Place, policy and practitioners: On rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the UK

Orchestrating home

“…The notion of therapeutic landscape has since been employed to study experiences of healing, recovery, health, and well-being across a variety of settings (Gesler 2005;Williams 1999Williams , 2007, including hospitals and clinics (Curtis et al 2007;Wood et al 2013), respite centres (Conradson 2005), hospice day care locations (Moore et al 2013), community gardens (Milligan et al 2004), yoga studios (Hoyez 2007), and places of day-to-day routines such as home (Dyck and Dossa 2007;English et al 2008;Martin et al 2005;Williams 2002). These studies highlight how 'physical and built environments, social conditions and human perceptions combine to produce a [therapeutic] atmosphere' (Gesler 1996, 96).…”

“…This relational aspect of therapeutic landscapes means that they are actively produced through their physical design (see for example Curtis et al 2007;Wood et al 2013), discursive construction (for example, Hoyez 2007), and/or situated activities and practices (see for example Dyck and Dossa 2007;Laws 2009). How these social processes interact with the physical, social, affective, or symbolic properties of a place dictates whether or not the place is experienced as a therapeutic landscape (Conradson 2005;English et al 2008;Martin et al 2005).…”

“…In its ideal form, home is considered a safe, protected place where individuals feel in control and are able to express a sense of self in an intimate and supportive environment (Milligan 2009;Warren 2009). It is often contrasted with institutional settings (Martin et al 2005), although such settings can be therapeutic landscapes if their design and activities produce a sense of home (Moore et al 2013;Tyreman 2011;Warren and Manderson 2008). Home is more than a symbolic representation of self, as various embodied and affective performances and practices take place within the space (Blunt 2005;Foley 2011;Yates-Doerr and Carney 2015).…”

“…In Australia, most rehabilitation following intensive in-hospital treatment now takes place domestically, provided largely by informal (and thus un-or underpaid) carers, with some support from formal (paid) care services (Anderson et al 2000;Dollard et al 2004;Dow 2004;Dow and McDonald 2007;Mayo et al 2000;Pearson et al 2012;Walters et al 2010). In such arrangements, home-based care is perceived -at a political and a local level -as both cost efficient for public health care systems and beneficial for the well-being of the patient (Martin et al 2005;Williams 2002Williams , 2004. Policy makers, health care providers, and the broader community see family members as integral to this notion of home as a preferred site of care, and over the past three decades they have introduced significant initiatives that rely heavily on family members providing the bulk of care (Dow and McDonald 2007).…”

Interaction between clients and physiotherapists in group exercise classes in geriatric rehabilitation

“…Emphasis placed on physical safety during rehabilitation has been found to discourage independent daily activity and reinforce passivity (Ballinger & Payne, 2002). Furthermore, much of activities during the rehabilitation have been found to adapt patients to the norms, expectations and values of the institution (Hart, Lymbery, & Gladman, 2005), which have been suggested to undermine the primary purpose of rehabilitation (Martin, Nancarrow, Parker, Phelps, & Regen, 2005).…”