“‘Call Security’: Locks, Risk, Privacy and Autonomy in Long-term Residential Care”

Abstract

Locked doors and secure units are often used as a solution in long-term residential care (LTRC) for residents with moderate to severe dementia who are at risk for wandering and potentially harming themselves or others. This practice creates important quality of life implications for residents as well as for employees. In this paper we explore broader assumptions, connotations and possibilities of LTRC built environments by comparing and contrasting the use of and philosophies regarding the locking of doors and entire units in facilities that maintain this practice to those that have open doors, open units and other accessible physical spaces. This sub-study is part of a larger international, interdisciplinary study that uses rapid site-switching ethnography within a feminist political economy framework to investigate promising practices in LTRC. Field observations and interviews with management, health providers, support staff, informal care providers, union representatives, residents and family members were conducted in 27 sites, 10 of which we elected to include for the purpose of this paper, located in Nova Scotia, Ontario, Manitoba, and British Columbia (BC), Canada, as well as Norway, Germany and the United Kingdom (UK). Locked doors and units, and inaccessible physical spaces affect the balance between “home” and “institution” in LTRC facilities in numerous ways including privacy, mobility and autonomy of residents, the ability to remain socially connected within the home, possibilities of integration with the larger community and overall quality of life and care.