Care, work and contradictions : experiences of dementia care in residential settings

Abstract

This thesis is an exploration of dementia care from the perspective of paid carers who care for residents assigned to dementia programs. It set out to understand the links between the social context of care, the care practice that takes place and the outcomes of care practice for residents. A critical theoretical understanding of old age, residential care and dementia care influenced the conceptual framework for the study and the interpretation of data.To understand the context, perceptions and outcomes of dementia care, a qualitative research approach, using a multi-site design and multiple methods of data collection was used. Fifteen care staff working in dementia programs in seven residential care settings and administrators in each setting were interviewed. Observations were made of social interactions and care processes in dementia programs. Levels of physical and mental impairment of the residents who attend dementia programs were assessed by way of residents' medical records and a formal assessment scale.From the study, it is suggested that dementia care involves complex social and political processes. The social context in which dementia care takes place constrains both care staff who work in dementia programs and the residents in their care. The experiences that care staff have of dementia care reflect their position within the Homes and a number of contradictions and dilemmas involved in care work. There are implications which arise from the study for the way that care and dementia are conceptualised in society, and for existing assumptions that underlie attitudes towards paid carers and their training needs. Recommendations for a critical understanding of dementia care and a broader perspective on training for paid carers are outlined.