to set a
frame for who she is and what her past has entailed. As Scheidt
and Norris-Baker argue from Cuba’s 1989 research, “relocation…may
involve reinterpretation of past place identities and changes in the
roles in which and individual engages in community settings” (2003:
61). By sharing her past “place identities,” Julie is involved in
reinterpreting her new place and current position. From this
willingness to extrapolate without inducement, Julie suggests that the
physical and social space of the retirement center, this symbolic
atmosphere, does not adequately define her. In this symbolic
space, she has lost the unobtrusive cues that would convey aspects of
her former social location and self. Instead, she shapes her
narrative to satisfy these demands by communicating the skillful
dimensions of her past; she defines the space for our interaction by
defining her core sphere with these selective pieces of
information. She exercises her authority in the personal sphere
by what she chooses to share; further, the path she illuminates
establishes a controlled frame for our conversation. Her stories
modify our shared symbolic environment as a practice of
control.
Rolf’s narrative of his history does not stem from a
need to redefine the symbolic space. Instead, his stories
themselves are his means of control. Suffering from memory loss,
Rolf tells stories conveying a vivid historical clarity:
As our time progresses, Rolf recounts several narratives from his
past. He tells of horseback riding, caring for an ailing friend,
his past work with animals, and a dinner party with a cast of notable
guests. For each story, he has a humorous message to convey,
carried gracefully through the abundance of vibrant details in each
narrative. Rolf makes a special effort to say each person’s first
and last name in the stories, communicating the strength of his
long-term memory. For other stories, Rolf picks up selected items
scattered around his apartment.
“What do you think this is?” He places a large stone before me
with ragged edges. “It’s greening; that should give you a
clue.”
I stare at the large block completely lost. “I have no idea.”
“This is copper, crude copper, from Isle Royale,” he says
beaming. He proceeds to tell me exactly who and how this copper
was retrieved, talking to me much like a knowledgeable teacher.
As he continues with the story, it becomes apparent that he still holds
a considerable amount of knowledge and understands nature well.
He gets up again and returns with two wooden bowls.
“Have you heard of buckthorn?” I have – that foreign plant my
family constantly tries to get rid of before it wipes out all the
native species. The two bowls are made of buckthorn Rolf
cut. Again, he gives me a detailed explanation of cutting and
curing the wood, but admits that he no longer has a lathe and therefore
did not create the bowls himself, but rather enjoys the skills of a
friend whose name is written on the bottom.
“I just thought the wood was so lovely,” he says, turning the bowls in
his hands as he stands again to return them to their place on the
wooden shelves.
These stories enable Rolf to express control and command. Filled
with intentional references of thorough historical accuracy, his
storytelling abilities illustrate his authority over this past
realm. This memory control contrasts sharply with his short-term
memory, which is extremely faulty. These stories, then, with
their incredible key to factual realities, compensate for this
lack. Through them he not only situates himself in his past, but
demonstrates the facets through which he still harbors control.
In his personal sphere, where many things are now arranged or guided by
other’s assistance due to his short-term memory impairment, Rolf has
little influence. In his accounts of the past, he has complete
authority, not only by deciding which stories to convey, but also
through the extensive detail. This window to his past is the
sphere of his control bounded by the capacities of his present.
Not all residents easily divulged information from their pasts.
No questions explicitly asked for this sort of information, thus the
pieces revealed offer intriguing insights. Responding to an
absence of cues to inform on the past, residents shared their stories
as a means to communicate realms of control. While these facets
are not explicitly evident, they are integral in defining how each
person understands and places themselves in the different symbolic
environment of the retirement community. After years of
experience with aged people in retirement communities, Gubrium
determined that “biographical work reflects local relevancies so that
[the narrative construction of elderly people’s lives], while
distinctively crafted, is assembled from the pertinent categories and
vocabularies of the settings. Participants construct their lives,
but not completely on their own terms” (1995:25). The narratives
offered by residents are evidence of this phenomenon. The stories
they share stem from their response to the limitations and organization
of their symbolic environment.
These stories share a responsibility with many other facets of life in
the retirement community to delineate a personal sphere of control for
the residents. As so many dimensions of their lives change with
the move to the NRC, residents use these stories of the past, the
spatial arrangement and decoration of the apartment, their control over
who enters and exits the sphere, and the practice of independent
activities to establish control and define the boundaries of this
personal sphere. These methods of control manifest uniquely for
each resident. This distinction stems from each resident’s
personal and subjective interpretation of the symbolic sphere of the
NRC. The common thread among these individual negotiations is
that each expression becomes an assertion of individuality and
control. In a myriad of ways, these residents strive to organize
their experiences to construct a personal sphere amidst the larger
symbolic environment.
The Wings: Experiencing the Smaller Communities
Establishing a central sphere of control is only the
innermost circle in the concentric spheres of participation.
Retirement communities, at their most basic, are places that draw an
age cohort into spatial proximity. This aggregate living
intentionally creates a symbolic environment for elderly people to be a
shared experience of life. Certainly these facilities develop to
provide care or the potential for care to elderly people, but by virtue
of bringing people together into one space, retirement facilities
become communities of people. Pain et al. explore varying
conceptions of community, suggesting that people like to trust “the
idea that there exists some organic, cohesive social structure that
brings together individuals…[and] offers an organizing and supportive
framework for everyday life and the management of change” (2001:
69). In this heavily loaded and dynamic idea of what constitutes
a community, there is space for understanding how retirement facilities
are understood as communities. In retirement communities like the
NRC, the primary objective is to reorganize their lives in this new
symbolic environment. By Pain et al.’s description, the idea of
developing and maintaining community would be especially valuable to
NRC residents as they try to make sense of their new environment.
Through “community” residents can find the “supportive framework” to
help them adjust (Pain 2001: 69).
This need for a community support becomes apparent
to residents in different ways. Rachel first determined her need
for community by not engaging. When she did not join people for
meals according to the Parkview East schedule, she found herself
lonely. She therefore reoriented her behaviors to join the
community. Bonnie expressed the need for community through
different experiences:
Since Bonnie moved into the NRC, she had been the primary caregiver for
her husband. Now she is adjusting to no longer occupying this
role. As a caregiver, she didn’t get out enough to meet other
people. Since her husband’s death, no one has been too
close. She worries about being lonely, but figures that this will
get better as “time heals.” There are a few people in West she is
able to talk to and it has affirmed for her the importance of having
people acknowledge her loss; even the simplest things have great
meaning. She is getting out more now, even inviting some into the
apartment, but mostly she interacts in community spaces for coffee
hour, birthday parties and other activities. The people here are
good; they have a shared experience of loss, “one consolation” for
Bonnie for living here without her husband.
Awareness of community primarily came to Bonnie in the loss of her
husband. Prior to this, she had been so busy with his care that
she did not have time to gauge community sentiment and find her place
within it. She created boundaries around her private sphere that
did not allow extensive perforation for community building; she
sustained herself through tending to her husband and embracing their
companionship. In his absence, these boundaries are constraining:
Bonnie fears being alone too much. She likes to spend time
reading in her apartment or just existing in her private space.
But privacy here is so well respected, she fears it may be too
private. With all the new HIPAA [Health Insurance Portability and
Accountability Act of 1996] regulations, she fears people will not know
anything about her. She wants people to be able to know she is
here and now even that is limited. For good relationships, people
need to know some things, she contends, not everything, but some
important things. They need to know that she is human and
experiences human emotions. She needs to be able to express this
with them in a community. HIPAA seems to go overboard and people
are left insulated, isolated she thinks. Previously, she could
control her privacy; now that she is part of a living cohort, the
government can mandate how and what is shared with others and she does
not like it. Even while her husband was ill, she wanted less
privacy. She wanted people to know what was happening, not in
every detail, but enough to know they were struggling. HIPAA
become a burden at that point, preventing people from kind gestures
like cards, a visit to the hospital, asking to help with errands,
anything. If people didn’t know, they couldn’t offer or share
anything; for her, HIPAA has gone too far.
In her perception, the people in West are considered to be independent
dwellers like in any apartment complex. She contends that most
people did not come to live alone, independent from everyone.
They want a little extra, a little background on people. People
want to be involved in each other’s lives above the interaction of a
general apartment building. Further, they “don’t want to be
ignored but included in the caring.”
For Bonnie, this becomes the role and importance of community.
She clearly asserts that her private sphere is not enough to sustain
her. Government policy has erected almost impermeable boundaries
that relegate people to these personal spheres. Yet the point of
living in a retirement community is to embrace the community. It
is therefore the responsibility of the residents to find the outlets in
the dense shield created by governmental privacy policy.
Gubrium’s work affirms this idea. By listening to countless life
narratives from residents of nursing home communities, Gubrium began to
consider “the possibility that life was not just something lived, but
might be a thing, like a cherished heirloom or a bad dream, that one
could look upon, inspect, think back on, look ahead to, close off, and
open up to experience” (1995: 32). In all these facets of
understanding life, people engage in an interaction with others to
understand their symbolic environment. This final possibility,
the opportunity to “open up to experience,” becomes the core component
in creating a community (Gubrium 1995: 32). As people at the NRC
move out from their central sphere of control they transition into this
open atmosphere to join community.
Part of this sense of community develops at the border between the
private sphere and the widening concentric circle of social
interactions around it. For 200 people to share a common space
requires at least a modicum of mutual respect. John expresses
this sentiment most clearly:
“I guess I just try to treat everyone how I would like to be treated,”
he says, expressing the golden rule as his core belief structure.
He also lives by the principle that “most people are good.” To
him, this means treating them according to the peak of their
goodness. Doing this for others, John is rewarded by
reciprocation. He says he likes that “No one bothers me
here.”
John creates a principle outline for the development of a respectful
community. For him, the first step is honoring other’s private
sphere of control and identity. Doing this himself, John
internalizes these values stemming from cues of the environment.
This, in turn, helps distill this mentality into the shared symbolic
atmosphere thus inducing others to follow the same pattern. By
admitting that no one “bothers” him, John is not suggesting that he
does not interact with people. Instead, he is invoking a sense of
respect for privacy shared by others. Edna expresses the
sentiment also.
Edna says that people are kind and respect each other’s privacy
here. They knock at closed doors before entering and respect
others’ choices for staying in. The way she sees it, the
residents all share a responsibility to keep the facility safe and
comfortable.
In her words, Edna places a greater weight on the common responsibility
of residents to honor the boundaries established by other
residents. Following these norms, interactions with others
becomes a balance of respect and care. All the people in the NRC
contribute to respecting the private spheres erected by others.
Typically, this sphere stems from the apartment, a space that other
residents honor with their behavior. Intruding into others’
apartments can be construed as disrespecting their privacy and by
challenging their control over this core sphere.
One of the key ways that people show this mutual
respect is through the displays outside each resident’s door.
Each room in all three facilities has a shelf or a ledge outside their
door. As I walk to each apartment, I notice that no shelf is
empty; every resident puts something outside his or her door as a
decoration. The items include paper flags, vases of fake and real
flowers, placards of the goodness of grandmas, figurines, Norwegian
embroidery and painting, and a variety of other minutiae specific to
each inhabitant. While no informant mentions these shelves, these
displays offer two symbolic cues. First, they are emblematic
signals of the character of the resident. Although the residents
do not mention the objects on these shelves in particular, they place
an emphasis on being able to define their apartment space through
material items. These shelves are an extension of that.
Just as the items within the apartment represent a fortuitous option
for choice, these items are similar representations. While a
small display, they are a microcosm of identity displayed through
goods. As such, they are valuable identity cues to people passing
through the hallway. In this capacity, they create a bridge
between the internal sphere of control and interaction with the larger
social circle surrounding this control center. This bridge is
also a connection of principle. Placing these items in an
increasingly common space indicates a level of trust. Residents
place the items in semi-public areas expecting their ownership to be
respected.
This trust extends beyond the display of goods. Residents also
trust each other to be responsible in maintaining the sanctity and
safety of the community facility as a whole. Evelyn demonstrates
this shared obligation:
“We are all responsible people,” she says. To her, everyone seems
to carry a sense of “protecting ourselves and each other.” She is
the first to mention locking external doors as a responsibility that
residents extend to others as common sense and kindness.
Molly, too, professes this as a grounding principle of community saying
“it is the responsibility of the people here too” to keep everyone
safe. She equally dispenses the obligation over the residents and
staff. An idea of community, then, develops from a shared social
norm of respect and responsibility. By accepting these norms,
residents act together to maintain the boundaries of the NRC.
These practices protect the social environment established within the
NRC from unwelcome external forces that might challenge the community’s
sanctified symbolic space, a site for self-expression and
control.
Windows across the Boundaries: Creating a Family
Yet the community means much more than this. As a retirement
facility, the NRC cultivates the type of community Hornum discusses in
her ethnographic study of long-term care residents. She uses
Turner’s development of
normative communitas, where, under the influence of time, the need to
mobilize and organize resources to keep the members of a group alive
and thriving, and the necessity for social control among those members
in pursuance of these and other collective goals, the original
existential communitas is organized into a perduring social
system. (Hornum 1995: 153)
This understanding of community suggests that its core is not an
obligation of responsibility, but rather shared interest in sustaining
people and helping them to thrive. Jared shares this sense that
community is more than simply fulfilling moral actions. He feels
“there is a genuine caring that people look out for each other.”
This sentiment shifts the concentric spheres in which residents
organize their lives. Caring for others indicates a deeper level
of interaction with people than simply managing safety. This
caring allows people into a different realm of connection. It
implies an intersection of spheres, an overlap of social
parameters.
For many residents, this social atmosphere of the NRC is a feature that
enhances their willingness to move into this new symbolic
environment. In his assertion that people should plan ahead,
Dennis cites the value of social connections:
Dennis and his wife moved to the NRC earlier than they intended because
an apartment opened up. Because of this, they feel they have had
opportunities to meet people and make new friends. Dennis
emphasizes that he thinks this is very important; people should move to
retirement facilities when they are still able to connect with
others. This will inhibit them from ever being isolated, ensuring
that their time in a retirement community is always enriched by
neighbors. While they have lived there, they have made many
connections with people. Dennis traces the “small world”
connections through past acquaintances to five or six other
residents.
The social connections are crucial features of life in the retirement
community for Dennis. In the event of illness, he suggests that
the NRC connections will be of utmost value to him. He moved into
the NRC still fully able to control his interaction in his social
sphere. By doing this, he hopes they will be able to sustain him
when his ability to control these spheres diminishes.
Consciously, he strives to orient himself to the symbolic space he
shares with others by encouraging the overlap of their secondary
spheres.
Once this social interaction is established, it becomes invaluable as a
source of caring attention. This sort of caring resonates in
Rachel’s experience of the NRC:
“Well, I’ve taken care of a lot of people in my life,” Rachel
says. She is not a nurse, but as a caretaker, a friend, she has
contributed to the care of many people. For that reason, she
finds it natural to share this same type of caring with others at the
NRC. She helps because “we get to be just like a family.
You can’t help but care. When they get sick you get sick
too.”
Rachel’s idea of caring for others moves beyond mentality to
actions. Being able to show others the sentiments in her heart
and receive their nurturing in return, Rachel identifies the social
situation as a “family.” Certainly a family mentality suggests
that the relationship between residents is more than a peripheral
awareness. A family structure creates a new definition of the
symbolic social environment residents share, one where the secondary
sphere of control is necessarily and willingly open to engagement with
others.
This sense of family emanates from others in the NRC as well.
Norah does not convey herself as the caregiver in the NRC “family,” but
expresses her conviction in this model:
“We become a family living here,” Norah explains. Through shared
experiences, things in common as an age cohort, and things in common as
life circumstances alter, Norah has truly appreciated this
community. She repeats that the community “feels like a family”
with neighbors and friends “watching out for [her].” During her
husband’s illness, these connections became increasingly
significant. As Norah became fatigued and drained by tending to
her husband, one of her neighbors noticed. As Norah left in a
rush one day, this woman made a point of offering her juice, a small
gesture that let Norah know someone was caring about her while she
expended so much energy to care for her husband.
Norah was the recipient of care illustrating the overlap of social
spheres. Even without being integrally woven into Norah’s daily
patterns, her neighbor could detect and respect her struggle.
Part of her neighbor’s awareness stems from her own parallel
experiences a few months before. These shared scenarios become
openings in this secondary sphere, ways that people are able to
intimately interact based on common frames of reference. The
symbolic environment of people with similar experiences enhances
residents’ abilities to negotiate, understand, and interact; the
process is more complicated among people with strongly divergent
symbolic cues from unparallel experiences. For example, there are
several widows or widowers living in the NRC. At least a few of
them value their ability to connect with others in a similar
situation. Marie shares her sense of security in these
connections:
When I come in, Marie is looking at a book with her husband’s name
emblazoned on it. Being in Parkview West made it easier to adjust
to her husband’s death. People in Parkview West “did what they
could.” The greatest contribution came from the sympathy of
people around her. There is a sense of shared grief among those
who have lost spouses or other close loved ones so people “check on how
each other are doing.” Marie has found it refreshing and helpful
to be able to talk and compare the stories and feelings of her
grief. When she gets to feeling a bit depressed, it helps her to
talk with other people and “find [she’s] quite normal.” The
depressed feelings she worries about are actually common among the
other survivors around her.
Marie is part of a community of shared grief ready, available, and able
to share and cope together. As Power’s study affirms, “the
intimacy of residents’ relationships did not prevent loneliness, but
the loneliness was shared as well as the pain of inevitable losses
along the way” (1995:188). While residents cannot alleviate
other’s losses, they can share the grief. Although she enjoys
spending much of her time in her apartment alone, Marie likes having
control over her ability to connect with people when she needs
support. At these times, she finds the community
invaluable. Norah shares a similar sentiment:
In her grief, Norah believes that it is “better to be in a place like
this. Outside, the world goes on. People take notice and
support you, but here people are often in the same situation. You
can handle everything a bit more slowly here; people here offer more
patience because they understand.” She is not alone. After
her husband passed, people asked if she planned to leave or stay.
The community and support answered for her: “I’m staying. It’s my
home.”
Norah makes a clear distinction between social interactions in and out
of the NRC. The sphere within the NRC becomes a source of
strength and comfort when the much broader external sphere proves
insufficient. The symbolic atmosphere of the NRC organizes
people’s experiences in similar ways. Because of this shared
organization of experiences, NRC residents are better able to support
one another in these elements of pain. Lydia even suggests that
the support system be institutionalized in the creation of a grief
group. This common pain becomes a window into even the center,
private sphere. As people feel they are losing control of this
sphere, losing the ability to control a distressing life, the mutual
support and understanding of other NRC residents becomes invaluable.
Still, this overlap does not impinge on the selectively permeable
boundaries of the inner sphere of control. Actually, this
selectivity is reinforced through social engagements. By creating
friendships, people admit some residents and not others into this
internal sphere of personal knowledge. Alfred and Evelyn still
actively control the passage of people into their internal sphere:
With several people, Alfred and Evelyn share a connection to St. Olaf,
an added reason that they were drawn to Northfield. With others,
they can trace their histories back to common friends, acquaintances,
neighbors, anything. They seem to value this sense of it being a
small world filled with people they can trust because they have all
gotten along with common acquaintances. Through this, they can
define themselves not as s strangers, but distant friends. They
are sociable people so they often invite others into their
apartment. While they can easily draw people into close
friendships, they find it is also easy to keep people at a distance
kindly, those that they do not connect with as easily or fully.
By choosing who to closely engage with and who to keep at a distance,
residents are able to control this secondary social sphere.
Furthermore, control is expended in how people adapt to the new
symbolic environment and how they allow themselves to be integrated
into the social fabric of the NRC. This integration is a balance
of trying “to retain a sense of personal freedom or autonomy at the
same time that they sought to retain and/or regain connections with
other people” in the community (Powers 1995: 191). As Norah says,
“you reach a level of comfort if you have the attitude to do so.”
She emphasizes that each resident makes a choice about how enmeshed
they desire to become in other’s social spheres.
Environment of Faith
Part of enacting these social connections stems from religious
conviction. Throughout the NRC there is a consensus of faith and
goodwill stemming from Christian religious beliefs. These become
a central facet of the symbolic environment of NRC residents.
Norah’s Christian faith guides her interaction with people and her
ability to connect with people:
Norah finds “opportunities every single day [to practice her faith]
because my life is oriented that way.” One of the most potent
ways she feels her faith is the “comfort, assurance of God’s presence
through people,” the kindness people show each other. “It’s hard
to think of anything that isn’t an opportunity” to share her faith
beliefs.
With this mindset, Norah’s social sphere becomes an extension of
Christian faith. She creates an unobtrusive control over the
essence of her connections with people by always holding her faith as
an organizing feature of her experiences with others.
For others, sharing faith becomes a core purpose in their
interactions. Lydia’s social interactions often revolve around
explicitly faith-based activities:
Lydia has helped establish a healing service presented in the NRC
chapel. She participates in Parkview East bible study. Each
week she joins her outside prayer group. These are just some of
the ways she actively practices her faith, striving to keep these
patterns in her life. Her faith becomes an active endeavor, one
that projects her conduct as faith-oriented.
The emphasis of her faith-driven activities becomes a framework she
controls for social interaction. She tends to allow her secondary
sphere to overlap with a wider ring of people at meal times and during
other activities, but only people who share this diligence of faith
gain entrance to her inner sphere of control. Amidst a new
symbolic environment filled with strangers, this diligent faith is one
way that she can exert a modicum of influence in determining with whom
she interacts.
Others exercise their right to choose not by selecting whom to interact
with, but by deciding whether or not to engage in social activity or
not at any given time. Marie often focuses on this dimension of
choice:
Rendering this choice, Marie believes she has “the best of both ways”
because she can choose to be alone or with others at her own
discretion. She has the “option either way” and she stresses that
these are her decisions.
Ultimately, this becomes a core decision that shapes her involvement in
social fabric of the NRC. Yet this expression of influence
affirms her own agency in shaping her own sphere of control and in
participating in larger sphere social interactions. She
determines when and how she will integrate people into her social
sphere.
The social sphere becomes a second concentric sphere beyond the main
personal sphere of control. Moving out from one level to the
next, residents surrender a bit of their control, yet gain valuable
social interactions with other residents. The interaction becomes
a trade-off, but one that offers more than ample rewards.
Residents still express much of their own control in determining how
and with whom they integrate their social sphere. Through the
shared symbolic environment, these connections often develop into
invaluable relations that help people cultivate a sense of
family.
Distinct Environments: Experiencing the NRC from the Wings to an Integrated Whole
As people continue to reference social interactions as inspiring a
sense of family, it becomes apparent that the social sphere each person
is alluding to is specific to their particular wing of the NRC.
Rachel calls Parkview East a family; Norah refers to Parkview West with
the same term. Edna finds the Manor to be a family. Jared
shares this sentiment with even stronger language:
“In the Manor, we are family, more so than the rest of the NRC.”
Tacit but seemingly indissoluble limits minimize even the potential
social interactions beyond these wings. Residents create an
ownership and a specific relationship to the other inhabitants of their
specific wing of the NRC. Outside the retirement community, aged
people define themselves by the company they keep, the circles they
move through, the spaces they inhabit. As it is for most people,
social spaces become identifying characteristics. In many ways,
the retirement community equalizes people. The social circles
that used to be prominent identifiers are diminished as people learn to
negotiate a new symbolic environment. Amidst this change, NRC
residents strive to find groups in which they can relocate
themselves. Part of this is accomplished by affiliating strongly
with a particular subset of the community. These smaller
communities “provide a more cohesive social environment” conducive to
building “supportive interpersonal relationships” (Sikorska 1999:455;
Zimmerman 2003: 12). As people try to reposition themselves, this
support network is essential and seemingly fostered more effectively in
smaller communities. In the NRC, these small communities are the
wings – East, West, and the Manor.
Each subsection of the NRC creates its own symbolic environment.
As Gubrium discovered by engaging nursing home residents at Murray
Manor, “a single nursing home might, from the points of view of its
participants, be several quite different organizations in practice....
[these] ‘worlds’…[are] separate and distinct, yet equally compelling”
(1995:26). Similarly, the NRC creates different “worlds” between
the separate wings of the facility. Spatially separated, the
sections cater to different clientele, thus naturally inspiring a
distinction. Parkview West is independent apartment living
offering the largest, newest rooms. The Manor allows HUD rent
subsidies and is an older, though certainly well-maintained,
area. It is oriented to be more strongly reminiscent of a typical
apartment building. These two have the most in common as
independent living spaces. Parkview East, as assisted living,
caters to a slightly more dependent cohort. As Herzberg concluded
from her study of the distinctions between two floors in one nursing
home, “social environments derive in part form the residents’
characteristics, such as the level of cognitive and physical
functioning. The environment also derives, however, from the ways
in which people are labeled” (1997: 79). Demarcated as a resident
of Parkview East carries the weight of this distinction, implying
decreased competency regardless of the accuracy of the
attribution. Similarly, Manor residents bear the label of
residency in HUD housing. This economic distinction
differentiates it from the other areas. Being labeled as part of
a symbolic environment may have an “impact on the resident’s
self-definition” (Herzberg 1997: 79). Through this self- and
wing-definition, these labels can also act as boundaries for social
interaction, encouraging residents to remain at this secondary
concentric sphere of interaction and influence.
Separate Spheres by Design and Choice
Interaction between the wings is the third tier of concentric
spheres. Its borders appear to be actively delineated and rigid
according to the spatial and social organization of the NRC.
Honoring these sharp boundaries, residents organize their own
experiences within the parameters of this sphere. The pattern
seems to diminish residents’ agency to determine the intermingling of
NRC wings. However, this organization of distinct symbolic spaces
may actually be the manifestation of the residents’ choices.
The symbolic environment promulgated by the NRC aids in this
distinction, reinforcing rather than creating the boundaries of these
concentric spheres. Not only are the wings spatially separate,
but movement between is facilitated only through one main indoor artery
or two main out door routes across driveway space. However, this
spatial separation merely contributes to the facilitation of social
distinctions.
The NRC offers a myriad of activities to promote
social interaction. From Sing-a-Longs to Bible Study to Game
Days, coffee hour to mealtime to movie nights, community spaces in the
NRC are constantly buzzing with a variety of activities. This
emphasis on social interaction distinguishes the NRC from many other
retirement communities. Rolf and Jared both express this
sentiment in reference to another local retirement community:
“Here we are more of a community rather than a collection like over there,” Jared notes.
To Rolf, the NRC seemed to provide more options, movement, activity,
even exercises rather than “just waiting for the black day.
Patients can participate.” Even people in wheelchairs are engaged
and wheeled down to events in the dining room, chapel, or elsewhere, he
notes aloud. “It is more like a little family.”
Distinguishing themselves from another retirement community, the two
residents notice a distinct pattern that encourages and enables people
to participate. From this social interaction, connections
develop. Residents become part of a community of people, a
“family” as Rolf reiterates.
While promoting this array of activities, residents still have some
control over who and what permeates their secondary social
sphere. For many like Rachel, the options are overwhelming:
Rachel chooses only those activities that she wants to join.
Sometimes she speculates that there is perhaps “too much going
on.” With her impaired vision, she just likes to take things easy
and so does not opt to participate in everything. “I have to cool
it sometimes because I get too upset,” she admits.
Since the activities are voluntary and not compulsory, residents
exercise their own authority to decide what they would most like to do,
what suits their interests and capabilities. Rachel is free to
decline participation in any activity. In this way, residents are
able to be selective about which social environments they interact with
and which they avoid.
The NRC does organize larger group entertainments enjoyed in the
chapel. These typically include musical performances or the
occasional speaker. While these activities draw residents from
all four sectors of the NRC, they typically do not inspire social
interaction or integration. Instead, they are organized to reach
each resident at their own level of interest and ability, intended
primarily to be personally enriching.
To find social interaction requires a more localized search.
While able to choose their activity, residents are largely induced to
stay within the boundaries of their wing for social engagement.
Most of these activities are site-specific. For example, each
wing offers monthly birthday parties but the celebration encompasses
only one wing. Similarly, each of the three wings hosts its own
story circle activities and each area has its own dining room.
This arrangement creates artificial boundaries between each wing and
diminishes residents’ abilities to choose their social atmosphere if
not their activity.
However, it is tough to determine if these boundaries are detrimental
to or vehicles for social integration into the NRC. Perhaps these
seemingly impermeable borders do not limit the choices of residents but
honor their aspiration to identify with a particular group in the
NRC. Given Herzberg’s (1997) premise that labeling people
according to their living environment facilitates related treatment,
the distinctions in name and intention of each space might establish
artificial boundaries between the residents. Evelyn, for example,
shares sentiments of distinction:
Evelyn sees people from the Manor, but says, “their place is different. We’re all connected, but different.”
This language connotes a clear and embedded awareness of separation
between the two wings. Her words echo an otherwise unspoken
sentiment of difference between the communities. While residents
offer no language of hierarchy between the wings, the labels shadowing
each one imply a sort of class structure. Based on a contingency
of finances and ability, distinctions between the wings become
apparent, as reflected in their largely divided social
environments. Within these unconscious categorizations, the
residents erect their own symbolic boundaries to parallel the spatial
confines of each unit. The symbolic environment is distinctly
different within each space. Under these auspices, the NRC may
not be imposing borders but actually effectively functioning to honor
the selectivity of borders developed by the residents themselves.
Role of the Councils
One of the ways the residents do express this as their will is through
the residents’ council. Both the Manor and Parkview West have
residents’ councils. Each is a conglomeration of residents
elected by the people in the specific wing; these elected few serve
their independent family communities. The two groups are
sponsored by and act for the independent wings. As a residents’
initiative, this illustrates their own construction of symbolic
borders.
The conduct of the two councils further delineates
the two wings by illustrating their divergent mindsets. Parkview
West just recently developed their resident council. Dennis
actively compelled the NRC to implement the council in West:
Even before the council, Dennis interacted with management. “I
give ‘em a hard time,” he says about the staff, grinning
congenially. Dennis pushed for a council because he wanted a
direct liaison with the administration. In some ways, he was
already filling this role, sharing things others mentioned with the
staff. Still, he wanted the residents to have a specific avenue
to address concerns, issues. While this added another tier of
bureaucracy or care, Dennis did not think there was an adequate route
to complain about people or situations and this would provide
that. “The administration was a little afraid of it,” he says,
but he pushed because the council would shrink the distance between
staff and residents. It could also start suggesting activities to
the new director.
In this description, the primary role of the council is to act as a
channel for connecting the residents to the management. More
accurately, it became a path for people to voice concerns and
complaints so that the management might address these issues. The
parameters of this organization may not be concretely set since it is
so new, but thus far other residents in West understand it as a venue
for complaints.
The Manor Council carries a more expansive
agenda. In existence for years, the Manor Council is more than
just a place to complain. Edna explains that the Manor Council
also cultivates social opportunities:
The six council members in the Manor sponsor social activities like the
monthly birthday party, potlucks, ice cream socials, mixers as well as
being a liaison to the management. Part of this organizing means
making people feel welcome and included and aware of the
activities. To do this, Manor residents are all very
congenial. Edna feels responsible for volunteering to make things
happen and to help people. When new people come to events, “you
squeeze people in” to tables, being welcoming and showing they are
wanted.
This council transcends the boundaries of the second tier “family”
social sphere and facilitates a mingling of residents. As
something the council and other residents feel responsible for, Manor
activities become agents of influence in the social sphere. These
activities become a reference of ownership. Because they are
exerting their influence to organize and participate in the Manor
activities, residents are more likely to engage, to allow the
permeation of their second sphere to intersect with others more
readily.
Parkview West encourages similar activities, but at the impetus of the
management rather than through the residents themselves. Without
this ability to claim the activities, residents’ primary extension of
control is to dissent and not participate. In this way, they
still harbor authority over the selectivity of their social
sphere. The Parkview West Residents’ Council also asserts the
authority of this unit as independent by extending site-specific
complaints. This becomes their primary work. This council
mentality demarcates a larger pattern of social interaction in the two
spaces.
Intersecting Spheres
Despite these intentional boundaries, all of these three sections come
together with the Care Center to create the Northfield Retirement
Community. This is the tertiary sphere of interaction. In
this space, residents exhibit the least control and therefore the least
interaction. This sphere becomes the domain of management.
At this level, management exhibits the same framework of care to all
residents. For example, the entire building is designed and
decorated to minimize the effect of being an institutional
setting. As Norah remarks, “it is furnished in a way that is
presentable.” She notes that the hallways are not given an
institutional look but the spaces “look like spaces you’d have in your
home. It’s just a homey setting.” The facilities are also
cared for with the same rigor and attention to quality in all
areas. The staff interacts in all the spaces even when the
residents do not.
Although residents do not organize their own experiences in the
tertiary sphere, this sphere nonetheless creates a symbolic environment
that infuses through all of their experiences in every sphere.
The predominant pervasive mentality stems from the core basis of the
NRC. As a nonprofit corporation based in the Christian tradition
with churches as the operative shareholders, this space resonates with
Christian tones that the residents can feel and appreciate. This
basis delineates an “ethos of service to the consumer rather than
profit for the owners” (Sikorska 1999: 455). For Jared, a
motivating factor in moving into the NRC is that it is a “Christian
home.” Dennis respects this ideological basis of the
management. He says the Christian aspect becomes “part of the
philosophy” of the board. Norah similarly recognizes this
Christian backing as a value, but one more visibly prevalent in action:
Norah believes that the NRC “makes it clear that his is a Christian
institution” in founding, ownership, and practice. She can tell
this is the mission and she thinks they make that clear. “If it
didn’t live up to it, there’d be comments” that it missed its
mark. The NRC lives up to these values simply in courteous,
faith-based practices without pushing the beliefs.
The Christian overtones become an organizing feature of how residents
experience the tertiary sphere of interaction. While they have
little influence in the structure of this symbolic environment, the
organization is desirable to them. They choose to come here
specifically for the Christian atmosphere. As such, Edna notes a
sense of common ground inspired throughout the NRC:
“Oh, I think it is because it is a Lutheran community. The
management and the residents are really friendly and warm because we
share the same values,” Edna tells me.
The Christian spirit seems to be an effervescent flow of values in all
tiers. While institutionalized by the management of the NRC in
the tertiary sphere of control, the mentality is shared at the
secondary level and internalized at the primary personal level.
Because it is present in these underlying spheres, residents appreciate
the mentality in the tertiary. In fact, the Christian spirit
becomes a respected and expected asset at all levels.
For the Catholic community at the NRC, this
Christian spirit becomes a means of creating a miniature community
across the spatial boundaries of wings:
As Bonnie notes, every week there is a gathering of the Catholic people
at the NRC, about twenty-five total from all the different
spaces. They have a prayer service or rosary. Many also
attend mass each Sunday at St. Dominic’s. The priest also stops
by fairly regularly, she tells me.
Through this forum, the sections of the NRC weave together to create
their own subset community of shared experience and faith. The
ability to practice this faith in a Lutheran community is a strong
benefit.
Interpreting the Care Center
Another asset for the NRC is the continuum of care provided on one
campus. This provides a sense of security for residents.
Some, like Dennis have greater experience with this provision of care:
Shortly after his move with his wife into the NRC, Dennis “lost contact
with himself.” It was at this point that they knew they were
supposed to be here, that this was an “answer to prayer.”
Immediately, he had care. Dennis spent some time in the Care
Center, and they both appreciate “the comfort of knowing caregivers are
right outside.” He is “pleased [they] made the decision.”
When needed, this nursing care is a blessing. It allowed Dennis
to receive the attention he needed while also keeping his wife
intimately included and connected in the experience. Having his
care on the same premises not only aided them in the crisis moment, but
also prevented them from being far apart during his rehabilitation in
the Care Center.
This promise of care is a desirable feature for many
residents. It is an added dimension of security. All the
apartments remind residents of the presence of skilled nursing care
just around the corner as they are equipped with two emergency pull
cords that will bring a nurse from the Care Center at any time.
These structures allow residents to feel a greater sense of security;
moving into a location that provides this care is an assertion of
controlling foresight.
Although a conscious decision that demarcates control, the Care Center
is not a place other NRC residents wish to reside. Several voices
provide evidence of this in varying tones:
Even amidst impairments that limit her ability to interact in larger
community circles, Emma says, “I don’t know where I’d move,” except to
the next step which is the Care Center and “I’m satisfied here.”
Alfred and Evelyn admit that they appreciate the security of having
more care readily available including other places to live if more care
is needed. Yet they both also state that they “dread the day”
they will have to live there. They would rather not leave
here. There is a next step “if needed,” but they pray that it
will not be necessary.
While the provision of security is key, residents disconnect themselves
from the prospect of living there, and largely even with interacting in
that area. The Care Center represents a different organization of
experience that threatens their spheres of control.
Lydia knows the threat of the patterns well.
She lived immersed in that symbolic atmosphere for a while following an
unexpected illness. While she is unable to move back to her home,
Lydia forced herself to rehabilitate enough to leave the Care Center:
Lydia was determined to move out of the single room spaces of the
“intensive care” area as she refers to the Care Center. To do so
required applying to East and being able to show a level of
competency. Lydia says this helps her “stay on the ball” as
living here is contingent on being able to provide a certain level of
self-care. I sense that even proving this competency has been
difficult for her. Throughout the interview she references
actions and behaviors that she would not like to do as they may risk
her chance to stay here.
While she commends the medical care attention she received, the Care
Center necessarily practices a more medicalized model of care. As
such, less attention is given to other aspects of resident
well-being. This is reflected in Lydia’s statement. Having
her own space and patterns allowed her to contribute to the symbolic
space rather than feel it impinging on her.
The symbolic environment of the Care Center is
externally appreciated as a less dynamic sphere, one not inviting the
full interaction of residents. While the medical care may be
necessary and helpful, the social care is presumed to be less
adequate. One example stems from Herzberg’s study of nursing home
residents with differing abilities. Herzberg found that roommate
relations, and even broader interactions, become strained when
residents paired together are of unequal cognitive or physical
functioning (1997:75). Simultaneously, residents develop a sense
of responsibility to their roommates. Roommates want to provide
support to each other, and “the inability to assist another resident
[leaves them] feeling ineffective and angry” (Herzberg 1997: 75).
The presence of a roommate therefore has the potential to disrupt this
personal sphere. In Parkview East, West, and the Manor, the
apartments are designed for individuals or married couples.
Fourteen rooms in the Care Center, however, are designed to be
doubles. This may in part explain the pervasive mentality that
residents in the other quadrants of the NRC hold against living in this
facility for a long time, if ever. Part of the distaste may
reflect an inability to establish a personal and spatial sphere of
control without the penetration of a roommate relationship.
The dimensions of this roommate scenario offer a greater pattern for
understanding why so many residents do not wish to live in or be part
of the Care Center. This facility symbolizes declining health and
with that declining control. Just as a Care Center resident would
be unable to care for their roommate, so too would they be losing the
ability to control their own care. While many residents like
Dennis have been able to regain their health in order to move back to
their Parkview or Manor apartments, others “are likely to encounter the
nursing facility as a final household” (Gubrium 1995: 33).
Residents must adjust to yet another symbolic environment. Within
this space, residents confront their own mortality and this mentality
of “the end” weakens resolve. Living there also carries
connotations of weakening control due to physical incapacity, a
symbolic state of existence to which residents must adjust. In
this capacity, the spheres of influence diminish so thoroughly that
residents have almost no control over even their private sphere.
These prospects are not desirable to residents already adjusting to
changed social spheres. Still, moving into an assisted or
independent living apartment first acts as a transition step between
community home and a nursing home. Through the Manor, Parkview
West, and Parkview East, residents are introduced to a common tertiary
sphere with eases movement between independent, assisted, and the Care
Center as health demands.
A mentality of isolationism is common as residents accept and maintain
boundaries around each separate wing, including the Care Center, an
area residents would rather not infiltrate as patients. Whether
inspired by the choices of the residents or shaped by the structures of
the NRC, the boundaries between these secondary spheres are only
meagerly permeable. Each wing shapes its own symbolic environment
and residents organize their experiences according to each shape.
The Fourth Sphere: Outside the NRC Walls
Residents may organize their experience within the
NRC according to the symbolic framework of their wing, but outside the
NRC, they participate in the symbolic space of the larger
community. Many NRC residents actively pursue activities and
connections beyond the facility. The objective of the NRC is to
provide a space that provides for residents’ physical, psychological,
and social needs. Through the provision of various activities,
nurses and medical aid, and options for creating social connections,
the NRC offers an image of self-sufficiency. Seemingly, it offers
everything a resident could ask for within only a few enclosed
acres. As Bonnie says, “Everything you need at this age is
provided or available in some way,” and this cuts down on
complications. Yet if everything could be contained in this
facility, if this were enough, why would the NRC offer a van service
into the Northfield Community?
While a complex social environment within the
retirement facility, the NRC recognizes the value and need for
residents to connect to the external community. As Scheidt and
Norris-Baker assert, “by continuing to be community residents, they are
able to maintain valuable psychological autonomy” (2003:58).
Their external interactions then become a facet of asserting control,
ability, and value in their lives. By maintaining previous
connections, the elderly situate their new sphere in relation to their
old sphere of symbolic patterns. As a fourth sphere of social
interaction, this layer becomes a site of interaction with the greater
community, the sphere that was previously their dominant atmosphere of
symbolic understanding. Now bounded by a myriad of logistical,
physical, and social borders, these interactions stem from two patterns
of social behaviors: NRC residents can choose to move into this fourth
sphere by entering into communication and interaction with the
community, or aspects of the community can permeate into the sphere of
the NRC residents.
Degrees of Connection
This first prospect, social interaction with the larger community
initiated by NRC residents, proves to be a prominent feature in the
lives of assisted and independent living residents. These
connections allow elderly people to look toward the future.
Fisher’s study on life satisfaction and successful aging suggests that
having “a sense of future is an important feature of successful aging”
and often emanates from a sense of “purposeful action oriented toward
some meaningful goal” (1995:240, 241). Often this involves
generativity, a personal sense of somehow leaving a mark and
influencing the world in a way that lingers beyond the limits of this
life. Powers affirms this desire to interact as “outside ties
continue to be important sources of support, [and] also, there is a
level of reciprocal and instrumental exchange” that determines the
value of connections for retirement community residents
(1995:186). Simultaneously, connections with people from the past
help residents maintain a sense of place in their previous symbolic
sphere. As much around them changes, as they adjust to a new
social environment, these connections to the past provide a sense of
continuity. These organizing dimensions of past and future
integrate to create behaviors in the present to maintain and develop
social relations. Despite the common impetus to interact with the
community, the social connections manifest themselves in a variety of
ways.
A large dimension of this variation stems from the ways in which people
enact their social interactions. From letter writing to attending
community events to visiting people, these potential contacts evince
varying degrees of connectedness for residents. The most basic
level is through letters and increasingly, emails. These two may
represent the lowest degree of connectedness because they do not evoke
an immediate connection between people but rather an interaction over
space and time. Simultaneously, letter writing may be a familiar
activity to this generation and therefore something they desire to
continue. Rolf, for example, has long been an avid writer and
maintains those practices of connection:
Rolf says he writes many letters. He says he has a long list of
correspondents. On his desk are several hand-addressed envelopes
with his name on them suggesting that his correspondents write back
with some frequency. He also has several papers on the table and
many pens and pencils in a cup – the tools for writing.
Similarly, Julie references her writing exchanges to illustrate their value:
Each year, Julie and her husband send Christmas cards to their friends
and family. In response, they treasure the holiday greetings
returned to them.
After leaving for a few moments, Julie returns with a letter. It
is from someone she interacted with in her job 30 to 40 years
before. The letter is a few years old and Julie mentions what a
treat it was to receive this letter. She mentions that she keeps
in contact with a few of these people, a few of the lives she touched
in her past.
This conscious effort to show evidence of her interaction with people
demonstrates its importance to her and the course of her life.
This letter writing is a form of productivity and emphasizes tangible
evidence of this creation. While this is certainly a viable way
of connecting to the community, the age of Julie’s letter suggests that
this method of interaction connects people to a lesser degree.
Perhaps this stems from changes in the symbolic sphere outside the
NRC. Younger generations are less apt to write letters and more
apt to choose the computer. This tendency is reflected in the
NRC. The community room in Parkview West offers two
internet-ready computers for residents. Many residents also have
computers with Internet access in their own rooms. They are
responsible for supplying these things, but for many the expense and
organization is well worth it. Julie is just beginning to
integrate this practice into her connections:
Admitting that she is not a very social person, Julie still likes to
maintain outside connections. When I stop by to interview her,
her husband, an avid emailer, is coaching her through the process of
her first email.
“It’ll be just a minute, she’s writing her first email,” he tells me by way of explanation.
“I’m done, but you’ll have to send it,” she calls from the computer in the den.
“No no, you’re going to send it too.” He winks as he walks away to help her with the final step.
While this new process of interacting proves a bit complicated for
people like Julie, it also opens up another avenue for connection, one
that indicates an active attempt to integrate themselves into the
symbolic spaces that predominate beyond the NRC.
Email typically decreases the barrier of time that
limits mail interactions, yet other methods are even more
effective. The next tier of interactions includes phone
calls. This practice allows instant linking by bridging time and
creating connection over space. This became an important way for
Bonnie to communicate during her husband’s illness:
She still has access to her phone – her primary way of keeping in touch
with people outside. She tries to stay well connected to all her
children, but during her husband’s illness she felt she did not have
enough time. Often she would tell the news to one child and have
him/her spread it. She also has a sister and brother in Arizona
she talks to weekly.
These telephone engagements became indispensable. As her
husband’s illness consumed her time and attention, the telephone became
a convenient way of interacting beyond the NRC without abandoning her
role there.
Through both phone and letter correspondence, NRC residents are
admitting a need to interact with people outside the NRC. In each
of these practices, the residents have complete control over whom they
target for interaction. They do not, however, necessarily have
complete control over who infiltrates into their sphere along these
paths. Junk mail and phone solicitations permeate just as they do
for people in outside living environments. Advocating their own
agency, residents can invoke some measure of control over these
channels also. Edna does this by screening calls:
As Edna and I are talking, her phone rings and she lets it go. “I
know what it is about - council stuff. They can wait,” she says
and continues our conversation.
Edna can choose how the phone is allowed to infiltrate into her sphere
by simply choosing whether to answer. This control is a valuable
asset in asserting her agency. Norah similarly enacts her freedom
of choice and autonomy through phone calls:
In the midst of our conversation, Norah’s phone rings. She pauses
to answer. After a few moments of her silence, she says, “I’m
sorry, I’m not interested and could you please remove me from your
calling list. Thank you,” and hangs up. She has just
authoritatively created a boundary of whom she will and will not allow
into her space. This telemarketer is unwelcome.
With clear assertion, Norah has established boundaries for
herself. She has determined how permeable she will allow her
sphere to be to the penetration of other outside community
influences. While connection to the community is valuable, some
facets do not provide any reward for residents. Interaction with
a telemarketer serves no purpose toward generativity and therefore
becomes an unfulfilling interaction for the residents. As such,
residents like Norah can take control of the situation and minimize
these intrusions.
However, taking control of these situations, even using these channels
- telephone, email, and letters - has limitations for elderly
residents. They assume a functional competency that not all
residents can achieve. For example, several residents with visual
impairment are unable to read the informed consent sheet I offer – I
must share the information orally. For Emma, this impairment goes
a step further:
Emma cannot read anything. When she gets mail, she stacks it and
waits for assistance. Her children come by to help her with her
mail and bills and anything that must be read. Her eyesight has
fallen so far that she can’t even use a reading machine, a device that
aids many of the other residents.
This physical limitation impedes her ability to interact through these
mediums. Instead, Emma relies on personal contact with people,
the third dimension of possible engagement with people outside the
NRC.
The third frame involves a complete transition across the boundary of
the sphere and into direct contact with people, diminishing the
limitations imposed by time and space. Movement of the elderly
out of the NRC includes visiting family, going out for meals with
friends, church attendance, and a variety of other activities executed
by residents. Each resident expressed a unique repertoire of
community activities to serve their diverse interests and needs; these
diverse channels are the ways in which elderly people are able to enact
this generativity in external social interactions.
Generativity in Service
Despite the diverse choices of individuals, there are patterns in the
shape of their selections. As an assertion of generativity,
residents in the NRC discuss various ways they volunteer to serve
others. This moves beyond the sense of lending a helping hand to
others in the NRC, to an active role of providing for others. For
John, this service behavior is an extension of his past behaviors:
“They didn’t leave me here to waste my time,” John says, smiling
broadly and leaning forward as he speaks of his children. Since
John can still drive, he visits a friend’s farm on a daily basis and
helps out. He knows the patterns of farm work and enjoys being
able to participate and offer assistance even at this stage of his
life.
These orientations of the past allow John to occupy familiar roles thus
maintaining a connection to his past. Yet this service is more
than providing for others; it extends social interaction in
return. John is nourished by the social connection to his fellow
farmer.
John’s particular kind of service is not necessarily
accessible to everyone. Impeded by the lack of driving prevalent
throughout the NRC, others are unable to serve in such tangibly social
ways. John is fortunate to still be a competent driver as this
ability opens greater opportunities for community engagement. For
others who have given up their cars or had them revoked from their
care, the lack of transportation acts as a limitation, a border that
limits their ability to penetrate the fourth sphere. Because of
this, residents experience a loss in choices and a loss in control that
often troubles them. “I can’t drive, so…” or “I gave up my car,
so…” became the catch phrases organizing this experience of
limitation. In response, the NRC offers a van service, yet the
hours are necessarily limited. While this increases and
encourages the permeability of the NRC sphere, it cannot supplant
autonomous mobility.
Residents more limited by a lack of transportation
still strive to serve others however. From within the NRC,
residents participate in service behaviors that extend to the larger
community. Molly is active in serving distant children:
Molly participates in a sewing circle that knits sweaters for children
in Appalachia. The project is called Operation Hope, an outreach
that serves the needy. Molly shows me a sample of the small
garments, proud of her work.
Marie, a fellow participant comments, that they get together to
“gossip, drink coffee, and knit.” Through the activity they “feel
[they] are doing something good,” something that has meaning outside
themselves and their immediate sphere.
Their experience connotes a wider circle of influence than is
accessible through John’s driving. This extension of aid over
space balances the diminution of choices and control outside the
NRC. This service also functions as a social activity for the
participants. It brings people together within Parkview West, the
second sphere of influence and control.
Yet other service activities can affect a sense of generativity through
interaction between the sections of the NRC. While people tend to
distance themselves from the prospect of living in the Care Center, it
becomes a viable site for community service:
Jared’s wife used to live in the Care Center. After her passing,
he has continued to volunteer there. He helps with activities
regularly, and goes on trips with the residents there to keep them
organized and help with walkers. His efforts become something
that shows care to others rather than simply self-serving gestures.
This conduct is again a direct interaction with people, offering
invaluable service. In this role, Jared holds a position of
control and authority compared to the other resident, by virtue of his
mental and physical capacity. In this role, he creates a
different sort of space for tertiary sphere interaction between the
wings of the NRC. Others choose to serve more inconspicuously:
Molly is part of a small group of people who help the NRC prepare
mailings and complete other small office tasks. This work, though
menial, becomes an asset to NRC staff.
This provision of service may only be seen by the NRC staff, but it
engenders a sense of satisfaction and meaning for those who complete
it. It is a service that exerts their control and choice.
Further, it suggests a loyalty to the NRC, a sense of ownership by
caring enough to want to promote it. Finally, it affirms the
competency of the participants and gives them a sense of value within
the management sphere of the NRC.
The Value of the Church Community
These service actions offer a significant contribution on various
levels of community. Through this avenue of community connection,
residents choose the activity they wish to engage in, which service
project they would like to promote. Ultimately, the interaction
revolves around an act of kindness toward others but it may or may not
engender an actual personal level of connection. One prominent
theme among residents was the desire to feel a community connection to
people. For several, this is achieved through participation in
community churches:
Lydia admits the importance of her religious connections as a
stabilizing force in her life. If it weren’t for her church, she
probably would have moved to live with her daughter out of state.
Yet the church helps her feel she has a home here. She used to be
a parish nurse; now, she is the recipient of that care. “I get a
lot of attention,” she admits with a sheepish grin. It seems she
would prefer to be on the delivering end rather than the
receiving. Still, the people from her church seem to care
immensely. They visit often, as does the priest. She says
he is wonderful and she is glad to be able to still attend her own
church services
Lydia’s church connection stems from before her move to the NRC.
As such, it offers a symbolic space that is familiar to her, one that
helps her locate herself within her new frames of references by
maintaining previous frames. Through this church, she maintains
some of her closest friendships:
Lydia is part of a prayer group consisting of members of her
church. This has been a standing tradition and has been a crucial
link for her; the people in it persist in being lovely to her, kind and
thoughtful and willing to show their love. She goes out with them
often for their weekly meal. This is just one of the ways she
actively practices her faith, striving to keep these patterns and
practices in her life.
This prayer group is a miniature version of the church community.
She is able to endure her new symbolic space and her health constraints
because she is supported through the intimate and faith-based
connections she maintains with this group. They encourage her to
move out of the NRC sphere and into the fourth concentric sphere of
community interaction in familiar and comforting ways. John’s
experience is similar:
John’s main community connection, the one that really helped him make
the decision to stay in Northfield all these years and through his NRC
years, is his connection with a local church. He sites Grace
Lutheran Church as a beneficial connection, one where he is able to
interact with people he has known for a long time, sustaining
friendships he values.
John’s experience similarly resonates with long-term affiliation
through friendships. While residents cite participation in a
variety of churches throughout the Northfield community, Grace has
become a bastion for attendees from the NRC. Part of this influx
stems from geographical proximity. Grace Lutheran is on the
property adjoining the NRC campus. It is a short walk in good
weather and a quick drive in bad. However, Grace is not a “home
church,” to all the people who now attend. Instead, it is a new
space of community interaction:
Edna attends services at Grace Lutheran regularly. While she has
gone to the services in the NRC chapel, she prefers the friendliness of
Grace, the friends she has and creates there.
For Edna, the people create the space. When she moves into this
fourth sphere of engagement, she is able to connect to and participate
in its community. Jared shares these sentiments toward Grace
Lutheran:
Conveniently, the NRC brought Jared close to church. Grace
Lutheran has become his site for religious services. It proffers
“an open and inviting atmosphere”. He likes being able to stay
connected to this institution and has an almost blemish-free attendance
record. He enjoys Pastor Ron immensely and likes to attend the
Bible Study he offers.
Jared values the patterns of the church as something familiar from his
past circuits of faith-based activities. The community at Bethel
becomes invaluable. Dennis agrees:
Dennis is also active at Grace Lutheran Church. He would like to do
more there, but already he participates in the men’s group and the
homosexuality discussions in the ELCA. He is also a Befriender at
church. Bethel appeals to them more than the chapel because it is
intergenerational and has wonderful music. They enjoy the pastors
and find them caring. They find “caring in the community”
overall.
Dennis’s expression summarizes the value of this location and church
communities in general for residents. Ultimately, these social
locations provide a site for interaction with an intergenerational
community. The current of shared beliefs enhances this
community. External churches provide a site for community
interaction, purpose, and caring that the NRC chapel does not.
While several people do attend worship in the chapel each week, it is
mostly for the sake of convenience. Their sentiments toward
chapel sharply contrast with the values share by Bethel members:
Rachel says she “loves the services” at the chapel and Pastor
Ryberg. “He is so cozy, so nice, so typical for elderly
people.” His sermons engage her and she likes most of the
hymns.
While certainly a positive endorsement for the NRC chapel services,
Rachel experiences in the chapel do not resonate with a sense of
community building. The services provide a spiritual experience
but not a community. This is not a congregation actively
organized to sustain itself and spread God’s word but a collection of
residents participating in familiar patterns and enacting ritual.
For members of Bethel Lutheran and other area churches, the services
themselves are valuable, but not the entirety of the value of the
church. Instead, the community of the church is invaluable.
This is another way that they can actively step beyond the perimeters
of the NRC into a different and fulfilling symbolic space.
Attending outside churches allows residents to move into this fourth
sphere of interaction in a way that satisfies their need to be part of
a community and perhaps even cultivate generativity through the members
whose lives they touch.
The Role of Family
Another primary manifestation of social interaction is through
connection to family. Most residents cite some family connection
as part of the reason they now live at the NRC:
Moving from a retirement community in the south, Alfred and Evelyn
decided they were too far away for their family members. They
chose family over climate.
Julie and her husband chose to come to Northfield because one of their
children lives here as well as much of Julie’s family in the
surrounding area. The emotional ties created a link to this
region as a supposed permanent future.
The decisions for these couples explicitly required relocation, but one
they willingly endured to be near family. Family becomes a source
of pride:
As Alfred and Evelyn talk, they state the things they are proud
of. One of their daughters is an artist and there is a picture on
the wall that she painted long ago. It was a gift to her father
many years before. She is apparently embarrassed that her father
still hangs it, but he likes it and is very proud of her for it and for
what has since transpired in her art career.
Molly as over 20 grandchildren. She gets to see her family on the
west coast once or twice a year; she likes to fly. As she talks
about her family, she directs me to look at a wall hanging her
grandkids made that and shared it with her. As she talks about
it, she almost cries; their presence in her life and their care for her
is deeply felt in her expressions.
With the immediacy of connection, family becomes a source of
generativity. Residents are in a position to give guidance and
care to the younger generation (Fisher 1995: 241). In this
capacity, younger, extended family members become increasingly
important in the symbolic environment of their elderly relatives.
They provide a crucial source of purpose for residents.
Beyond being a conduit of information to family,
however, elderly residents become increasingly physically reliant on
their families. When Bonnie and her husband moved here, she
recognized this dependence:
As Bonnie planned her move, she organized and discussed it all with her
local son. She needed him to commit because it would be added
weight on him. She considers she and her husband to be like two
more children.
This dependence is not just in physical endeavors, but children also
often become responsible for aiding the spiritual and emotional health
of their family members by providing meaningful outlets. Through
them, they are given not just choices and access to opportunities that
would not otherwise be available, but activities that prove meaningful:
Dennis’ son often picks him up to go to St. Olaf to workout, especially
to swim. He likes physical exercise but has no means of getting
anywhere to practice it without his son.
John’s strongest connection is to his children. His only daughter
in six children seems to be the one who visits him most often as he
cites their conversations often. He admits he sees more of some
than the others. In fact, one family is planning to stay with him
soon. His apartment is large enough to host them as they pass
through to their other engagements. This offers them time to
spend together, more time and convenience than would otherwise be
feasible. His sons help John stay active in things he otherwise
wouldn’t be able to pursue alone. “I have five boys to take me
hunting and fishing. Mostly I just go along and they do the
hunting, but I get to enjoy myself and get out a bit.” He smiles
broadly at this activity that is now an opportunity for leisure
interaction with his family members.
These interactions with family provide residents with a channel to move
into a sphere of greater interaction with the community. These
family members also represent a symbolic atmosphere familiar to the
residents and crucial to their adaptation to their space.
However, this family support may not always be fulfilled to the degree
desired by the resident. While residents can control their
efforts to engage their family members, they cannot influence the
actions of those in the fourth sphere, the larger community.
Rachel understands this predicament:
Rachel recognizes that she leans on her family more now. Still,
“they are busy people…” she admits while looking in the distance.
“I get to see them enough,” she finally concludes. As her
schedule opens to a vast array of freedom, she senses the tight
constraints on her family’s time.
This dependency on family confuses Nagy’s theory of family. In
his perspective, each generation cares for the next as a way of
repaying their caretakers (Plantinga 1995: 55). As elderly people
grow dependent on their children, this upsets the balance and leaves
adult children in an awkward place trying to maintain
equilibrium. Still, the expectation is reasonable from the
elderly as they are often unable to move into the fourth sphere of
social interaction with the larger community without the aid of their
family. Since many of the elderly people moved closer to their
family, they become the natural source of assistance as already
established connections in the fourth sphere of engagement. As
people adjust to this new social sphere, they rely on the people they
are familiar with and emotionally connected to: family. Impeded
by a lack of transportation, distance from friends, and medical
impairments, family members adopt a role of providing services to
mitigate these limitations and invite their elderly relatives, often
parents, into social engagement. They help diminish the barrier
into the fourth sphere and make it feasible.
Some people choose to diminish the barriers
themselves. Norah and Molly both willingly fly places to visit
friends and family. In this way, they take control of the
barriers imposed by distance and move beyond them to maintain an active
space in the fourth sphere of community interaction.
Inward Flow
Yet helping residents move into the symbolic environment of community
engagement is not the only way for them to interact with the fourth
sphere. The alternative method is for community people to
permeate into their sphere. This seems a less embedded practice
than that of elderly people moving into the external social
space. Perhaps that is because retirement communities in general
carry a social stigma. They are disengaging for many people and
even family members are sometimes hesitant to visit as they are
perceived as “institutional.” Bonnie experienced this wariness
first hand:
Bonnie’s son and husband were both pleasantly surprised by the NRC; it
is so different from the institutional vision of nursing homes people
tend to generalize. “It is like living in a small home.”
While the boundary between the two spheres is not impermeable to
external inflows, members o the outside community tend to create a
buffer that deters entrance; the border becomes saturated with stigmas
and stereotypes involved in the meaning of being
“institutionalized.” In response, the elderly people, aware of
their intense need to be involved in the community, simply move outward.
While still leery, family often become the primary
visitors to the NRC sphere. Visiting for special events or
regular interactions, family members visit because they are ultimately
a primary source of interaction with the external social sphere.
Whether they come to take care of mail and bills or simply to visit,
the residents are nourished by this interaction. They shape their
symbolic spheres to ensure their schedule is conducive to these
visits. In her declining health and increasing dependency on the
space of her apartment to maintain her status as an independent liver,
Emma is reliant upon people from the community coming into her sphere:
To aid her ability to participate in lifelong learning, Emma has had
young people come in to read to her. She also has her meals
delivered each day and outside people to clean her apartment. She
finds these interactions enjoyable.
These community representatives give Emma a sense of connection to the larger sphere without having to engage in it.
However, even these inflows are limited by the size of the apartments:
Edna had to prioritize to fit into the limited space. Further,
she has had to give up hosting gatherings. Her kitchen is too
small to cook quality meals and her apartment too small to host
people. Still, when she moved in, she knew and realized that
“you’ll give up space and stuff. You learn to balance.”
Because of the size, residents’ apartments are not conducive to having
large family gatherings or small children. While residents are
encouraged to use community spaces for gatherings, this spatial
constraint limits the influx of family and other outside
visitors.
Dual Role of Staff
Yet family and friends from outside are not the only inward flow from
the community. The NRC employs over one hundred people who move
almost imperceptibly across the border between community and NRC
spheres. Their role is a bit tenuous because they are so enmeshed
in both tertiary sphere of the NRC and act as windows to the fourth
sphere for residents. Still, the residents consider their
engagement with staff as a congenial interaction:
Norah says that interactions with staff help the NRC feel like
home. She appreciates that staff members do not intentionally
create a separation between residents and themselves. Instead,
she feels comforted by the fact that the “staff treats us like people”
rather than just a patient number or apartment number. Speaking
for everyone, she says of the staff “we feel they are our
friends.” The staff is very personable and personal. They
know each person by name and she respects this effort to truly engage
with them. She notes that even some of the servers are very
attentive, remembering if someone likes to have green tea and making
sure they get it. “They make an effort” and she values
that. Yet they provide more than just friendliness and
friendship. The staff members are also quite efficient. “If
you need them, they don’t bumble. She finds this conduct valuable
as something the NRC either trains or demands of the workers, or
something that it simply draws out of them.
These types of affirming interactions help residents to feel at ease in
their environment. By interacting with the staff as people, they
are engaged with the fourth sphere of interaction. As
ambassadors, the staff brings in the symbolic atmosphere of the
community when they come to the NRC. They share these ideas and
cues with residents. However, they are also fully embedded in the
social sphere of the NRC:
The interactions are friendly, but they are “like a teacher,” as Bonnie
puts it. “They cannot ever get too close because they have to be
impartial, they have their role.” Still, they make her life so
convenient.
The boundary they must create to do their job helps shape the symbolic
environment of the NRC. As such, they do not always carry just
the social sphere of the larger community, but define, maintain, and
maneuver the symbolic frames within the NRC. In this dual
position, what they bring into the interactions differs from that of
someone less integrated into the NRC.
Ambassador
In my interviews, I acquired this role. I became a welcome
outsider that over thirty residents were willing to invite into their
homes. This became an opportunity for residents to enact
generativity; they could participate as a way of leaving a mark in this
symbolic space. Almost all the interviewees asked me to elaborate
on how I planned to use their contributions. As I explained the
project, several mentioned their delight at being part of such a thing:
As I was leaving, Dennis wished me luck on paper. He was
delighted that someone was so interested in the lives of people
here. He was glad to be able to help.
Molly gave me a kind hug as I left, thanking me for listening and for doing a project like this.
Through this paper, my respondents have left a legacy of their
perceptions, ideals, and my interpretation of the symbolic space they
revealed to me. They are glad to be part of it because I brought
in an entirely new set of organizing principles from this external
tier. More than that, I carry the task of interpreting their
sphere and presenting it in another symbolic environment.
Yet these complexities of intermingling spheres
offer only a modicum of their willingness to participate. More
than the final product itself, I engaged these people and offered a
truly attentive ear from the external community. I crossed the
border of the fourth sphere into engagement with them, a step many
strangers from the community are not willing to take. Certainly
there are performers and speakers who come into the NRC, but largely
they are there to share their own stories or skills rather than listen
to those of the residents. I came into this space to interact
with them, to listen. As such, they appreciate my presence:
Emma gave me a hug, feeling my hair. “Oh, long hair… that’s nice. Come back again,” she tells me.
Norah walks me to the door of her apartment and says she hopes she’ll see me again.
Edna sees my family at church a few days after I have interviewed
her. She tells my mom that I was a delightful young girl and she
hopes I’ll continue to visit or at least be at church.
Doris tells me to come back again. She’s not sure if her answers
are helpful at all, but she’d be glad to see me again.
As I leave Rachel, she says, “I’ll be praying for a sweet girl like you.”
These kind sentiments reflected that I truly engaged these people
enough to have them enjoy my company and appreciate my presence.
With each hug or expression of kindness, I wished to extend the
same. This project allowed me into the private spheres of these
residents, the most strongly controlled core of their lives. I
feel blessed to have been permitted this level engagement and delighted
that it seems to have brought them enjoyment as well.
Summary and Conclusions
Situated in a retirement community, all of these
residents express commonalities. As people age, no rite of
passage indicates “a shift to new stages in the life cycle” (Hornum
1995: 153). Without this clarity, elderly people may occupy an
unstable liminal space. While this insecurity may not be the case
for everyone, “moving into age-segregated housing [may] actually
[facilitate] and [clarify] the steps necessary” for successful aging
(Hornum 1995: 153).
The NRC provides this opportunity for residents who need a space for
transition. The facility they inhabit is more than a building,
but a unique symbolic space created by the dynamic interplay of social
structures and personal frames. In this capacity, it organizes
their experiences in similar ways. By interpreting
and organizing life in the frames of concentric spheres, these
residents experience similar social interactions.
Yet the strength of this conceptual framework is that each resident
contributes to the shape, dimensions, windows, and boundaries of their
concentric spheres. At the NRC, each resident is allowed and
encouraged to exercise their right and ability to choose. Sharing
similar structural and symbolic spaces, residents express their
individuality through choice. This freedom provides avenues for
self-definition and expression of identity.
Channeling these expressions through the framework of concentric
spheres, the NRC strengthens both the space for a thriving shared
community and the space for expression of individual identity.
This dynamic balance allows greater quality of life for
residents. These spheres and the social and personal structures
that contribute to them help the NRC achieve its ultimate goal: this is
not an institution, but a dynamic, loved home and a place for
successful aging.
Works Cited
Albert, S.M., and J. A. Teresi.
2002 Quality of Life, Definition and Measurement In
Encyclopedia of Aging, vol. 4. D.J. Ekardt, ed. Pp.
1158-1160. New York McMillan Reference USA.
Fisher, B.J.
1995 Successful Aging, Life Satisfaction, and Generativity in
Later Life. International Journal of Aging and Human Development 41(3):
239-250.
Gubrium, Jaber F.
1995 Perspective and Story in Nursing Home Ethnography. In
The Culture of Long Term Care: Nursing Home Ethnography. J.N.
Henderson & M.D. Vesperi, eds. Pp. 23-36. Westport,CT: Bergin &
Garvey.
Henderson, J. Neil
1995 The Culture of Care in a Nursing Home: Effects of a
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Pp.37-54. Westport,CT: Bergin & Garvey.
Hornum, Barbara
1995 Assessing Types of Residential Accommodations for the
Elderly: Liminality and Communitas. In The Culture of Long Term Care:
Nursing Home Ethnography. J.N. Henderson & M.D. Vesperi, eds.
Pp. 151-164. Westport,CT: Bergin & Garvey.
Herzberg, S.R.
1997 The Impact of Social Environment on Nursing Home Residents. In Journal of Aging and Social Policy 9(2): 67-84.
Johnson, S., & Bowman, S.
2003 Elder care and housing. In Encyclopedia of Community:
From the Village to the Virtual World, vol. 2. K. Christensen
& L Levinson, eds. Pp. 427-430. London: Sage.
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vol. 3. Pp.1663-1683. New York: McMillan Reference USA.
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2001 Long-term Care and a Good Quality of Life: Bringing them Closer Together. The Gerontologist 41(3): 293-304.
Kane, Rosaline A., K.C. Kling, B. Bershadsky, R. L. Kane, K. Giles, H.B. Degenholtz, J. Liu, and L.J. Cutler
2003 Quality of Life Measures for Nursing Home Residents. Journals of Gerontology, Series A 58(3): 240-249.
Markides, K.S.
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“Northfield Area Chamber of Commerce.”
2004 Online. Available <http://www.northfieldchamber.com>
“Northfield Retirement Community.”
2003. Online. Available <http://www.northfieldretirement.org>
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2001 Introducing Social Geographies. London: Arnold.
Plantinga, Cornelius.
1995 Not the Way It’s Supposed to Be: A Breviary of Sin. Grand Rapids, MI: William B. Eerdman’s.
Powers, Bethel Ann.
1995 From the Inside Out: The World of the Institutionalized
Elderly. In The Culture of Long Term Care: Nursing Home
Ethnography. J.N. Henderson & M.D. Vesperi, eds. Pp. 179-196.
Westport,CT: Bergin & Garvey.
“President’s Office: St. Olaf Mission Statement.”
2003 Online. Available <http://www.stolaf.edu/president/guidingdocuments/mission.html>.
Scheidt, Rich J. and Carolyn Norris-Baker.
2003 Many Meanings of Community: Contributions of M. Powell
Lawton. Journal of Housing for the Elderly. 17(1-2): 55-66.
Sikorska, Elzbieta.
1999 Organizational Determinants of Resident Satisfaction with Assisted Living. The Gerontologist 39(4): 450-456.
Strykes, S.
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vol. 5. Pp. 3095-3102. New York: McMillan Reference USA.
Vesperi, Maria D.
1995 Nursing Home Research Comes of Age: Toward an Ethnological
Perspective on Long Term Care. In The Culture of Long Term Care:
Nursing Home Ethnography. J.N. Henderson & M.D. Vesperi, eds.
Pp. 7-21. Westport,CT: Bergin & Garvey.
Zimmerman, S., Scott, A.C., Park, N.S., Hall, S.A., Wetherby, M.M., Gruber-Baldini, A.L., & Morgan, L.A.
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in Residential Care and Assisted Living. Social Work Research 27(1):
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Appendix A: RECRUITMENT LETTER
(bolded statements are meant to break up the long text and highlight significant points for the reader)
Dear Northfield Retirement Campus Resident,
I am a student at St. Olaf College. I was born and
raised in Northfield. I want do a study to find out what
Northfield Retirement Campus residents think and feel about the quality
of life here. This will help me to fulfill a requirement for my
research methods course in my sociology and anthropology major taught
by Professor Carolyn Anderson.
I would like to invite you to participate in my
study by allowing me to interview you. I am interested in
exploring the qualities of the retirement community that both
positively and negatively influence your quality of life here. I would
like to conduct interviews to ask questions about your experience
living at the Northfield Retirement Campus. During the
interviews, I will be taking notes, but your answers will be recorded
in no other way. I will also be noting some of the spatial
features of the Northfield Retirement Campus.
I have explained my study to Tom Nielsen, Director
of Operations of the Northfield Retirement Campus and received
permission from him. He has also approved this letter and the questions
I intend to ask you.
The interview will take about an hour of your time. I will ask you to
reflect on the positive and negative aspects of living at the
Northfield Retirement Campus. I will use my notes from interviews and
observations to write a paper that will be available to you and the
Northfield Retirement Community staff. I hope the insights
therein will be valuable both to residents and staff.
I will take the greatest of care to make sure your responses remain
confidential. This means that I will not disclose your participation in
this study to anyone else or include any information in papers,
presentations, or discussions about my project that would allow someone
else to identify you. If at any time during the interview you would
prefer not to answer a question or to stop the interview completely, I
will honor your wishes.
If you are willing to participate in my study, please fill out and
return the enclosed response form to me in the stamped, addressed
envelope. You may also call me or e-mail me
I am very excited about the possibility of talking to you personally
about your experience as a resident of the Northfield Retirement
Campus. I hope that you will decide to participate. Thank
you!
Laurie Moberg
school: (507) 646-2711
home: (507) 663-0724
mobergl@stolaf.edu
Appendix B: RESPONSE FORM
Dear Laurie,
I received your letter about participating in your study on perceptions
of quality of life of elderly people residing at the Northfield
Retirement Community. I agree to be interviewed. Please contact me.
NAME: _____________________________________
PARKVIEW WEST UNIT NUMBER: _____
PARKVIEW EAST UNIT NUMBER: ______
NORTHFIELD MANOR UNIT NUMBER: _______
TELEPHONE NUMBER: _______________________
GOOD TIME TO CALL: _________________________
Appendix C: TELEPHONE CONTACT PROTOCOL
Hello, Mr./ Miss/ Mrs. _______________________________. This is Laurie
Moberg, the St. Olaf College student who sent you a letter about
participating in my study on perceptions of quality of life at the
Northfield Retirement Center. I received your response form (telephone
message, e-mail message) telling me that you are willing to be
interviewed. The interview will take about an hour.
When could I plan to interview you?
Would you like me to come to your home, or would you prefer to meet with me __________________?
Thank you. I will see you on __________ at _______________ (date and
time). I may call again to remind you to expect me at this time.
I am really looking forward to talking with you.
Appendix D: Letter of Informed Consent
Thank you so much for agreeing to take part in my project for a
research methods course required for my major in sociology/
anthropology taught by Professor Carolyn Anderson, who is supervising
my project. My project is about perceptions of Northfield Retirement
Campus residents about their quality of life, and I will be
interviewing twelve residents. I will be asking you a number of
questions about positive and negative aspects of living here, and the
interview will take about an hour. I will write a paper that will be
available on the sociology/ anthropology department web site, and I may
present a summary of my findings at a professional sociology or
anthropology conference.
I will protect your identity and the confidentiality
of the information you give me. This means that I will not disclose
your participation in this project to anyone else or include
information in any papers, presentations, or discussions about my
project that would allow someone else to identify you.
I hope the results of my study will contribute to
the discussion and understanding of what contributes to greater quality
of life for senior residents of the Northfield Retirement Community. My
final paper will be available to participating residents and NRC staff.
Your participation is completely voluntary. You may
decline to respond to specific questions, or you can stop the interview
at any point. If you change your mind about allowing me to use your
information after the interview, please let me know by May 1, 2004.
Do you have any questions? Thanks again for agreeing
to be interviewed. I am anxious to hear your responses to my questions,
but before we get started, would you please sign the following consent
form?
INFORMED CONSENT FORM
I certify that I have had the nature and procedures of this study on
Perceptions of Quality of Life of Elderly Residents at the Northfield
Retirement Campus explained to me. The interviewer, Laurie Moberg, has
described the potential benefits and risks of my participation in this
study, and has informed me that my responses will be kept confidential.
I have received a written copy of the information she provided me. I
also understand that I may withdraw from this study at any time on or
before May 1, 2004.
Date ______________________ Signature ___________________________________
CONTACT INFORMATION
IF YOU HAVE ANY QUESTIONS, OR WISH TO GET IN TOUCH WITH THE INTERVIEWER
OR THE PROJECT SUPERVISOR FOR ANY REASON, PLEASE DO NOT HESITATE TO DO
SO.
Interviewer
Laurie Moberg
St. Olaf College
1500 St. Olaf Avenue
Northfield, MN 55057
school phone: (507) 646-2711
home phone: (507) 663-0724
mobergl@stolaf.edu
Project supervisor
Professor Carolyn R. Anderson
Department of Sociology and Anthropology
St. Olaf College
1520 St. Olaf Avenue
Northfield, MN 55057
Telephone number: (507) 646-3133
E-mail address: anderscr@stolaf.edu
INTERVIEW QUESTIONS
The topics involve questions of comfort, security,
meaningful activity, relationships, enjoyment, privacy, dignity,
autonomy, and spiritual well-being, based upon previous social research
models (Kane 2003: 241).
General
1. How long have you lived at the retirement center?
Spatial/Emotional Comfort
2. What makes you feel at home here?
3. What could be done to make your feel more at home?
Probes: What do you like/dislike about your apartment?
What do you like/dislike about the facility?
What do you like/dislike about the grounds?
Do you enjoy living here?
Security
4. How secure do you feel here?
5. I notice that the entrances to the facility are all monitored. How do you feel about this feature?
Meaningful Activity
6. What activities do you enjoy that are offered by the NRC?
7. What other activities would you like to see offered?
8. What type of activities do you do on your own?
9. How often do you participate in activities away from the NRC?
Relationships
10. What kinds of relationships do you have with other residents?
Probes: How about close friendships with other residents?
How about disagreements with other residents?
How about visits from other residents in your home?
How about visits to other residents’ homes?
Do you enjoy interacting with people in community spaces? Tell me about that.
11. Describe your interactions with Northfield Retirement Community staff members.
Probes: What kinds of positive interactions do you have with staff members?
Have you had negative interactions with staff? (What made them negative?)
Have you ever felt you wanted to complain about the staff? What did you do?
Have you every wanted to challenge someone on the staff? What did you do?
12. How well do you stay in touch with friends and family outside the NRC?
Probes: Who visits you? How often?
Who calls you on the phone? How often?
What opportunities do you have visit people outside the community?
Are there times when you are aware of being alone too much?
What do you do when you feel that way?
13. What helps you to cope when a friend or family member passes away?
Privacy/Dignity
14. Do you have a roommate? What is your relationship like?
Probes: How well do you get along?
What are the positive aspects of sharing a room?
What are the negative aspects?
15. How well do you feel your privacy is respected?
Probes: How well do you feel you can entertain visitors privately?
How well can you keep possessions private?
Autonomy
16. How did you decide to move to the NRC?
17. Do you feel your independence is limited?
What do you feel limits your independence?
Probes: To what extent do you feel you are able to leave as you wish?
To what extent do you feel you control your own schedule?
Spiritual Well-being
18. What opportunities do you have to practice you religious beliefs?
19. How do you enjoy services in the chapel?
General – concluding
20. Overall, what aspects of living here do you like the best?
What aspects do you like the least?
21. What would you change if you could?