Material Citizenship: An ethnographic study exploring object–person relations in the context of people with dementia in care homes

Abstract

Materiality has become an increasingly important topic in sociological studies of health care. How objects support the identity of people with dementia in care homes is an emerging area. While early research has tended to focus on sentimental or cherished items (such as photographs or keepsakes), the present study focused on functional objects (such as curling tongs or a hairdryer) as a mechanism to actualise citizenship. This article presents findings from an ethnographic study into the everyday experiences of people with dementia living in a residential care home in southern England. Drawing on a framework analysis of observations of daily life, object‐elicitation interviews with residents, in‐depth interviews with staff and relatives and documentary research, the findings demonstrate that object relations are a critical but overlooked site for citizenship. Residents are rarely involved in decision‐making relating to their personal possessions, lack control over objects and are often discouraged from material interactions important to the maintenance and cultivation of identity. We introduce a new concept ‘material citizenship’ to advance thinking and practice in this area and argue that it is valuable for care practices to combine a material citizenship approach with existing care practices; thus, elevating the importance of object–person relations in dementia care.

Good practice in the provision of care for people living with dementia in nursing homes: a systematic review

“…Of the 30 studies included in the review, 16 were qualitative descriptive studies,(13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28) 11 were cross-sectional studies,(28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38) 2 were mixed methods studies,(39, 40) and 1 was a cohort study. (41) Participants included people living with dementia, relatives, staff working in nursing homes, experts in dementia care, administrators and lawyers.…”

“…Settings were described as nursing homes (n=20), residential care facilities (n=3), dementia care unit (n=3), care homes (n=2), assisted living facility (n=1) and hospital or nursing homes specialised in palliative care (n=1). Studies were conducted in Australia (n = 8),(15, 16, 17, 26, 28, 30, 40, 42) USA (n = 6),(14, 20, 24, 33, 37, 43) UK (n = 5),(19, 20, 21, 39, 42) Norway (n = 4),(18, 23, 27, 29) the Netherlands (n = 2),(31, 35) Denmark (n = 2),(22, 25) New Zealand (n=1)(42) Sweden (n = 2),(34, 36) Canada (n = 1),(32) Northern Ireland (n = 1),(31) Indonesia (n=1)(13), South Africa (n=1),(42) and Malaysia (n = 1). (41) Two of these studies were conducted in multiple jurisdictions.…”

“…It addresses a number of themes identified in this systematic review (table 1) and illustrates how these can be implemented into practice. The themes addressed in this vignette include: person-centred care,(14, 28, 35, 40, 41, 44) cultural impact,(28, 42) meaningful engagement,(19, 20) eating and meals,(30, 32) the role of family members,(14, 17, 30, 31, 35, 42) restrictive practices,(25, 26) psychotropic medication,(25, 26) materials,(21) end of life care(31, 33, 36) and staffing. (16, 17, 31, 33, 45) Niamh is the registered provider of a 30-bed purpose-built nursing home facility.…”

“…This vignette provides examples of quality dementia care from a resident’s point of view. It covers the following themes: determinants of quality care (13, 15, 16, 30, 37, 38, 39), outcomes (18, 30, 39), person-centred care (14, 17, 18, 28, 32, 35, 41, 44), cultural impact (28, 42) care planning (17, 29, 39), meaningful engagement (19, 20), eating and meals (30, 32, 46), the role of family members (15, 17, 31), restrictive practices (26, 30, 38), activities (15, 18, 25, 27, 28, 34), materials (21), health care (14, 23, 31, 40), end of life care (31, 33, 36), staffing (16, 17, 24, 31, 33, 42, 45) and staff training (14, 16, 17, 20, 24, 31, 41, 42).…”

“…(24,26,30,38) Additional resources, resident participation, structured care planning, risk management processes and integrating residents into the community are essential for overcoming these barriers. (21,24) Challenges in providing high quality care for residents with dementia in nursing homes included staff shortages which often forced staff to prioritise task-based duties,(28) High work-loads also impacted meaningful engagement with many staff feeling constrained by having other tasks to do and having other residents to attend to. (19,20) Staff also experienced challenges associated with shifting mind-sets from generalised to personalised care, which in practice disrupted social norms for nursing home staff.…”