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In the following study, I examine the experiences and dynamics of gender norms in an old age care home setting in England. The care home aims to provide comprehensive care to older adults, encompassing their physical, emotional, and social well-being. However, existing literature on old age care often overlooks the social and gendered dimensions of care, focusing primarily on the medical aspects of ageing. This research seeks to address this gap by delving into the intersection of gender constructs and the experiences of well-being and dignity among care home residents.

Drawing on theoretical frameworks such as Raewynn Connell's theory of gender and power, Julia Kristeva's theory of abjection, Erving Goffman’s front-and-back stage, and Sara Ahmed's ‘affective economies’, I take a constructivist understanding of gender and age to shed light on the care home context's complex relationships and social dynamics. Ethnographic research conducted during the summer and autumn of 2021 provides a rich understanding of the daily life experiences and voices of old-age residents as well as care workers, uncovering the intricate ways in which gender and age intertwine to shape interactions and the expression of gender identities within the care home environment. This dissertation predominantly uses data in the form of field notes derived from participant observation with both care home residents and care workers, as well as some interviews with care home residents.

The main findings from this research highlight the impact of gender norms on the experiences of both residents and care workers, demonstrating that the care home environment can reproduce and intensify norms that limit and facilitate social interaction and this has a direct impact on social life and belonging in the care home. By exploring the intersection of age and gender, this study challenges reductionist attitudes towards older adults and offers valuable insights into future research on care and old age. I also highlight the ethical considerations involved in caring for older adults in residential settings. Through the study's findings, we gain a deeper understanding of the diverse experiences of care home residents and the implications of providing compassionate and inclusive care.

By bringing to light the interplay of age and gender constructs through a lens grounded in theoretical frameworks and ethnographic exploration, this research contributes to ongoing efforts toward a more holistic and compassionate approach to care for older adults. Findings from this study highlight the imperative to foster an inclusive and empathetic caregiving ethos that honours the diverse experiences of older adults, contributing to the ongoing dialogue on the social dynamics of care and the profound implications for the well-being and dignity of those residing in care homes. Due to its context-specific analysis of this particular care home, with the incorporation of detailed case studies, this study's unique contribution lies in offering a rich account of gender dynamics in caregiving within the care home setting. This study offers insight into the future benefits of ethnographic research in residential care settings, the beneficial relationship between humanised care and research ethics, as well as the symbiosis of ‘caring care’ and ethnographic methodology

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‘MALE MAGNETS’, ‘FIRECRACKERS’, AND ‘FUSSY ENGLISHMEN’: AN ETHNOGRAPHICINVESTIGATION OF THE INFLUENCE OF GENDER NORMS ON WELL-BEING IN AN ENGLISH CAREHOMEByJayme TauzerA thesis submitted for the degree ofDoctor of PhilosophyFaculty of Health, Education and Life SciencesBirmingham City UniversityMarch 2024DeclarationI declare that this thesis is my original work and has not been submitted elsewhere for theaward of a degree. Any sources used in this thesis have been appropriately acknowledged. Ifurther declare that any contributions made by others to this work, including any jointauthorship, have been clearly and fully acknowledged and disclosed in this thesis.1AcknowledgementsFirstly, I would like to thank my supervisors, Professor Fiona Cowdell, Dr Kristina Nässén, andProfessor Robert Smith, for their guidance and encouragement throughout this researchjourney. Your insightful comments and constructive criticism have been instrumental in shapingthe direction and scope of this project. I would also like to thank the faculty and staff of Health,Education, and Life Sciences (HELS), at Birmingham City University, for providing a supportiveacademic environment that facilitated my research and progress.Many thanks go to the InnovateDignity team, who provided training and professionaldevelopment and a focus on becoming a leader and voice in the field of care sciences. Thankyou for showing flexibility and strength in guiding us to adapt together through the manychanges our project saw over the years. I would also like to acknowledge the support providedby the Horizon 2020 Marie Sklodowska-Curie Action (MSCA), which allowed me to conduct thisresearch and present my findings at international conferences. Special appreciation for myfellow ESRs, the only people in the world who could understand the challenges of developingour research careers in an international and interdisciplinary setting at the peak of a globalpandemic. Hats off to my PhD rock, Emma Balkin.The irony of studying care relations at a time when we globally experience a collective lack ofboth is not lost on me. I am incredibly fortunate for the unwavering support and commitment ofmy wonderful family and friends throughout this endeavour. I am an especially lucky recipientof Santiago's daily kindness, humour, and care. Special thanks to the friends who are also peereditors—to the eloquent Jules Reich for her attentive emdash perfectionism and to DanielTalamantes for the particularly skilful reading of my work, cultivated from years of reading,writing, and thinking together.I am grateful to the care home that graciously hosted this study. This was not merely a researchsite, it was a temporary home. From providing me with a living space, supporting my comfortand practical needs throughout the study, fixing my first ‘chip butty’, and bringing me to thelocal pub to root for England in the World Cup, your hospitality has far exceeded myexpectations.And finally, I extend my deepest gratitude to the participants of this study, both care recipientsand care workers, for their willingness to share a bit of their world with me. Holding space withyou and exploring this dissertation's topics together has been a privilege. Thank you forwelcoming me into your homes and your busy work spaces. I am honoured to share your storieshere; I hope I have done them justice.2AbstractIn the following study, I examine the experiences and dynamics of gender norms in an old agecare home setting in England. The care home aims to provide comprehensive care to olderadults, encompassing their physical, emotional, and social well-being. However, existingliterature on old age care often overlooks the social and gendered dimensions of care, focusingprimarily on the medical aspects of ageing. This research seeks to address this gap by delvinginto the intersection of gender constructs and the experiences of well-being and dignity amongcare home residents.Drawing on theoretical frameworks such as Raewynn Connell's theory of gender and power,Julia Kristeva's theory of abjection, Erving Goffman’s front-and-back stage, and Sara Ahmed's‘affective economies’, I take a constructivist understanding of gender and age to shed light onthe care home context's complex relationships and social dynamics. Ethnographic researchconducted during the summer and autumn of 2021 provides a rich understanding of the dailylife experiences and voices of old-age residents as well as care workers, uncovering the intricateways in which gender and age intertwine to shape interactions and the expression of genderidentities within the care home environment. This dissertation predominantly uses data in theform of field notes derived from participant observation with both care home residents andcare workers, as well as some interviews with care home residents.The main findings from this research highlight the impact of gender norms on the experiencesof both residents and care workers, demonstrating that the care home environment canreproduce and intensify norms that limit and facilitate social interaction and this has a directimpact on social life and belonging in the care home. By exploring the intersection of age andgender, this study challenges reductionist attitudes towards older adults and offers valuableinsights into future research on care and old age. I also highlight the ethical considerationsinvolved in caring for older adults in residential settings. Through the study's findings, we gain adeeper understanding of the diverse experiences of care home residents and the implications ofproviding compassionate and inclusive care.By bringing to light the interplay of age and gender constructs through a lens grounded intheoretical frameworks and ethnographic exploration, this research contributes to ongoingefforts toward a more holistic and compassionate approach to care for older adults. Findingsfrom this study highlight the imperative to foster an inclusive and empathetic caregiving ethosthat honours the diverse experiences of older adults, contributing to the ongoing dialogue onthe social dynamics of care and the profound implications for the well-being and dignity ofthose residing in care homes. Due to its context-specific analysis of this particular care home,with the incorporation of detailed case studies, this study's unique contribution lies in offering arich account of gender dynamics in caregiving within the care home setting. This study offersinsight into the future benefits of ethnographic research in residential care settings, thebeneficial relationship between humanised care and research ethics, as well as the symbiosis of‘caring care’ and ethnographic methodology.3Table of ContentsDeclaration 1Acknowledgements 2Abstract 3Table of Contents 4List of Figures 6Chapter One: Introduction 8Map to the Thesis 14Context and Relevance to the Field 17Research Aim and Questions 18Chapter Two: Background 20Rationale 21The Humanisation of Care as a Value Framework for This Study 23Setting the Stage: Descriptions of the Care Home 26Challenges 30Ethics 33Accessing a bounded/protected location and people in the times of COVID 59Chapter Three: Engaging with the Literature 62Theoretical Frameworks 88Chapter Four: An Ethnographic Approach 103Chapter Five: Ethnographic Findings 126Section One: Three Case Studies 130Case I: George & Julia 133Case II: William 156Case III: Orla 175Section Two: Social Life in the Care Home 184Section Three: Power & Gender in the Care Home 215Chapter 6: Discussion and Conclusion 251“Caring Care” 255Integration of Theories with Findings 258An Ethnographic Perspective on Care 273Strengths and Limitations 281Implications for Research, Practice, and Policy 286Research 288Practical Applications for Care Practices 2904Policy 292Final Thoughts 295References 299Appendices 3185List of FiguresFigure 1 - “George and Julia”, Author’s illustration, page 7Figure 2 - Care Home PPE during Fieldwork, page 25Figure 3 - The bistro decorated for Italian Night, page 27Figure 4 - Care home venue, page 28Figure 5 - Eight Dimensions of Humanisation and Dehumanisation, page 92Figure 6 - George and Julia, page 134Figure 7 - Julia's knitting, page 141Figure 8 - Sketch of William sitting in his room, page 158Figure 9 - A brief overview of theoretical frameworks, page 2536“Old age is not a disease—it is strength and survivorship, triumph over all kinds of vicissitudesand disappointments, trials and illnesses.”Maggie Kuhn, American activist and founder of the Gray PanthersFigure 1. “George and Julia”, Author’s illustration7Chapter One: IntroductionIt was a warm, misty evening, and I was sweating under my light rain jacket as I coasted into theback parking lot of Comfort Days1, the North England care home where I had been living andconducting fieldwork over the summer. Without stopping, I leaned over and, while still movingforward on my bicycle, touched the fob in my pocket onto the keypad—a small trick I hadlearned over the past weeks of leaving the care home each evening to cycle and clear my head.A box of fish and chips rested against my back, radiating fryer warmth through my backpack.Though I swore I would stop eating fish and chips so often, it became a summer habit in thissmall town with limited options when I did fieldwork later than the onsite Comfort Days cafewas open. I coasted smoothly around the corner of the drive, nodding hello to a few staffmembers having their smoke break at the edge of the property. The new pavement of theparking lot was notably different from the town's patched and pot-holed roads, signifying theregion's lack of recent public upkeep.As I was locking my bike at the back of the building, Kate23, a care worker with whom I hadbecome familiar, came outside. I checked the time: 8:55 PM, just before the night shift. Kateseemed to have left her evening shift a few minutes early and looked upset.“I never took my break, so they just told me to come out now, well—” Kate was fumbling for herkeys, and her dog was waiting on its lead. Kate would often bring her dog to work with her, as3 Please see Appendix 4 Participant Information Table for list of all participants’ pseudonyms.2 All names in this thesis are changed to protect anonymity.1 Fictionalised name to protect anonymity8he was small and well-mannered, and it made some of the residents happy to see him. Thismeant that Kate would have to mind her dog while performing her other duties, adding a bitmore work, but she was happy to do it for the residents. I offered her some of my fish andchips, and she politely declined, but, taking a seat on the picnic table next to me,absentmindedly helped herself to some vinegar-dressed chips while ‘ranting’ about a resident, aman I will call George.“He is a bottomless pit!” Kate was crying, but she wiped her few tears away aggressively andtold me they were “just” tears of frustration. “I over-extend and over-extend, and someday Imight just burn out.” Kate was young but not the youngest of the carers. In her early 40s, shehad worked in care for over a decade and had always lived in the town. She had a very kind andpatient demeanour, and residents seemed to adore her. This was not the first time I talked withKate as she “decompressed” 4 from a shift. She told me she was coming in more often as othercare workers were ill, and Comfort Days struggled to keep staff for all shifts. After some more‘ranting’, a few placations from myself, and a few more shared chips, Kate left in her small car,and I made my way upstairs to my guest room—an apartment fit like a hotel room with a bed, akettle, and a private bathroom. The apartment, usually reserved for visiting families, had notbeen open for visitors since the beginning of the COVID-19 outbreak.As I unlocked the door to the apartment, I glanced at a sign on the wall listing a helpline numberfor overwhelmed care staff. I wondered if they would offer anything more valuable to Kate than4 Suggests the need for a transitional space in which the mind and body have to adjust in order toprocess experience from inside Comfort Days and neutralise it before re-entering the world outside.9my own feeble sympathies and understanding. I felt deflated in the face of Kate’s frustrations,and in the face of George’s “bottomless pit”—which was Kate’s way of addressing his very real,and unmet need for attention and emotional care. I heard laughter from a “House” adjacent tomy guest apartment, one of six large apartments within the care home that housed around tenresidents each (more on the layout of the care home later). This House had a team of careworkers who got along quite swimmingly. Sometimes care work looked so easy and natural,joyful even. But just as often it looked like Kate and George—a disconnect between receivingand giving, sometimes awkwardness, regret, or even despair.—-I came to Comfort Days as an outsider in all meanings of the word. Located in a small town innorthern England, one which was so self-identified that care workers commuting just 10minutes from a neighbouring town were sometimes lightly roasted for their differing accents(undetectable to my ears), Comfort Days housed residents from all over England and hired careworkers from all over the UK and the world. I am American, and I am not a care worker, nor aresident. I am an early career researcher, a doctoral student, conducting ethnographic researchat this care home. This study is part of a collaborative research project (more about this lateron) to explore how gender impacts care services and to do so ethnographically. I come from abackground in Psychology and Social Anthropology, and I feel a strong sense of duty to givevoice to those who may often be overlooked. In this project, I want to develop a study thatwould consider and highlight the voices of old adults. However, to study care is to studyrelationships; care is not a simple, uni-directional exchange from care worker to care recipient.10Thus, the residents’ experiences could not be separated from the care workers, managerial staff,family members, friends, and myself. Though taking place just after the most intense waves ofCOVID-19, when the residential care home was a site of extreme protection and separation, thelines of care were enmeshed, making it impossible to focus solely on one actor in this meshworkof care.With this research, I aim to examine the experiences and dynamics of gender norms in this oldage care home, which was designed to provide comprehensive care to older adults,encompassing their physical, emotional, and social well-being. However, existing literature oftenfocuses on the medical aspects of old age, neglecting the social and gendered dimensions ofcare. Old age is often defined by physical and mental ailments associated with frailty andcognitive decline, leading to a medicalised narrative that overlooks the holistic needs of olderadults. Residential care homes promise to provide full care under one roof, including physical,emotional, and social needs. Understanding the daily life experiences of residents and how theynavigate their social relationships is critical to ensuring that care homes can fulfil this promise.Taking into account the contexts that shape gender identities, such as regional cultural valuesand generational values, I aim to take a more nuanced look at care relations. Care acts rangefrom bodywork such as bathing, support with exercise, feeding, and provision of medications tosomething much less easy to define but of equal importance to well-being, such as giving spaceto connect with others, validating one’s feelings, or ensuring privacy. Gender impacts theserelations, sometimes more explicitly, but always, it seems to sit there in some form, shaping11how we relate to one another. Gender influences the assumptions formed around people’sdesires and needs, which may cause residents to receive different care acts for differentreasons. One woman’s hygiene is tended to more regularly because she is seen as a womanwho holds value in her appearance. A man who served in the military is given more time in thelibrary alone, perhaps because he is seen as a male figure needing autonomy. Gender roles areoften reflected in the findings of this ethnography, especially in what people say, but when wetake the time to observe how people act, this is not so simple. Care is not a one-size-fits-allprocess but a negotiation, a complex contract between the carer and the care recipient.Carer-resident relations nuance this dynamic, as do pervading stereotypes of older people ashomogenous in their needs and priorities, thus sometimes not having a gender. Reductive viewsof gender identity risk the oversimplification of care strategies.Here, I aim to fill this gap by exploring how gender constructs intersect with the experiences ofwell-being and dignity among residents in this care home. Drawing on theoretical frameworksincluding Raewynn Connell's theory of hegemonic masculinities, Julia Kristeva's theory ofabjection, and Sara Ahmed’s affective economies, analysis of the data unearthed takes aconstructivist understanding of gender and age to shed light on the complexities ofrelationships and social life within the care home context. Through ethnographic researchconducted in the summer and autumn of 2021, the daily life experiences and voices of old-ageresidents are brought to the forefront, highlighting the ways in which gender and age intertwineto shape interactions and the expression of gender identities within the care homeenvironment. By exploring the intersection of age and gender, I challenge reductionist attitudes12towards older adults and provide valuable insights into person-centred research and the ethicalconsiderations involved in caring for older adults in residential settings.Through ethnographic methods, I will focus on the needs and demands being vocalised anddemonstrated by the old adult care home residents and care home staff. I will examine howthese demands are related to gender and age. The findings will discuss how gender and agecontinue to intersect to shape and influence identity formation throughout life, even inretirement and residential care. Through this study, I will provide insights into themethodological approaches and ethical considerations for person-centred research with olderadults living in care settings.13Map to the ThesisThe structure of this thesis merges existing literature on care and on gender perspectives onageing within the context of residential care provided by ethnographic findings. Byincorporating social sciences, especially critical gender perspectives, into health and careresearch, a comprehensive lens is provided to explore intricate issues. This approach broadensthe analysis to investigate the complex interplay of social, cultural, and psychological factorsthat profoundly influence care experiences. In presenting this thesis, I aim to convey a strategicrationale that prioritises clarity and coherence, establishes a narrative focus, and allocatessufficient space and significance for the stories and experiences central to this study.Chapter 1: Introduction - Exploring Critical Gender Perspectives on Ageing in Care ResearchIn this thesis, I examine critical gender perspectives on ageing in the particular context ofresidential care. The introduction chapter lays the groundwork for the following dissertation.Following this ‘map’, I will provide a contextual backdrop that emphasises the significance andapplicability (and absence) of critical gender perspectives within the field of ageing in careresearch. Furthermore, I clarify the research question and objectives guiding this project.Chapter 2: BackgroundWithin this chapter, I furnish a thorough background of the study, encompassing its rationale,challenges, setting, ethics, and literature to contextualise the study inquiry. These components14form the bedrock upon which I build my research, providing essential context for understandingthe study's scope and significance.Chapter 3: engaging with the LiteratureWithin this chapter, I explore existing literature relating to care, ageing, and gender.Additionally, I present the theoretical frameworks that serve as the backbone of this study.Drawing from various established theories and frameworks, such as Connell's Theory of Gender& Power, Kristeva's Abjection, Ahmed’s Affective Economies, and the Humanisation of CareFramework, I weave together a comprehensive and multidimensional lens to analyse the data.Chapter 4: An Ethnographic MethodologyHere, I will address the practical implications of conducting this research, includingconsiderations of anti-oppressive ethnography, researcher reflexivity, and the situatedness ofthe researcher within the study context. Moreover, I outline the participant observation andinterview methods, shedding light on the strategies employed to gather rich and meaningfuldata in the care home context.Chapter 5: Ethnographic Findings & AnalysisThis chapter constitutes the heart of the study, as I present the findings derived from the dataanalysis. Within the backdrop of ageing in North England's care setting, I delve into the themesof power and gender, critically questioning and examining these dynamics. The findings arestructured into four sub-chapters: a chapter featuring three case studies that zoom in on15individuals' experiences as they navigate living in the care home, another on social life and onmeals and eating in the care home, and lastly, a chapter dedicated to social events that servesto consolidate the diverse themes and to more deeply explore the the dynamics of power andgender in care relations.Chapter 6: Discussion and ConclusionsIn this chapter, I engage in a comprehensive discussion of the implications arising from thestudy findings. I explore how my study contributes to the broader discourse on thehumanisation of care, shedding light on its potential applications and transformative effects.Additionally, I critically reflect upon the limitations of our study and discuss the implications forfurther research, practice, and how this project points to policy implications.Chapter 7: Final thoughtsWithin this concluding chapter, I reflect on the study and its implications for the field of ageingin care research.16Context and Relevance to the FieldIn the contemporary landscape of the United Kingdom's care sector, marked by a surgingdemand for long-term care fueled by demographic shifts, escalating healthcare costs, and thecompetition and marketisation that characterise a growing private care industry, a closerexamination of a small care home assumes significance. This study is particularly relevant inlight of the prevailing trend towards home-based care and the closure of many smallerindependent care facilities. Even so, an estimated 421,100 people reside in care homes in theUK (AgeUK, 2018). An in-depth study facilitates the exploration of the challenges unique tothese smaller setups, offering valuable insights into their constraints and opportunities, andaiding in crafting informed decisions to ensure the sustainability of care services.However, the complexity of providing round-the-clock care, especially in the absence of aclear-cut "solution," remains a central conundrum (Cottell, 2017). The dynamic nature ofcaregiving demands, combined with evolving societal expectations and changing economiclandscapes, poses significant challenges to developing care that meets residents’ needs (Duffyet al., 2015). A notable disparity arises in the evolution of care practices and our understandingof what constitutes good care. While the demand for long-term care escalates, care workerturnover rates increase, austerity measures chip away at fraying social services, and care homesare painted as horror sites of bare-bones care, neglect, and potential abuse which have all beensources of scandal (Mulley, 2011; Humphries et al., 2016; Lloyd et al., 2014). The shiftingdynamics in care provision necessitate a concurrent evolution in our understanding of qualitycare, encompassing not only the physical and medical aspects but also the emotional, social,17and psychological dimensions crucial for the overall well-being of individuals in long-term caresettings. The pursuit of excellence in long-term care requires not just a response to immediatechallenges but an ongoing commitment to advancing our understanding of what defines qualitycare in a rapidly changing sociocultural and economic context. Recognising the multifacetednature of the issue is the first step towards crafting holistic and adaptable solutions that canwithstand the dynamic nature of the care sector.Research Aim and QuestionsThe overarching aim of this study is to explore the experiences and dynamics of gender normsin an old age care home setting in the UK and their implications for residents' well-being. Afocus on well-being will help think about what constitutes good care, as good care should fosterexperiences of well-being (Galvin & Todres, 2013). To make sense of gendered experiences ofdignity and well-being, a critical gender framework offered by Raewynn Connell (2009) informsthe design and analysis of my project, and the focus on well-being is underpinned andsupported by a humanisation of care serves as a ‘value framework’ for this study, which, in veryintroductory terms, means that this study is guided by the notion that there are manyinterconnected dimensions of well-being which can range from being humanising ordehumanising, and that to capture the richness of experience requires holding the possibilityfor both while examining the lived experience—more on this in the next section (Todres et al.,2009).18Research Questions:● What are residents' experiences and challenges with gendered expectations, roles, andpractices within the care home?● How do gender norms manifest and intersect among residents and staff in the carehome; how do gender norms influence care interactions within the care home?● What are the implications of the findings for care practice in caring for older adults inresidential settings?By focusing on the specific context of this care home, this research sheds light on issues of carethat require a close look, such as the direct impact of changing care trends on elderly individualsand their families but also delves into more large-scale issues, such as the intricacies of thegendered and feminised care workforce, where women constitute approximately 82% of all careworkers. Unpacking the challenges faced by these predominantly female care workers in termsof low-paid, low-status jobs, workload issues, and limited career development opportunitiesprovides a better understanding of the complexities surrounding care provision. Moreover, aclose look at care work exposes the cultural and social norms perpetuating the devaluation ofcare work, offering a foundation for challenging stereotypes and advocating for the recognitionand equitable treatment of care workers. Ultimately, this research contributes vital informationthat can shape more targeted and effective policies, fostering a supportive environment for careproviders and enhancing the overall quality of care in the UK.19Chapter Two: BackgroundA wide array of care services have been and are being designed to meet the new and dynamicneeds of a growing population of old adults in need of care. There is research on these services(though one could argue still not enough), but there is even less research with care recipients.Research that centres the experiences and perceptions of care recipients, and in the case of thisstudy, old age residential care recipients, needs to be much more deeply understood. Researchon older adults can reproduce stereotypes of older adult care recipients. Many studies consider"the elderly" as objects of research rather than as people who mutually produce understandingsof experience. To ensure that services meet the actual needs of this population, we need tounderstand the subjective experiences of ageing in residential care from the perspectives ofcare recipients.With a particular focus on experiences and perceptions of dignity and well-being, I aim tocontribute to the humanisation of the care field with the findings of this project, which is part ofthe INNOVATE DIGNITY Marie Skłodowska-Curie fellowship focused on the humanisation of careresearch with particular attention to older people (Galvin et al., 2013). Dignity and well-beingare profoundly varied subjective phenomena that impact and shape our experiences acrossinterpersonal, institutional, and societal contexts. The observation and consideration of thesesubjective phenomena, and the perspective that one's experience is relative and reflexive, invitethe depth and flexibility offered by qualitative research methodology.20The goal of this study is to offer a deeper understanding of older adults’ experiences andperceptions of dignity and well-being living in a residential care home, as well as to provideinsight into the ethnographic, humanisation-based methods by which we can understand theintersubjective experience of residents of a residential care home.RationaleThe development of care homes in the UK has led to a significant transformation of the caresector, with profound implications for care workers, care recipients, and the broader society.Despite the growing body of research on care work, there is limited understanding of howgender and relationship dynamics shape the provision and receipt of care services in carehomes. Furthermore, existing studies have focused on care workers' or recipients' perspectivesrather than examining their interactions and relationships.The rationale for this study is multifaceted. Firstly, by investigating the relationship betweengender, relationships, and care services, I seek to contribute to a richer understanding of thechallenges and opportunities associated with care work in a private sector independent carehome setting. Secondly, the study sheds light on the complex and dynamic interactions betweencare workers and recipients, which should be addressed in existing research. By examining theperspectives and experiences of both groups, the study aims to generate insights into how carework is negotiated and performed in practice and how broader social and cultural factors shapethese practices.21Finally, the study has practical implications for the UK's design and delivery of care services. Byidentifying the strengths and limitations of current care practices, the study aims to inform thedevelopment of care services responsive to the diverse needs and experiences of care workersand care recipients. Furthermore, by highlighting the impact of gender and relationshipdynamics on care work, the study aspires to contribute to broader debates on gender equalityand social justice in the United Kingdom and beyond.Rich and descriptive data generated by ethnographic research methods will be useful forunderstanding life in residential care better. The ethnography took place in a residential carefacility located in northern England, which offers a continuum from independent living toend-of-life care. This qualitative research study is designed to deepen current understandings ofhow older adults living in residential care experience daily life: to find out what residents enjoy,whether they form new relationships in the facility, or prefer to be alone or with family. I aim tounderstand older adults’ experiences of dignity and well-being. I would like to understand howolder people experience their daily lives in the context of residential care. I want to know whatresidents in this space do daily and what they think about their experiences here. Throughparticipant observation, conversations, and interviews, I want to ask residents what they thinkabout their situation and to participate in and observe the normal day-to-day functioning of thecommunity5.5 Data includes both residents’ and staff experiences, as witnessed and told. Please see Appendix 4Participant Information Table for list of all participants’ pseudonyms.22Findings will contribute to our understanding of the lives and actual needs of people living inresidential care by providing insight into the experiences and perceptions of older persons livingin this environment. Since the data will be descriptive and qualitative, it will contribute to adiscussion on care and develop a research methodology that promotes the consideration ofcare recipients. As produced by this study, new knowledge of issues that impact well-being incare may support a better understanding and application of novel research methods to engagewith older people.The Humanisation of Care as a Value Framework for This StudyThis study contributes to the overarching goals of the Marie Curie Skłodowska Action (MSCA)INNOVATEDIGNITY Fellowship. This fellowship is an international program designed to trainearly-career scholars in care science, focusing on the experiential aspects of well-being and carefor older individuals through qualitative research. Building upon the Humanisation of CareFramework (HCF), a theory-based model used to explore the experiential dimensions ofwell-being, I aim to critically examine the intricate and context-dependent understandings ofwell-being in the care context (Galvin & Todres, 2013). By applying the HCF, we can gain insightsinto how individuals' care experiences can either humanise or dehumanise them within the caresetting. The framework is similar to Tom Kitwood's person-centred approach (1997). Still, itfocuses on the phenomenological aspects of the caring experience and highlights thedimensions of well-being that stem from potentially humanising and dehumanising encounters.23Therefore, the HCF is a valuable framework for guiding qualitative research on care andwell-being (Todres et al., 2009).In the HCF, dimensions of well-being are interconnected and woven into the fabric of humanexperience. These dimensions include uniqueness/homogenisation, sense of place/dislocation,and agency/passivity. They form a spectrum, ranging from humanised experiences (agency) toless desirable ones (passivity). The humanised characteristics are considered "ideal" types,although they may not always be achievable or desirable in all care contexts. For instance, whenexamining uniqueness/homogenisation, "uniqueness" may not be the most desirablecharacteristic when adherence to hygiene protocols during the COVID-19 pandemic is required.In other words, the HCF enables us to explore different dimensions of care to better understandindividuals' well-being experiences within their contexts and consider actions that may eitherpromote or hinder their well-being.The HCF provides a broader perspective on well-being that extends beyond the absence ofillness, portraying care as a reflective process that occurs in relationships rather than a meretransaction. Furthermore, this approach allows us to view older adults as agential individualsrather than passive care recipients. Research on older adults often perpetuates homogenisingstereotypes and overlooks the diverse and intertwined identities that shape their lives (Arber,2002; Calasanti, Slevin, & King, 2006; Minkler, 1997). Adopting a humanisation of careperspective helps us delve into each individual's complex and nuanced aspects, placing olderadults' experiences and perceptions at the centre (Cruikshank, 2008; Todres et al., 2009).24Situated ethics, also known as the ethics of humanisation of care, offers an alternative approachto procedural ethics by acknowledging caregiving practices' multifaceted and context-sensitivenature. While this approach may seem "messy," it is crucial to recognise that research can beintegral to the care matrix. Understanding the contextual dimensions in which care is providedis essential for delivering humanised care that respects each individual's unique needs andpreferences. By emphasising the importance of context in care, our ethnographic study alignswith an ethics of care and humanisation of care framework. This framework provides a valuablealternative to rigid ethical procedures, highlighting the significance of comprehending theindividual's circumstances.Consequently, an ontological thread connects the humanisation of care practices and theconsent to participate in qualitative research. Both processes occur within relationships,representing reflexive interactions between individuals. Recognising the value of context inshaping lived experiences is central to understanding well-being within the context of careacross various settings. This emphasis on context is foregrounded by an ethnographicmethodology, which aids in comprehending and describing the relationship betweenindividuals' subjective experiences and social structures.I hope to contribute to research which challenges prevailing homogenised and homogenisingunderstandings of what it means to be both an older adult and a recipient of care. While I25realise that findings from this project represent one voice among many in the choir, I am excitedto work on progressing the way we look at the human experience in old age and care.Setting the Stage: Descriptions of the Care HomeFigure 2 Care Home PPE during FieldworkAs I approached the modern building that housed the care home, "Comfort Days" on theoutskirts of a small post-industrial town in northern England, its institutional nature wasapparent before entering the property. The sleek design stuck out in the sea of brick housescharacteristic of northern English towns. Some signs on the fence showed that the Care QualityCommission (CQC) awarded the care home a high-quality score.26Upon entering the building, I was whisked into an ante-room, given sanitiser and PersonalProtective Equipment (PPE) and greeted by friendly staff members who exuded warmth andcompassion. They took my bags, offering to store them behind the counter until I was shown myroom. Their genuine smiles and willingness to engage in conversation added a touch offamiliarity to the otherwise impersonal setting. Throughout the corridors, I could hear thegentle hum of chatter and occasional bursts of laughter between workers. The sterileatmosphere, though comforting in its cleanliness and sense of safety during COVID-19(everyone in PPE and the floors shining from a recent mopping), conveyed efficiency andfunctionality rather than a sense of homeliness.Moving through the care home, I observed that the layout emphasised efficiency andpracticality. The building was organised in a structured manner, with clearly defined areas andpurposeful spaces. While this design facilitated the smooth operation of daily routines andcaregiving, it did little to evoke a sense of comfort or familiarity. The surroundings felt more akinto an institution rather than a place intended to replace the home for its elderly residents.There were some attempts to link the care home to the surrounding community. For example,the various rooms were named after local landmarks, illustrating the effort to connect thebuilding with its local history.Several communal areas within the main building aimed to foster social interaction andengagement. However, during my visit, these spaces were not in full use due to the COVID-19restrictions. Upon entering the care home, you find yourself in a spacious reception area. The27reception desk is always staffed by someone who, at least during my study, was there to helpvisitors to the designated visitation area or to instruct them to use the proper PPE after signingin. To the right of the reception, you'll notice the elevators and the back entrance to the mainbuilding, which leads to the independent living apartments. There is also an on-sitehairdresser's salon, which takes residents on appointments. To the left is the Cafe, which is openand well-lit with round tables and a wall of windows.Figure 3. The bistro decorated for Italian NightOn each end of the large reception area and cafe are the ‘Houses’. There are two Houses at eachof the three levels of the main building. Each House accommodates 8-10 residents and providesa community within the more extensive care home.28Figure 4. Care home venueOn the second floor, you can find the gym. It is well-equipped, though during the time of thestudy was used to train CPR courses and store various things, as residents were not approved touse the gym facilities during COVID-19. Across from the gym is the “pub” venue which hostsvarious social events: dinners, viewings of movies or special televised events (such as theOlympics when I was living here), bingo, concerts, et cetera. And besides the venue is a smalllibrary room with a shelf of books, some armchairs and a fake fireplace roaring on an HD screen.The building's layout prioritises functionality and efficiency, with clear divisions betweendifferent areas and purposeful spaces. The floors are kept clear and are either linoleum orcarpeted with a firm, unfussy carpeting designed to avoid the chance of falls. There arehandrails mounted along most walls. The lighting is bright, and most doors have clear signage inlarge font. Though the care home strives to create a nurturing environment, it is important to29note that the challenges posed by its institutional nature take work to overcome. The designand structure, while organised and efficient, may still remind residents that they are in a spacemeant to replace the familiarity of home.The staff's efforts to mitigate the impersonal atmosphere were evident during my first Togethervisit. Their presence brought life to the care home, injecting moments of joy and companionshipinto the residents' daily lives. While the building lacked the warmth of a traditional home, it wasnot a depressing environment. Instead, it stood as a testament to the care home's awkwardnegotiation of safety and protocol and human elements of care and home.ChallengesStudying gender, relationships, and care services in a UK care home presents several challenges,mainly when using ethnographic methods such as participant observation and interviews. Someof these challenges include:1.4.1 Access and EthicsI will mention here briefly before delving into the ethics section below, which will go into detailon the way that the ethics application process, and my thinking around ethical research witholder adults, some of whom cannot provide informed signed consent, has shaped this projectprofoundly, that one of the primary challenges of conducting an ethnographic study in a carehome is gaining access to the setting and the participants. Care homes are highly regulatedenvironments, and I need to obtain the proper clearance from multiple bodies, including the30Health Research Authority, the Faculty Ethics Committee, the MSCA Ethics Board, and the carehome managers (Tauzer et al., 2023). Moreover, throughout the study, I negotiated with thecare home staff and residents to obtain informed consent and ensure their participation doesnot compromise their privacy, dignity, or well-being. This requires careful planning,communication, negotiation, and sensitivity to the power dynamics and hierarchies within thecare home.1.4.2 Positionality and ReflexivityAnother challenge of conducting an ethnographic study is manageing my positionality andreflexivity. My gender, age, ethnicity, and other characteristics influence my interactions withthe care workers and care recipients and affect the data I collect and analyse. This is not achallenge, per se, but it is a consideration and something I must remain aware of throughoutthis project. Moreover, my role as an outsider to the care home created tension or suspicionamong the participants, who may perceive me as an interloper or a threat to their routines andrelationships. I attempt to maintain an awareness of this by regularly reflecting on mypositionality and establishing trust, rapport, and respect with the participants through ongoingcommunication and feedback.1.4.3 Ethnographic ChallengesFinally, conducting an ethnographic study in a care home setting presents severalmethodological and practical challenges. These include the need to balance my role as anobserver and a participant, negotiate the competing demands of data collection and analysis,31and manage the emotional and physical demands of the fieldwork. I must develop various skillsand strategies, such as active listening, note-taking, reflexivity, and self-care, to navigate thesechallenges and generate rich and meaningful data.These challenges include gaining access, ensuring ethical conduct, manageing positionality andreflexivity, and addressing ethnographic research's methodological and practical challenges.Nevertheless, by being aware of these challenges and taking proactive steps to address them, Imake every effort to generate valuable insights into the complexities of providing and receivingcare in a gendered and relational context.32Ethics 6The focus of the following chapter is on the tensions between conducting ethnographicresearch, where a sense of ethics is bound up in every action, and the formalised ethics processput into place to protect research participants. I hope to offer a reflective account of a socialscientist engaging in rigorous and ethically sound research in the qualitative health field. It isimportant to highlight the barriers to conducting research with older adults who live inresidential care settings and who may lack the capacity to provide formalised consent toparticipate in research. This chapter is meant to pick at some interdisciplinary tensions, but itshould be foregrounded that ethical considerations are vital and should always underpin everyaspect of the research process.Before detailing my own experiences with both formalised and situational ethics in this study, itis important to acknowledge that many researchers have been making efforts to better includethe voices of older adults in research. The inclusion of older adults as co-designers has spurredmethodological innovations in qualitative health research (Mulvale et al., 2019). Participatorymethods such as workshops, focus groups, and community-based participatory research (CBPR)are increasingly employed to facilitate active involvement. These methods are adapted toaccommodate the specific needs of older participants, ensuring that the process is inclusive andrespectful of their capabilities. As one example, Kile (2021) described the use of photovoice and6 This sub-chapter draws substantially from an article titled, “From Ethical Approval to an Ethics of Care:Considerations for the Inclusion of Older Adults in Ethnographic Research from the Perspective of a ‘Humanisationof Care Framework’” published in The Journal of Ageing Studies (Tauzer et al., 2023) and has been reproduced herewith the permission of the copyright holders.33storytelling as effective methods for engaging older adults in co-designing community healthinitiatives.Despite the benefits, there are challenges to involving older adults in research. Barriers such asphysical limitations, cognitive impairments, and technological challenges can hinderparticipation (Altawalbeh et al., 2020). Addressing these barriers requires thoughtful planningand resource allocation. Ethical considerations are paramount when involving older adults asco-designers. Issues of informed consent, confidentiality, and the respectful treatment ofparticipants are critical. Researchers must ensure that the involvement of older adults isvoluntary and that their contributions are valued and acknowledged appropriately (Rogers,2023). Sustaining the involvement of older adults beyond the initial research phase and scalingparticipatory methods to larger populations are ongoing challenges. Long-term engagementstrategies and the integration of participatory methods into standard research practices arenecessary for sustained impact. In the following, I will explore my orientation toward thesechallenges in the development and planning of this study, and discuss the many possibleco-benefits of research and care. I emphasize the relational aspects of developing rapport toensure that research efforts remain ethically sound.One pleasantly warm afternoon, I asked Theresa, a 75-year-old resident if she'd like to join meout on the balcony to get some fresh air. Theresa declined, explaining, “I just want to sit insilence–sometimes you think I’m dull but I am not, I like peace. They want me to be busythough. It is like in school. Sit straight, don’t speak! Sit and look busy and they don’t bother.”34Overhearing this from the kitchen, a care worker, Mary, explained, “Oh, she must be talkingabout her school days. She was quite a stern school teacher, weren’t you, [Theresa]?”Theresa shrugged and gave a half-smile, and I wondered if this was what she really meant. Itseemed an adequate, in fact quite eloquent, response to my invitation to socialise outside atthat moment, rather than a musing about her past. Theresa is one of many participants of thisstudy whom, when I assessed, I considered not having sufficient capacity to provide informedconsent. Theresa was enrolled on the advice of her daughter, who felt that she would likelyenjoy participation. Theresa is often social and philosophical, and she offers up herunderstanding of daily life in the care home. Other times, she is private and declines invitationsto socialise. An important component of a qualitative event is that it is connected to othermeanings, contexts, and events. This means that any singular moment or experience has anembeddedness which, even when not consciously recognised, exists implicitly (Merleau-Ponty,1962). Thinking with this embeddedness, we can understand the small interaction with Theresa,where she communicated momentary dissent to participation. Consent, which occurs inmoments and is shaped by context, occurs through interaction. And each interaction is a newassessment of consent, or, just as importantly, an opportunity for participants to communicatedissent.As was often the case, especially during my early days of research, Mary offered a narrative aswell. In providing Theresa’s backstory, Mary was giving some context which might enablefurther conversation between Theresa and me. Perhaps she was even apologising for Theresa’s35refusal to join me, which may be viewed as rude–this already speaks to the limited rights carehome residents may possess. Dissent, even to daily interactions outside of formal consentrequired for study participation, is viewed as poor manners or a lapse in judgement, rather thanas a clear and justified communication of one’s unwillingness to participate at a given moment.These interactions were opportunities to strengthen rapport with staff, who often did not quiteunderstand my role as an ethnographer while they tirelessly provided care work. The momentswhere staff or family members shared their knowledge were helpful: they are the experts in thisspace and they are sharing their expertise, helping me to become more of an insider over time.They are also expressing attitudes: one should not reject the invitation of another, the idea thatresidents’ preferences are best understood in relation to their previous role as productivemembers of the workforce (“she was quite a stern school teacher”). Yet these instances, whenstaff would speak “for” residents, risk convoluting the dynamic, sometimes confusing residents,and detracting from a more intimate, present exchange where they are given the chance todecide if they want to participate, or not (Sunghee et al. 2015).The formal ethics requirements to involve adults who cannot demonstrate the capacity toprovide written consent as legally required by the Mental Capacity Act (including assessing thecapacity to consent), can, in practice, contradict these moments of consent which emerge inreal-life situations. As I assimilated to the care home, I experienced many challenging momentswhich called the consent procedure into question, where my interpretation was required to36understand how to most ethically proceed with my inquiry, and where my positionality servedas a starting point to make these decisions.An ethnographic approach helps highlight the interpersonal dimension of care events and thequalitative, existential nature of well-being, but studies of this design often face significantgatekeeping at the ethics approval phase, far before ever setting foot in the care home space.Barriers to consent exist at the structural and institutional levels, through ageist attitudestowards all older adults, especially those who lack capacity, as well as at the interpersonal level,through power dynamics between care workers and care recipients.The humanisation of care framework may help to think through the consent process and tohighlight that consent is momentary and occurs in relationships. Potential barriers to conductingqualitative research with older adults who may lack the cognitive capacity to provide informedconsent can exemplify the tension of procedural ethics with the subtler ethics which lie withininterpersonal navigations both in care relationships and within the ethnographic approach toresearch. I will illustrate my use of process consent through some vignettes.Situated ethics, or the ethics of the humanisation of care, presents an alternative approach toprocedural ethics, one that acknowledges the complex and context-sensitive nature of caringpractices. While this approach may be "messy," it is crucial to recognise that research can be acomponent of the care matrix. Understanding the context in which care is delivered is essentialto providing humanised care that respects the individual's needs and preferences. By37highlighting the contextual dimensions of care, we can demonstrate how our ethnographyengages with an ethics of care and humanisation of care framework. This framework provides auseful alternative to the more fixed ethical procedures, emphasising the importance ofunderstanding the unique circumstances of each individual.Thus, there is an ontological thread that runs through the acts of humanisation of carepractices, and consent to participate in qualitative research: it occurs in relationships, a reflexiveevent between individuals. The value of context in shaping one’s lived experience is central tounderstanding well-being as it pertains to care across varied contexts. This is foregrounded byan ethnographic methodology, which helps us to understand and describe the relationshipbetween people’s subjective experiences and social structures.Negotiated Process ConsentCare and caring are wrapped into consent: residents and staff navigated my presence as Ibecame more of an insider in their daily lives, deciding where and how I fit. Not all participatingresidents lacked the capacity to provide written, informed consent, but a majority did. It wasimportant to identify a consent procedure that would include all willing participants, regardlessof their capacity to provide informed written consent. Approaching this study with theperspectives of the HCF and the imperative to be as inclusive as possible, the preliminaryprotocol asserted that process consent is the most suitable way to fairly engage a population inwhich many participants lack the capacity to provide informed, written consent. Negotiatedprocess consent is not uncommon in the world of qualitative health research, and the value of38this consent process has been written about by dementia researchers specifically, as it supportsthe inclusion of participants who may lack the capacity to provide informed, written consent(Dewing, 2008).Obtaining informed consent is a crucial aspect of ensuring that potential participants' rights andautonomy are respected. However, in situations where a person's capacity to consent isimpaired, such as in some cases of dementia, obtaining informed consent becomes morecomplex. The traditional model of informed consent may not apply to individuals with cognitiveimpairments, and it is essential to find alternative ways to include them in decision-makingprocesses. In this context, the model of process consent developed by Dewing becomesparticularly relevant. This model acknowledges that individuals with dementia may not be ableto provide traditional forms of consent, but it aims to use all remaining capacities of the personto obtain their consent. This approach emphasises the importance of getting to know theperson and understanding their preferences to ensure that their wishes and rights arerespected. Process consent highlights the relational aspect of consent: it is not a one-offoccurrence, but a process, which is regularly negotiated and communicated interpersonally(Grout, 2004).In this consent process, the participant is repeatedly, through relations, either providing ordeclining consent to participate in the research. Negotiating consent requires moving beyondthe signed document, even beyond the verbal “yes”, to reading for non-verbal signs of consentas expressed by the body. Consent as negotiated occurs within every interpersonal interaction39(Dewing, 2008). Process consent is a methodological tool of obtaining consent when the personwith dementia has very limited capacity for informed consent, on the one hand, whereasinformed consent using proxy (e.g., consultee, see below for explanation of this term) as theprimary way of obtaining consent, followed by assent of the person with dementia as secondaryto informed consent rather than the primary source for consent.This process highlights that consent is not merely a one-off event, but that it is regularlynegotiated through various forms of communication, whether this is verbally, through mood, orbody language (Nolan, 2002). Perhaps even more importantly, especially as this project takesplace in the private living spaces of participants, negotiated process consent allows saying no.Consent to participate in the project does not, and should not, mean that I have full, unlimitedaccess to the lives of participants during the study. Negotiated process consent aligns with theethos of the ethnographic approach, where consent occurs as the researcher and participantbuild a relationship (McKeown et al., 2010).In the first application for ethical approval, I argued that I should employ process consent withevery resident, regardless of their capacity, so that every potential participant could engagewith the study in the same fashion7. The goal here was inclusion, and the argument hinged onthe strength of the ethnographic process in establishing the level of rapport required forprocess consent. I explained that the recruitment process would begin the moment I arrived atthe community, and data would only be collected once I could introduce myself, begin to embed7 'Consent as process' is typical of ethnographic works operating outside of medical contexts which may havemore strict requirements to ‘protect’ potential interlocutors.40myself into the community and obtain consent. Furthermore, in a fluid and changingenvironment, signed consent forms may act as a barrier to participation (Boulton & Parker,2007), and may bureaucratise the relationship between researcher and participant(Mapedzahama, 2017), thus harming rapport and stunting the natural flow of data (Wynn &Israel, 2018).This being my first experience applying for ethical approval both in a healthcare setting and inthe UK, I relied on the expertise of my main supervisor, who is experienced in UK-specific ethicalrequirements for qualitative research in healthcare settings, to navigate the culture of theformalised ethics process. However, the ethics application justifying the use of process consentwas not approved by the UK National Health Service Research Ethics Committee (REC)8, which isresponsible for studies taking place in care settings9. We were asked to include a version ofsigned consent or written advice for each enrolled participant and to only interview participantswho demonstrate, through careful application of the MCA10 indicators, the capacity to providewritten, informed consent for themselves. Taking this feedback seriously, I re-designed the10 Mental Capacity Act - Health Research Authority https://www.legislation.gov.uk/ukpga/2005/9/contents9 In England and Wales, assessing mental capacity follows a careful process required when working with apopulation which includes, or may include, adults who demonstrate a lack of capacity to provide informedconsent to participate in research. According to the Mental Capacity Act (MCA), all individuals must beassumed to possess capacity unless established otherwise. Establishing capacity was done by sharing theParticipant Information Sheet with potential participants and then asking some questions about the study togauge whether the information was retained, understood, and could be repeated back to me. Because I hadyet to establish rapport with most residents, I triangulated with staff and family members when assessingcapacity. All participants should be assessed in the same way, and no assumptions about capacity or lackthereof should be made before assessment. The Health Research Authority (HRA) outlines that in order todemonstrate capacity, one must be able to understand information relevant to make a decision, retain saidinformation, use or weigh the information given, and finally, be able to communicate (by any means) adecision based on the provided information.8 NHS RECs are required to follow the legal framework of the Mental Capacity Act, it is not the REC with whichI take issue, but the frictions that can result when applying an ethnographic logic to health-care research inthe UK, especially when working with a population which may include those who demonstrate a lack ofcapacity to provide informed, written consent.41consent process to include consultee advice for those residents who do not possess the capacityto consent to participate, and to require written informed consent for interviews, and from stafffor observation. The strength of the participant observation design is not only that it enablesone, but it requires one to move through the layers of familiarity slowly and with time. Inseeking ethical approval for an ethnographic study in residential care during the pandemic, Igained useful insight on issues of gatekeeping and paternalism of older adults, issues whichpersist outside of this context.Especially while issues of isolation and stigma facing older adults in residential care have beenso recently highlighted by the COVID-19 pandemic, conversations on barriers to participationand inclusivity in research matter. There are issues with using consultee advice at a time whenfamily and friends are not allowed to visit or spend time in the homes of residents. In myexperience with recruitment, friends and family were glad to have a “fresh young face” tointeract with their family members–highlighting the collective understanding of socialisation asan important component of well-being. However, I was gaining permission to access the carehome at a time when many were not allowed or able to visit with their loved ones. Even withequal access to residents, there are tensions with consultee advice, e.g., the assumption thatfriends or family members may truly know what the person wants; or that some legalconsultees may not have lived or been in close relations with their parents for a long time,therefore not knowing what they would like or want. In an example later on in this paper, thereis a resident whose behaviour and preferences appeared different during the time of the study42than was expected by both family and care staff. This demonstrates that consultee advice doesnot accommodate for the fact that preferences change.Awareness of these tensions helps to further understand the impacts that protected caresettings during the pandemic (and beyond) may have on the agency and rights of older adultresidents, who are often viewed as static in identity. However, this process is constricted by theMCA's legal restrictions on involving only those who have written consultee's advice–especiallywhen used with ‘vulnerable populations’. Though an integral aspect of safeguarding, the ethicsreview process risks reinforcing cultural stereotypes of older adults, as not able to makedecisions and lacking agency, which contributes to the governance of this population. This isarguably as much a political act as one grounded in ethical concern (Stevenson et al., 2015).Consequently, the ethics review process can reinforce paternalistic attitudes towards olderadults and can silence populations and individuals who do not demonstrate a specific ability toprovide informed, written consent, and threaten to stymie research endeavours, preventingnew research from ever taking place.The process consent approach differs from the informed consent required by committees withthe assessment of capacity on one occasion rather than as an ongoing process, which oftenends up in excluding the person with dementia rather than using any form of remaining capacityto include them in research. Process consent is contingent on rapport, which was flagged by thecommittee as a potential area of concern for the study design, as rapport is not a quantifiablething that I can present prior to my fieldwork period. You cannot ensure that rapport will build43between myself and each resident and member of staff (and it did not), but the notion thatrapport is a subtle art which will guide me through my research to engage with those whodesire interaction was not well recognised by the REC at the time, and the focus was instead onthe issue that rapport is not a one-off event (Bell, 2014).In order to include residents who demonstrate lack of capacity to provide informed writtenconsent in participant observation, we included consultee advice, which relies on the opinion ofa close relative or friend to determine whether their friend or family member would likelyparticipate in the study. The Mental Capacity Act defines consultees as those who would bemost fit to give an opinion about the potential participant’s willingness to participate in thestudy. Consultees do not provide consent on behalf of potential participants, but they provideadvice, helping to include the potential participants wishes and preferences in the decisionmaking process. The concept of negligible harm is important here, as consultees need to gauge,basically, whether their friends or family would want to sit and talk with me, or sit with me, inthe care home, which is their home.However, prioritising the opinions of close relatives or friends over those who interacted withresidents more regularly was complicated during this pandemic period when many residentshad not been able to have visitors for months. Staff helped me reach out to those who theyunderstood to be the best likely consultee. Communication between residents and family wasoften facilitated by staff, not by me or by residents directly. Had family and friends been allowedto enter the separate sections of the care home housing groups of residents, I would have met44with them, discussed my plan with the resident and their family member(s), the process ofseeking advice on the behalf of resident participants would have been more relational, includingpeople from many parts of the participants’ lives.Taking place in a private residential care home located in the United Kingdom, this ethnographicstudy took place throughout the spring and summer of 2021. I resided in a private on-siteapartment in the care home for weeks at a time over the course of three months, making a fewreturn visits thereafter. During these periods, I was in the care home 24 hours a day. The factthat I was residing in a care home during the COVID-19 pandemic, during an event which placeddisproportionate pressure on this population through prolonged periods of isolation, increased(and often changing) regulations, and experiences of loss and illness, shaped this project fromdesign to dissemination of findings. The design for this ethnographic study evolved with healthand safety protocols as the care home adapted to public health concerns during the pandemic.I was required to obtain informed, written consent for interviews with residents of the carehome. Thus, this limited the number of interviewees to just three participating residents of thecare home. Interviews are valuable – it is a different type of data source, and there is a sense ofvulnerability and earnestness during these events. One interview gave a man a chance to speakabout the challenges of caring for his wife who has dementia, and who was also a participant inthis study. In another interview, I spoke with a retired nurse resident about her expertperspective on care, and how she felt her care was handled during the 2020 lockdowns, when,in a few months’ span, her section of the care home lost seven residents to COVID-19. The third45interview was with a man who was a temporary resident when his daughter, his primary careworker at home, would travel for work.At first I was disappointed that I would not be able to conduct interviews with more residents.However, though the interview privileges a type of storytelling, it is not the only, or even bestway to tell one’s story. So much is said in observation and interaction as well, and this form ofcommunication enabled those who were not ethically, legally, or perhaps cognitively capable ofinterviewing to share their experiences and what mattered to them. Ethnographic data isobservational, documenting body language, how participants move through space, how theyreact to other people and non-human agents. This form of data collection is easily blurred intodaily life: participants over time began to see me as a confidant as my role in the communitygrew more natural. It became more difficult to understand when a conversation was data orwhen it was a moment between friends. This poses complex ethical challenges, fusing therelationship between care and research, as will be detailed in the following case studies.I participated in the daily life of the care home through care acts: making tea, helping residentsmake phone calls, reading mail, washing dishes and disinfecting surfaces, having a chat, listeningto stressed staff talk about their shift, and much more. Care sat firmly at the centre of all theseinteractions, and care occurred between residents, staff, and me. The movement and messinessof the space meant that attention to body language, verbal cues, and having a sense of thenorms of each section of the care home (for they varied greatly) was important to ensure thatmy presence was not intrusive or stressful for staff or residents.46JuliaThe day after interviewing George, I sat with his wife, Julia, and we knitted together for a fewhours, speaking about her experiences moving into the care home with her husband. Julia hadbeen enrolled after consultation with her husband, who in addition to providing informedconsent for himself, was enthusiastic about Julia’s inclusion in the study. The day prior, I hadcomplimented Julia on her cardigan. She said that she made it and then, “I make everything thatI wear”. I asked her if she’d like to show me how to knit, and we agreed to try it together thefollowing evening.“Well, I haven’t done this in ages”, she began slowly, clumsily looping the polyester pink yarnaround two large knitting needles. She patiently explained to me how one would “cast on”, butbefore too long, Julia was knitting expertly, and her instructions stopped, she focused on her joband began to speak openly about her life, telling me about her childhood and her training tobecome a teacher. Her chipped pink nail polish glittered as her knobby, stiff fingers movedquickly, wearing the memory of a lifetime of knitting. I paid close attention to what Julia wastelling me, but I also knew that perhaps Julia was not fully aware of me, of my intention forbeing there. Eventually, a man yelled from his room and Julia’s awareness came back into theroom. I assured her that he was fine, and she shuddered, saying, “I wish they could dosomething about that racket. He is always yelling and I am worried nobody is there to help him”.Then she looked around, and not seeing George, she asked after him. We started talking about47how it feels to live in different rooms from her husband, and the conversation, becoming morerelated to my topic of inquiry, allowed me to reacquaint myself and my role to Julia.The experience of sitting and having a chat over time allowed for interruptions, shifts in topic,reacquainting to the topic, and continuing to discuss matters outside of my inquiry in a way thatfelt less rigid, and more natural. During this time, Julia told me some things that I did not feelwere appropriate to directly quote, so I did not capture Julia’s verbal account exactly, as I wouldin an interview. Instead, I captured a feeling of the interaction, a sense of what Julia wasexpressing. Rather than gleaning the interaction from a singular perspective, I tried to capturethe mood and feeling from the entire interaction, making my role clear where appropriate whilealso allowing for the spontaneity of our dynamic to play out (Pols, 2005).Like my experience talking with Julia, many of the interactions in the care home wereambiguous, but by reading body language, and tone, and by carefully observing the ‘natural’flow of care workers and residents, I etched myself into the daily life of this care home andgently and as transparently as possible. Though the process is complex, it upholds the valuesunderpinning the HCF: that consent is an interpersonal process which occurs temporarily andcan change across moments. In the following section, we will share some experiences ofseeking consent throughout this research project to further explore the complexity of theseinteractions.48Eva“It’s warm out there!” I greeted the room, which was buzzing with the sound of electricfans. It was a hot afternoon, and the windows were open to create a cross-breeze in the room.Eva was sitting in a chair in the dining room, dressed in her nightgown (someone explained thatthis was the only clothing item most residents owned thin enough to be appropriate for thisweather). Positioned under a fan, Eva’s face was glistening and pale, and her soft white hair waswet on the edges, causing small curls to cling to her temples like wet leaves on a windshield .Mary, one of the care workers, continued to gently dampen Eva’s face with a cloth. “It certainlyis, and this poor thing”, she said, turning to Eva, “we are simply not accustomed to this kind ofheat, are we dear?” Eva sighed and raised her eyebrows in agreement. “Yes, it’s far too warm” Ichimed in, hoping to join in the small talk. Eva looked away from me, frowning, and then toMary. Since Eva appeared uncomfortable with my presence, I chose to sit in a chair a bit furtheraway.In this situation, I quickly understood my participation to be an imposition, as there were clearsigns that Eva had felt a sense of discomfort with my voice and presence. Of course, a swelteringafternoon might be a particularly difficult time to engage with someone unfamiliar. I alsowondered how it would feel to be sat in a thin nightgown, a logical response to staying cool inthe heat, but not with much consideration for Eva’s feelings of privacy or dignity. Though Evawas in a common area used by all residents, staff, and anyone who entered the community, herclothing, and the activity of being given a washcloth, were private activities.49Following this event, it is important to explain that I did not observe Eva from a distance withouther knowing. As I grew more used to each ‘community’ within the care home (a separate livingquarter with its own common areas made up of about 10 residents and 3-4 staff at any giventime), I grew better at focusing my observational eyes on those residents and staff who werewilling to participate, and not observing the others, such as Eva in this instance. The householdsare open to any visitors and the common areas would often contain many different people,coming and going, and when I wasn’t on “data collection mode” I would still be around,interacting with people, from whom I did not have consent (or consultee advice), or, as in Eva’scase, were part of the study, but from whom I did not have present consent to observe for thepurposes of data collection.I had previously spent time with Eva and grew to understand that she often preferred mypresence along with the company of other staff. Eva, who is non-verbal, and who has been livingat this care home for four years, is a favourite resident among care workers, and they oftenexplain things to me as they are helping her with mealtimes. Staff will explain how they readEva’s face for signs of being hungry, or not interested in a certain dish. They explain how theymight adapt the daily menu to a soft diet.Whether or not these explanations bother Eva, I cannot readily discern. Staff do not speakabout Eva in front of her, rather opting to speak in “we” (“we eat lots of tomato soup, don’twe?”). In this way, it did not feel voyeuristic when I participated and observed in her care. Butthere was a line drawn: I would not accompany Eva to her room or to other areas alone, which I50might occasionally do with other residents, with whom I’d established a stronger rapport. I alsowould not often address her directly, sit too close to her, or even sit at the same table,depending on her mood. During my time in this section of the care home, Eva and I haveexchanged the occasional smile, kind glance, or nod. But most of the time, we kept ourdistance. Through my time in her private living space, I placed myself gently at the periphery,mostly through observation, but also through participation, as Eva and her care workersnavigated the presence of an outsider in Eva’s home. Importantly, though a stronger rapport didnot build during the study, Eva did not always dislike my presence, and in fact, she seemed quitecalm and understanding when I would accompany her along with a member of staff. Had Evaconsistently demonstrated discomfort with my presence, I would not have included her in thestudy, as was the case with some other residents. This is a very sensitive distinction which issubjective in nature. Here, I relied not only on my ability to ‘read’ Eva, but on the comfort andnaturalness of staff with whom Eva had a more consistent rapport.Over time, I became more familiar with residents’ daily schedules, and would know whencertain residents may be willing to spend time with me. Discerning consent was slightly moredifficult with residents who preferred to stay in their room, as I would have to impose in orderto gauge consent. I often did this by offering care staff to bring residents’ their tea or coffee.This way, I would have a reason to knock and say hello but would also allow for residents toinform me that they would rather be alone, either verbally or through body language (or if theywere sleeping, with a physical therapist, on the phone, or in the bathroom, et cetera).51RebeccaBecause she was comfortable with telling me when she did not want to participate, I feltconfident that Rebecca’s participation was consensual and I visited her whenever she said shewas ‘up for it’. Through staff, I learned that she did not marry, had no children, and her niecesigned the consultee advice sheet, but this was about all that could be gleaned about her lifebefore the care home. When she was in the mood for my visits, she would often tell me aboutthe series she was watching at the time, an antique shopping competition. We wouldsometimes sit in silence for periods of time as she grew more engaged with her show.My experiences with Rebecca help illustrate care work through ethnographic presence andsensibilities. She was not always an eager participant, but consent was there, subtly, in theinteractions that we did have. This calls into question what a “good participant” may look like.Participation, and what defines “good” participation, could be seen as similar to well-being,which is outlined by the HCF as operating along several connected, but separate values, such asinsiderness, uniqueness, and embodiment, running along a spectrum ofhumanisation-to-dehumanisation. The dimensional understanding may help us to complicatewhat it looks like to participate “well”: remaining solitary, prioritising privacy, and dissenting toparticipation can be equally valuable to understanding the shape of experience in the carehome. There was a slowness, a subtlety to the time I spent with Rebecca. Unlike someresidents, who had a seemingly endless supply of opinions and stories to share about theirexperiences in the care home, Rebecca required patience, slowness. Then, sometimes, shewould tell me about how it feels to be in her bed, hearing people out in the room but notknowing any of them, about not wanting to know them. Sometimes she would share her52feelings of not wanting to be a part of the care home, that her bed-ridden state was physical,but her rejection of the care home was more than that, it was a choice. Her insiderness, keepinga sense of separation from the community in the care home, is where Rebecca seemed to find asense of safety. “It will be good for her, having those chats, I’m glad that you go in”, one careworker told me, and another: “everyone enjoys a nice chat”. True, I reflected, but for Rebecca itseems somehow equally valuable to reject the invitation for a chat, to establish her right to aprivate life in a living situation as public as the care home. Through the slowness of ourrelationship, Rebecca showed me how she protects her sense of agency by having a boundariedrelationship with care workers and with myself.Rebecca’s case reminds us that advice given by staff members may not necessarily align withthe desires of the resident. Although staff may have a closer relationship with Rebecca, thisdoes not necessarily mean that they know all of Rebecca’s preferences or wishes. This raises thequestion of who is best suited to provide guidance in such situations, which is an issue with theviability of consultee advice (and the importance of this being advice, and not consent on thebehalf of an individual). Rebecca’s case also highlights the empowering effect of activeparticipation, particularly in situations where individuals feel trapped or powerless. By activelyparticipating and expressing her thoughts and feelings, Rebecca can importantly enact hersense of agency and also contribute a valuable voice on how it feels to navigate a limited senseof agency in the care home.53The cross-disciplinarity of care work and research further structured how participants and Iengaged in this study. These collaborative moments expose a multiplicity of interpretive lensesat play–carers offer their interpretations, first, as a supportive insiders’ knowledge to help withmy introduction to the field. Later, my interpretive lens, was shaped by not only the fact that Iwas new to the care home, but that I was using my time differently–instead of providing a set ofcare services for residents over an eight-hour-shift, I could come and go more flexibly, spendinglonger amounts of time simply ‘being’ with residents. This eventually meant that I heldinformation that could only present itself slowly, information about mood, preferences, andsubtler needs (like making a call or getting a new pillow) which sometimes would fall throughthe cracks in a busy day of care work.My role, as a PhD student studying the care home, also meant that these collaborativemoments could sometimes feel awkward, and my inquiry could be interpreted by some ascriticism. Sometimes I would come into a community of the care home to see carers quickly getoff their phones, or stop chatting casually with one another. Though care workers were given aparticipant information sheet detailing that their identities would be kept confidential, I worriedthat they felt they had to participate in the study to please management who had been a part ofthe recruitment process. There is no way to prevent the possibility of subtle coercion in thiscase, but I assured the care staff that I was interested in the daily life of the residents and myrole was not to hawk over carers as they did their jobs, but that I hope to be “part of thefurniture” (Draper, 2015, 39). My working-class background, and the fact that my mother had54worked as a “lunch lady” in public schools, strengthened rapport between carers and myself, asa “trusted outsider” (Bucerius, 2013).My ‘outsiderness’ shaped and guided many interactions around consent and intention.Throughout the study, my foreign identity was often brought to the forefront of interactionbetween residents, staff, and myself, and was instrumental in establishing consent. First, I amAmerican in the United Kingdom during a time when so few outsiders made their way into theisolated care spaces. My clumsy, untrained hands would often give me away as someone who isnot a regular member of staff. Even the way I prepared tea exposed me as an outsider; I steepedtea too long and added too little milk (“is this builder’s tea?” one resident joked). Ire-introduced myself to residents, accepting “close-enough” titles, such as ‘nursing student’,‘American girl who wants to talk to us about care’, ‘who wants to know how we like it here’, orsometimes just ‘the girl’ (which required some more information on my part). When necessaryand appropriate, I would remind everyone of my role, and my goals in talking to them, and Iused my role to help remind residents of why I’d want to ask them questions or sit with themwhile they lived out the details of their daily lives. Furthermore, my role as an outsider to thecare home culture impacts not only possible rapport between residents, staff, and myself butalso means that I may not always correctly read body language or cultural and social cues in theway they are intended by participants.Throughout the study, I experienced a shift in my initial hierarchical positionality - a commonfeature of any research context - through a process of mutual accommodation. As we became55accustomed to one another, the hierarchical and procedural form of seeking ethics becamemore entrenched, as I became a “guest of the guests” (Boccagni & Bonfanti, 2023). Additionally,vulnerability occurs and is experienced by everyone involved in the study–not only those lackingthe capacity to consent–such as the vulnerability experienced by staff workers in relation tomore privileged residents (Reed-Danahay, 2001). These observations highlight the significanceof an ethnographic approach in healthcare research, which requires sensitivity to powerdynamics and the complex dynamics of vulnerability in healthcare settings. This experienceunderscores the importance of process consent not only for individuals lacking capacity but alsoin any setting where a power dynamic exists between the researcher and participants.Doing ethics is a messy process. It took time to build a sense of what consent, and just asimportantly, dissent, looked like from each potential participant in this project. It took time tounderstand the general flow of the communities within this care home, each being quitedifferent, and to gently find a space where I could fit in. Importantly, it took time to build trust.Relational ethnographic work requires a ‘caring for insiderness’ (Desmond, 2014; Todres et al.,2014). My positionality was both an asset to gaining information about this community and abarrier to understanding certain complex cultural cues. The interaction required to repeatedlyassess consent, (an initial concern for the HRA ethics committee as being “overburdensome”),varies greatly from individual to individual and this sense for being a burden is developed overtime and through rapport. Informing Julia that I am interested in her experiences for my study56throughout our conversations looked different than my long afternoons spent with Rebecca, forinstance.The need for not just more, but deeper, explorations of the world of residential care for olderadults is pointed to over and over (Westwood, 2014; Sandberg, 2013; Simpson et al., 2018;Cowdell, 2013). Yet, the struggle to represent the experiences and voices of participants who donot demonstrate capacity began the moment this project came into existence. This begs thequestion not only of representation, but the power structures which generate saidrepresentations (Marcus & Fischer, 1986). It describes the care home from within, experiencingalong, which will help us to move beyond paternalistic views and treatment of older adult carerecipients (Connor, 1989), and to engage with the lived experiences of residents. Thephenomenological approach underlying the HCF is useful when engaging in such research. Evenwith consultee advice, I was still tuned into looking for signs that each participant wants to takepart in the study (e.g. through body language and verbal expression). This relational approachto consent, bound up in the ethnographic design, is good practice and is informed by such aphenomenological approach to well-being and care.Describing the way one might tread carefully through intersubjective events to best respectone’s wishes to consent or dissent to study participation is difficult to describe in an itemisedformal ethics application, or to make sense of in a procedural fashion (Simpson, 2011;Fluehr-Lobban, 2003). The case studies presented in this paper show that there is scope for adifferent approach which is much more ethical and inclusive than can be fully accounted for in57procedural ethics. There is no possibility that I could have described my experiences with Julia,Eva, or Rebecca before going into the care home and meeting them, or even to explain whichpercentage of residents would likely want to sit and have a chat with me on which days, orwhich times of the day the care home would be most active. Instead, ethically engaging with,including, or excluding potential participants was bound up in the care logic of the care homeand relied on all actors to carefully negotiate our positions (Roger, 2023).In a project which aims to highlight the stories of those living in this care home, how are thesestories witnessed, gathered, and represented? The justification for this project existing at all isthat older adults’ experiences of care, and in this particular case, residential care, isunderexplored, and tend to focus on the institutional failures over the lived experiences of olderadult residents (Malta-Müller et al., 2020). It is not too bold to call this project one ofanti-oppression, one which would do well engaging with ongoing debates in post-colonialismand disability studies–grappling with subjectivities and directly engaging with a 'politics ofposition’ to highlight which voices are enabled to represent whose experiences (Rogers, 2023).Consent, like care, is not an immutable thing, but it is a messy, nuanced process. Conductingresearch with the ethos of process consent, wherein one reads each situation for consentbetween individuals, allows for the inclusion of participants regardless of their capacity toprovide informed consent. The methodological issues of engaging adults with varying capacitiesto participate in ethnographic research are supported by the philosophies of care and caring.Well-being, an existential, multi-faceted experience which occurs along varied, and sometimes58even contradicting, characteristics, is supported in this process, a way to “care for insiderness”(Todres et al., 2014). The balance, for instance of privacy or solitude, for the chance to shareone’s experience and engage in research is a choice which is taken away by overly paternalisticethics barriers. Research can be a component of the care matrix. The fact that engaging inresearch can improve mood and well-being among older adults has been explored(Butterworth, 2005; Grout, 2004). With process consent, consent is negotiated through therelationships built between researcher and participant, be it staff or care home residents. Thestrength of the ethnographic design parallels the humanisation of care framework: to de-centrethe verbal interview as a story-source, to listen and observe for the embodied ways participantsmay communicate what matters to them, to “unmask the elderly mystique” (Carney & Grey,2015). A consent process which adequately values and understands the complexities ofethnographic research in care home settings with older adults is a necessary next step inaddressing our need for more inclusive research, and ultimately better care.5960Accessing a bounded/protected location and people in the times of COVIDThe residential care home presents an intriguing setting for an ethnographic study. The notionof the dwelling and its transformation within the care home (Ingold, 2005) provides fertileground for investigating processes, customs, and collective experiences (Giddens, 1981).Institutional ethnography has been widely employed in healthcare research, ranging fromstudies in psychiatric hospitals (Goffman, 1961) to community clinics. These ethnographicprojects, which aim to explore specific groups or cultures, invariably raise questions aboutboundaries (Candea, 2007). Since Rose Laub Coser's seminal work, "Life in the Ward" (1962),researchers have been eager to delve into the intricacies of institutional life throughethnographic approaches.In her early exploration of hospitals, Laub Coser portrays them as "little islands," emphasisingtheir foreignness and distinct cultural practices (1962:3). In contrast, Zaman's (2005)ethnography of a hospital in Bangladesh highlights how the borders of such institutions areconstantly being reshaped and redefined by the individuals who enter and exit them. Thenotion of boundedness (Candea, 2007) and closed communities gives rise to discussions onpower dynamics and access issues within disability and gerontological research. Gatekeeping,while essential, can also present challenges. The COVID-19 pandemic has intensifiedgatekeeping practices, reigniting debates around access in healthcare settings and sheddinglight on power dynamics during this challenging period. The residential care home, as anexclusive and exclusionary institution (Foucault, 1975), is subject to the biopower exerted onolder adults, as critically examined by gerontologists and sociologists (Estes, 1979; Estes, Biggs &61Phillipson, 2003). Accessing this community poses politically charged obstacles intertwined withnotions of paternalism and assumptions about the agency of older adults.Practical and material considerations are at play, given that my field site is a residential facilityfor older people, making it essential to ensure the safety of participants, staff, and myself. Thepandemic has introduced unique challenges for conducting embedded research in thiscommunity. Residents are more isolated, care staff are likely under increased stress, and myown isolation is amplified. The data collected during this heightened stress and safety concernswill inevitably differ from what would have been obtained under normal circumstances. TheCOVID-19 safety regulations have demonstrated the permeability and negotiability of theseinstitutions (Armstrong & Klostermann, 2023). Logistically, ethnographic research has becomemore challenging due to restrictions that impede the traditional notion of "being there,"requiring the ethnographer to navigate access and safety in new and different ways.The design of this project necessitated more extended periods of embedded fieldwork withfewer breaks or shorter periods spread over an extended timeframe, as dictated by thelimitations imposed by the pandemic (Tauzer, 2023). Negotiating access to the field was anongoing process, though I received little to no pushback from the care home itself, the ethicsprocess and the consideration of family members and friends who have limited access to theirloved ones living in the care home during data collection.62Various adaptations have been proposed to continue ethnographic research during thepandemic, such as digital ethnography or "ethnography from home" (Góralska, 2020), as well aspatchwork ethnography (Gökçe et al., 2020). These adaptations aim to reflect the realities ofour lives shaped by evolving restrictions on social interactions and the increasing role of digitalplatforms. Embracing the concept of boundless locations in the research design (Candea, 2007)or adopting a multi-sited ethnography approach (Marcus, 1995) helped me think about how Iaccommodated the temporal and spatial fluctuations inherent in this project. Even whenphysically present in the field, the research is likely to exist in an unbounded and liminal state(Turner, 1977), as I traverse between the field and home while encountering tightening barriersand gatekeepers seeking to safeguard the care facility's residents.63Chapter Three: Engaging with the Literature“Since it is the Other within us who is old, it is natural that the revelation of our age should come to usfrom outside — from others. We do not accept it willingly.”Simone de Beauvoir, The Coming of Age“The trouble is, old age is not interesting until one gets there. It's a foreign country with an unknownlanguage to the young and even to the middle-aged”May Sarton, The House by the SeaA prevailing dehumanising attitude towards older adults impacts not only the provision ofservices but also shapes our social imagination to such an extent that data collection often failsto consider older people altogether. Existing care research on older people often peripheralisesgender identity in its analysis (Calasanti, Slevin & King, 2006; Clarke & Bennett, 2013),desexualises older individuals (Calasanti & King, 2005; Gott, 2005; Heaphy, 2007; Simpson et al.,2018), and promotes a decline narrative that flattens older adults’ perspectives on subjectiveexperience (Davis, Grant & Rowland, 1990). Without a better understanding of existingconceptual approaches, these issues may be replicated in future research. For this reason, I willreview how we grapple with gender and ageing in conceptual literature to identify empiricalwork that addresses or complicates how we look at gender and ageing in care. The following isan overview of existing literature that looks at old age and gender as intersecting categories toexplore the potential for a gender approach to deepen existing understandings of old age care.This review is meant to first map out conceptual approaches to ageing and gender and thenlook more closely at how these attitudes, genealogies, and positions inform current research.64Because gender is a contested concept with many theoretical approaches and genealogies, andthis review is structured with the hope to engage not only with existing research on gender butthe varied ways in which old age and gender intersect, this review will be organised in twostages. This two-part design of this review is inspired by a similar format conducted on ageingand social exclusion (Walsh, Scharf & Keating, 2017). However, in this review, rather thansynthesising existing frameworks to guide domain-based reviews, I first conduct a looseoverview to build a map of conceptual and theoretical framings of the interaction betweengender and ageing. This method attempts to establish a footing in this interdisciplinary field andengage varied modes of operationalising the slippery concept of gender. Since age and sociallocation research is spread across multiple disciplines and can contradict gerontology, a broaderoverview is a reasonable starting point for this review. Once this map has been sketched, Iapproach empirical peer-reviewed literature to examine how existing research in the care fieldfits within the identified conceptual frameworks. I have selected this two-tiered process to helpgive shape and transparency to the amorphous nature of gender in research and the layeredcomplexities of combining gender and ageing. This design is an asset in etching out a map of thetrends and findings for this nebulous and interdisciplinary topic.This literature review section presents a review of international literature focusing on genderand old age. Stage one involved a loose sociological review of varied approaches tounderstanding gender identity in old age: identifying conceptual understandings, criticaldebates, and critical themes of the discussion of age and gender interdisciplinarity. Stage twoinvolved conducting overviews each of the conceptual themes highlighted in the first stage (five65in total) with a particular (though still quite broad) focus on care contexts and recent empiricalresearch considering older adults' experiences and perceptions. Reviewing existing literature ongender and ageing, this chapter calls for centring conceptual themes in making sense of theexperiences specific to ageing individuals in future care research. Using dated sources in myliterature review serves to underscore the enduring nature of certain issues within care researchon older people. By referencing older literature, I aim to demonstrate that these themes havepersisted over time without significant progress or evolution in the discourse. This approachallows me to highlight the longstanding nature of issues such as the marginalisation of genderidentity, the desexualization of older individuals, and the promotion of a decline narrative.My introduction to issues of old age injustice began in the academic sense over a decade beforeembarking on this doctoral project. As a first-year psychology major, intending to take thescience courses required for admission to medical school, I wandered into a class in the biologydepartment titled “Healthcare Inequalities”, led by Dr Andrea Steiner, who would, over thefollowing four years, become my main supervisor and the inspiration to delve into thespecificities of age-based discrimination in the US healthcare system. Among peers discoveringMarxism, racial injustice, anarchist cooperative movements, and environmental rights, my focusseemed strange, perhaps a bit mild in comparison. But for me, the angry words of ageactivists–Barbara MacDonald (2001), May Sarton (1970; 1988; etc.), and Maggie Kuhn, asexamples–burned with the passionate rage, embodied inquiry, and reflective honesty that Icraved as a young adult mapping out and making sense of her world. The injustices faced by theold could not be parsed out from other issues of social injustice.66It bears noting that my orientation to studying healthcare (injustices) occurred in my homecountry, the United States. However, even in these early days of studying “critical socialgerontology” relating to the specificities of the crumbling US healthcare system, it was madeapparent that much of the interdisciplinary thinking on old age and, specifically, socialgerontology, occurs trans-Atlantically. Writers such as Carroll Estes, Margaret Minkler, andStephen Katz, to name a few, introduced me to the concept of old age as an intersectionalaspect of social location. Biggs and Philipson, in the United Kingdom, were often in conversationwith these North American writers. Molly Andrews led the way in lifecourse perspectives andthe use of narrative to delve deeply into the lived experience of old age. Thus began my quilt ofsocial gerontologists, who would follow me through my Masters' studies in Anthropology, andon into this current work, to which I will now turn my undivided focus.For stage one of this review, I review literature that relates to the conceptual framework ofgender and age with looser inclusion/exclusion criteria. I include literature from any date andinclude dissertations as well as peer-reviewed publications. This path is woven as I gather andsearch for trends and themes in this interdisciplinary area of focus. I focus particularly on howgender is used in research on ageing and unearth some subthemes which will help guide thesecond stage of the review. Search keywords to guide the first stage of the review were derivedfrom the established literature on gender and old age. Keywords relating to the topic of genderincluded: gender; men and women; gender identity. Keywords relating to ageing and olderpeople included: ag(e)ing; older persons; older adults; seniors; elderly; elders; senior citizens.67For stage two, my search is more systematic, and is presented as an overview of the literaturewith a sociological leaning. I focus on current research that deals with age and gender in care,with stricter inclusion/exclusion criteria. I used AgeLine (EBSCO); ScienceDirect; Scopus; GoogleScholar, Google Books, and PsycINFO. The inclusion criteria were as follows: (1) literature since2011 (the past decade); (2) academic, peer-reviewed journal articles, books, and researchreports that present original work; and (3) empirical, qualitative studies which focused on theexperiences and perceptions of recipients of care. Initially, I limited my review to studies whichtake place in residential care but found this too limiting. Any literature on care, in any capacity,was considered for this review. I decided to exclude literature that focused on the experience ofcarers—this limited my findings significantly, but without this limitation, the review would bedominated by studies on the experiences and perceptions of carers rather than care recipients,or those who expect to need care in older age.Stage one identified five conceptual domains: lifecourse, intersectionality, embodiment,performativity, and sexuality/sexual identity or orientation. Stage-two domain-specific keywordswere generated after domains were identified in stage one and are presented with thestage-two findings. I conducted overviews of care literature using these five domains. Usingfindings from these overviews, bookended by critical conceptual reviews, this literature reviewpresents a unique approach to understanding the complex and under-researched world ofgender and ageing in care.68The purpose of this first section is to overview discussions, debates, and critiques on genderand old age on a conceptual level. This overview is purposefully and necessarily, broad andinterdisciplinary. My goal here is not to overwhelm with an eclectic breadth of literature but toestablish a collection of the central critiques and shortcomings wrapped into how we study theintersections of gender and old age. As a starting point, I will overview the development ofcritical gerontology and its somewhat stunted communication with feminist literature. Ageingoccurs in context and intersects with other identities across the lifecourse. The way socialcategories interact and influence the ways we age has been explored by the field of socialgerontology: the study of the psychological, biological and social analyses of ageing in a socialcontext (Longino & Powell, 2002). It is important when looking at gender to be wary of theepistemological trappings that can reproduce and promote hegemonic attitudes; in careresearch, this may be doubly so, since we must grapple with trends to over-medicalise andhomogenise older bodies (Sandberg, 2013). It is also important to note that theorising aboutexperiences of ageing has mainly been conducted by the ‘ageing enterprise’ (Estes 1998;Gubrium & Wallace, 1990) and not by older people themselves, except some influentialautobiographical texts (Davies, 1989; Macdonald, 1983; Sarton, 1970).Critical social gerontology is the study of age within society and the ways in which age serves asa point of identity on political, social, and individual levels (Estes, 1999). Critical gerontology,which often takes a political and economic stance on ageing, posits that ageing cannot beseparated from a socio-economic matrix which positions different individuals to age differently.This perspective focuses on inequalities in old age and operates in the critique of previous69perspectives on ageing which homogenised and simplified the aged population (Phillipson,1982). Foucauldian perspectives on biopower, feminist perspectives on gender-based disparitiesin agency and ‘the feminisation of ageing’ (Minkler, 1996) have been useful in understandingageing as a social process. Social and critical gerontologists have identified the impact of genderin old age in many areas of life such as retirement (Minkler, 1990), housing needs (Svihula &Estes, 2008), and access and utilisation of services (Biggs, 1999; Estes, 1998; Laliberte, 2014).Critical gerontology has identified that a pervasive neoliberal logic of productivity in old age maypromote a binary when understanding ageing: either one is successful (a productive, consumingsubject), or one is sickly, weak, and frail (Calasanti & Slevin 2006; Estes, Biggs & Phillipson 2003).Critical gerontologists have coined the term “the feminisation of ageing” (Estes, 1998; Mujahid,2008) to describe the phenomenon of women living longer and in relative positions of lesseconomic and social power than men (Hess, 2018; Byles et al., 2010; Tuohy & Cooney, 2019).The invisibility and mistreatment of older women in a patriarchal context have been writtenabout across a variety of contexts and have been rigorously explored, especially in second-wavefeminism (de Beauvoir, 1996; Frieden, 1994; Greer, 1991; MacDonald & Rich, 1991; Steinem,1995). That disproportionate dependence that older women have on the state is a product ofsocietal values and economic structures (Minkler, 1996), and the contradictory demands forwomen to spend more time providing informal care services (Wilson-Ford, 1990) are recognisedas some of the most salient factors that create a gendered pattern of dependence in old age.Since critical gerontology takes a largely socioeconomic lens on issues of ageing, theexperiences of individuals with regard to their intersecting identities in old age can beunder-explored by this perspective (Hulko 2002).70The ‘feminisation of ageing’ is used widely to frame and justify inclusion criteria for health andpolicy research (Davidson, DiGiacomo, & McGrath, 2011). Scholars from public policy, socialwork, sociology, and feminist studies apply a gender lens to ageing studies (Clarke & Bennett,2013; Song & Kong, 2015; Tuohy & Cooney, 2019; Winterich, 2007), and the ‘double jeopardythesis’ of age and gender has been used to argue that older women are often at a necessarilymore disadvantaged position in old age (Chappell & Havens, 1980; Chepngeno-Langat &Hosegood, 2013; Ferraro & Farmer, 1996; McKay, 2005). The term double jeopardy is usedprimarily in policy research to describe the combined disadvantages that individuals comingfrom certain categories may face, such as being old and being a woman (Liska Belgrave et al,1993).These issues and patterns are important to consider, but framing all research in this way riskssilencing varied experiences of ageing and reproducing a binary understanding of gender. Inreaction to this “operational essentialism”11, critics of this perspective argue that a ‘doublejeopardy thesis’ promotes a “misery lens” by which we examine older women (Ovrebo andMinkler, 1993). That is, the view that all older women must necessarily live at a disadvantage tomen threatens to reproduce assumptions of autonomy and agency. Furthermore, critics of the‘double jeopardy’ perspective posit that this framing of older women’s experiences replicatesand strengthens simplified and wholly negative understandings of what it means to age as awoman, thus bolstering sexist stereotypes of ageing women (Ovrebo and Minkler, 1993).11 Operational essentialism of gender has been defended as a method to promote equality for women - theoperational aspect of gender which is used in policy and public health promotion (Spivak, 1985)71These categories are a fact of our current society and must be considered when evaluating howgendered identities impact ageing. However, we run into an epistemological conundrum if byresearching gender and power, we in turn reinforce a pervasive gender binary. There are indeedsociological categories of gender that adhere to binary and heteronormative understandings,which act upon individuals throughout the lifecourse to position us differently. A lifecourseperspective helps us to look at how social location impacts the ways we age narrative studieslook at the lifecourse perspective as a mode to centre the individual’s life experience in ouranalyses of ageing in context (Woodward, 2006). Thus, it should be useful to operationalise thelifecourse as a conceptual framing to look at differences in old age.Feminist gerontology has responded to the conceptual issue of gender by engaging moredirectly with the complex and multi-faceted nature of identity. Expanding on Bytheway’s earlierdefinition of ageism, feminist gerontologists aim to take a more holistic view of the individualand to engage with subjectivity and identity. Feminist gerontology views gender as a relationalconstruct that provides women and men with advantages and disadvantages throughout thelifecourse. Feminists pursue a holistic view of people’s lives, emphasising strengths, oppression,differences, and abilities; analysing old age more inclusively; and advocating social change toreduce inequities (Hooyman et al. 2002: 10).Lifecourse Perspective on Ageing & GenderWhen gender is applied as a variable, this implies an inherent and consistent difference, whichfuels the “othering” of women compared to the normative male experience (Hochschild 1978;72Matthews 1979). Gender-as-variable work also operates under a binary assumption of genderwhich has and continues to be problematised as erasing the existence of individuals who liveoutside of this dogmatic binary framing of gender. The lifecourse perspective on ageing is atheoretical framework that examines how individuals develop and change over their lifetimes,particularly focusing on ageing and the processes that occur as people grow older. Thisperspective emphasises the dynamic interaction between historical, social, and cultural factorsacross the entire lifespan. Taking a lifecourse perspective on ageing may help to map differencesamong ageing individuals without promoting overly prescriptive understandings of what ageinglooks and feels like for older adults based on gender identity alone. A lifecourse perspective onageing can help to understand the way different individuals age differently and to engage withgender as an analytical tool rather than as a variable that necessarily positions older women toage at a disadvantage to older men.Exploring the lifecourse domain revealed a smaller volume of literature than anticipated(n=457), and only 12 of these studies proved relevant for this review. While there were somestudies centred on older women in this category, many of them were quantitative, emphasisingrisk and frailty. Qualitative studies that did exist primarily explored the experiences of familycare workers and centred on risk factors. Surprisingly, there was a dearth of literatureconcerning the lifecourse experiences of LGBT elders. These themes were predominantlyheteronormative, with a greater emphasis on women than men. This highlights the necessity ofconsidering the perspectives of older adults themselves when utilising the lifecourse frameworkto gain a deeper understanding of ageing and care.73Regarding the literature on the lifecourse perspective, gender identity was mainly taken intoaccount when discussing familial structure. For instance, studies examined the experiences ofolder widows (Isherwood, King & Luszcz, 2017), voluntarily childless older men and women(Warren & Pals, 2013; Allen & Wiles, 2013), single older women (Timonen & Doyle, 2014; Reilly,Hafford-Letchfield & Lambert, 2020), and men and women living alone (Timonen & Doyle,2014). Frazer, Cleary & Oyebode (2011) interviewed women with dementia who lived alone,delving into the liminal aspect of their experiences as they faced uncertainty about maintainingtheir independence. Hafford-Letchfield et al. (2017) explored the links between relationshipstatus and well-being among older women living alone in old age in the UK, but this survey datacalls for more in-depth qualitative research on the topic.The lifecourse perspective literature also proved valuable when examining adults who aged withspecific diagnoses, such as HIV (Cahill & Valadéz, 2013; Wallach & Brotman, 2013). However,these studies primarily focused on men and stigma, neglecting a deeper gender analysis. Sleepissues in older women were found to be less correlated with medical or physiological factorsand more associated with familial and caregiving responsibilities throughout their lives (Walkeret al., 2012). Reduced cooking activity among women in later life was not attributed todisengagement but rather to new forms of engagement with others, such as using formal mealservices or dining out with family, indicating continued change and growth throughout thelifespan (Lane et al., 2014). Other themes explored included choices or lack thereof regardinglocation and place in late life (Van der Pers, Kibele & Mulder, 2015; Stones & Gullifer, 2016),74loneliness and community engagement among LGBT elders (Hughes, 2016), loneliness andactivity among older men in Wales (Milligan et al., 2015), as well as agency (Pirhonen & Pietilå,2018) and positive ageing (Stenner, McFarquhar & Bowling, 2011) concerning the lifecourse.Overall, studies within this domain predominantly adopted a "gender-as-variable" approach anddid not utilise gender as an analytical tool. Surprisingly, even studies focusing on marriedcouples often failed to consider gender, with keywords related to gender, men, or womenabsent from their abstracts. Furthermore, literature from this domain frequently relied onheteronormative assumptions.Gender and Age as IntersectionalityIntersectionality and performance in gerontological research appears to draw many recentstudies (Ferrer et al., 2017; Nikander, 2009; Previtali & Spedale, 2021; Syed, 2023). Withindementia research, some care literature utilises intersectionality as a conceptual framework tochallenge the objectification of older adults in care studies and to gain deeper insights into theircare experiences (Hulko, 2009). This approach aligns with a person-centred interpretation ofcare (Kitwood, 1997), which emphasises the individual receiving care. The intersectionality lenshas been particularly developed in studies on selfhood in dementia and late old age (Sabat &Harre, 1992). Wendy Hulko's ethnographic research with adults with dementia in Torontoattempts to operationalise intersectionality by examining class dynamics, individuals' priorities,and strategies as they navigate changes in cognitive capacity (Hulko, 2010).75When viewed as a social category, old age does not simply compound oppression but generatesa distinct array of challenges and positionalities (Calasanti & King, 2015). An intersectionalapproach helps illuminate the structural and personal interplay between gender and age.Intersectionality, as a concept and analytical framework, has been explored in various contexts.Initially introduced by Kimberlé Crenshaw (1991) in a legal context, intersectionality has sinceproliferated in the social sciences as a means to analyse and conceptualise the multifacetednature of identity categories. The idea of intersectionality existed intuitively before it wasformally coined, with a complex history involving multiple scholars and actors (Yuval-Davis,2011). While some argue that intersectionality is only applicable when discussing theexperiences of black women, I acknowledge its widespread usage and find it useful to includewhen searching for literature on identity and ageing.In an analysis of how a person-centred approach to care may contribute to the re-gendering ofindividuals with dementia, Sandberg (2018) contends that unquestioningly locating one'scontinuity of self solely within gender expression risks reinforcing normative gender attitudesand overlooking the structural power disparities perpetuated by a gender binary. If adults arere-gendered to promote continuity, feminist critiques may become obscured in favour ofpreserving a simplistic notion of self and identity within the context of care provision. Without amore intersectional understanding of care in old age, studies run the risk of homogenising andoversimplifying the experiences of care recipients (Kontos & Marten, 2013). Adopting anintersectional perspective can aid in comprehending how individuals are positioned alongmultiple identity dimensions and offer a valuable approach to understanding the ageing76process. Furthermore, this approach can help emphasise the need for transdisciplinaryapproaches to understanding, as argued by Phillipson (2015) who suggests that critical racestudies would benefit from incorporating a gerontological perspective on the experiences ofolder adults.When age was considered as an intersecting factor, the focus primarily revolved around middleage, examining income as a determinant of well-being. The majority of research utilising theterm 'intersectionality' originated from Canada and the United States. However, gender oftenreceived minimal attention in these studies or was treated as an 'other' aspect of identityalongside racial, class, and other social distinctions among older individuals (Buch, 2015). Anintersectional approach played a central role in a US-based survey that explored the priorities,concerns, and recommendations regarding ageing and health of black lesbian women aged 41to 91 (Seelman, Adams & Poteat, 2017). Additionally, an examination of self-reported healthidentified the interactive impact of race, gender, and socioeconomic status on individuals'perceptions of their health and well-being (Brown et al., 2016). A study conducted inSwitzerland, focusing on differences in hospital stays, revealed that women tend to have longerstays, and this disparity is influenced by social factors such as income level, marital status, andsocial resources (Hedinger et al., 2015). Socioeconomic status and familial ties were alsoidentified as significant factors impacting gender and retirement mobility (Xu & Wang, 2019). InBarbados, it was found that lower-income older adults were more likely to rely on care providedby their adult children. Gender emerged as a crucial determinant of economic independence inold age, emphasising the importance of economic status and familial connections in shaping77outcomes (Quashie, 2015). In a case study involving a transgender older individual receivingcare, it was recognised that further research is needed to understand how the lifecourseinfluences the ageing experiences of adults from diverse backgrounds (Carroll, 2017). Notably,the literature in this domain is relatively recent, suggesting the emerging nature ofintersectionality as a concept for comprehending difference and identity throughout thelifecourse.Embodiment and GenderCritics in social gerontology strongly emphasise the neglect of the ageing body in gerontologicalstudies (Twigg 2004; Gilleard & Higgs 2011). They argue that, from a sociological perspective,old age is overly medicalised and all too often associated with a narrative of decline (Phillipson& Walker, 1996). Examining the homogenisation and control of older bodies, critics highlighthow we actively marginalise them (Katz, 1996). Consequently, gerontology has rejected theinclusion of the body, paralleling feminist research, which shifted towards socialconstructionism to comprehend identity and disassociate it from corporeal references.However, over the past decades, there has been a more vital call to reconsider the body as animportant site for identity and meaning-making in old age (Twigg, 2004). Authors, influenced bypostmodernism, have increasingly framed the ageing body as a cultural construction that bothshapes and is shaped by one's social reality (Katz, 1996; Woodward, 1999). The body is afundamental aspect of ageing, and it would be unrealistic and limiting to overlook itssignificance. The management of the body in care work has often been analysed through aFoucauldian lens, exploring concepts such as the professional gaze, power dynamics, and the78notion of "docile bodies." While these frameworks help us understand these systems, there is arisk of perpetuating a medicalised and detached understanding of one's lived experience. Twigg(2004) expresses concerns about the excessive reliance on Foucault's theories to interpret theexperiences of ageing bodies needing care.Furthermore, feminist research has been criticised for neglecting the ageing body, but manyauthors argue that prioritising the ageing body can help counteract its invisibility in other fields(Segal, 2013; Cruikshank, 2003). When ageing adults are asked about their bodies, it challengesour assumption that ageing is inherently traumatic or alienating due to our youth-centric values(Arber & Ginn, 1995). Exploring the body becomes crucial in understanding how culture shapesgendered experiences of the self. Gullette (1997) posits that culture plays a significant role inageing, reading our bodies as scripts of irrelevance and stigma. By focusing on embodiment, wecan better comprehend intersectionality, including how bodies are racialised throughout thelifespan (Rajan-Rankin, 2018). Cultural influences such as consumer culture,technology-mediated self-monitoring, and the performance of youth have all been examined fortheir impact on ageing and the body.As described in the conceptual overview of embodiment, research in this domain was largelyfocused on cultural aspects of gender expression, maintaining youth, and experiencing ageing asbodily change. Interestingly, some papers did not mention gender in their keywords or abstractsbut did include gender analysis in their findings (Ward & Holland, 2011). In others, richfirst-person data on the body and meaning-making in old age is central, but gender is not79included in the title, abstract, or keywords (Thomas et al., 2014). Some studies included genderin the keywords and abstract and offered insight into embodied ageing. Still, the analysis wasnot there, and gender was understood as a ‘covariate’ to be accounted for to produce accuratedata (Robertson et al., 2015).Commonly, the body was described as a site of resilience and as a tool for navigating care needsto others—framing experiences of resilience among older adults with dementia in residentialcare (Newman et al., 2019), older adults and their families as they navigate inter-team careservices (Dahlke et al., 2018), and how autonomy links to the body and life story of the olderadult care recipient (Dahler, 2018). In studies which highlight resilience, gender is not used as ananalytical tool but instead mentioned as a factor of one’s bodily reality, looking at embodimentand lacking an in-depth account of gender while claiming to consider gender identity (BenMortenson et al., 2012).Studies which used gender beyond a surface level mostly focused on youth culture andconsumerism as forms of maintaining one’s gender identity. Examples of this category include:women in hospices in Spain expressed more concern about the appearance of bodily declinethan men (Hilário, 2016), the materiality of clothes and implications on care and performance ofgender (Twigg & Buse, 2013; 2018), gender performativity through hair care (Ward, Campbell &Keady, 2016). Linking bodily experience to meaning-making and planning for older age amongthe younger-old (Cranciun & Flick, 2014; 2015), oral health as ‘doing’ family, and gender and ageintersections to this aspect of well being and generativity/influence on one’s kin (Emily Kettle et80al., 2019), women’s experience with well-being transitioning to extra-care housing (Shaw et al.,2016), ageing women’s mental health and social engagement (Sabik, 2017), class and status andhow this plays out on the body and performance in residential care socialisation (Brossard,2016), and home-making as dwelling in a precarious body (de Jonge et al., 2011) continue in thisvein. These approaches invoke gender as a factor in ageing settings, but do not interrogatebinary understandings and stereotypes.Another common theme was the ageing body as a site to perceive oneself: self-perception andinternalised age stereotypes (Sargent-Cox & Anstey, 2015) or perceived uselessness (Zhao et al.,2017). Looking at what older people think others think of them through a survey across the EU,gender is identified but only as a variable to organising findings (Vauclair et al., 2018),negotiating sameness and difference in community care (Oliver et al., 2018). Mental health andincome level, including gender considerations on masculinity (Fernández-Niño et al., 2014). In acase study on one informant’s narrative of her own ageing body (Mercado Thornton, 2015), theageing body was framed from a materialist standpoint, looking at the decline in terms of labourand productivity. Still, gender was not used in the analysis. The ‘fourth age’ was not commonlyincluded in this domain. In a US survey on sexual body image and age, the upper age limit wasjust 68 (Montemurro & Gillen, 2013). I found a study looking at embodiment and identity indementia, but not until the end of the paper is gender mentioned as an element of bodilyidentity (Kontos & Martin, 2013).81Overall, studies in this domain provided rich accounts of ageing, often finding that one’s bodilyidentity contradicts pervasive views of decline/negativity associated with the ageing body.Regarding care context, this domain reached literature that explored social and cultural aspectsof vulnerability and resilience, relation to others, and meaning-making. Gender as anythingmore than a variable/descriptor was not as common across studies. When used analytically,gender was majorly used to explore gendered tactics/strategies to ‘maintain’ appearance or todiscuss women’s disproportionate concern with appearance concerning youth culture.Overall, including the ageing body in gerontological research and considering gender as a crucialanalytical lens can provide textured accounts of ageing experiences (Mercado Thornton, 2015).Understanding the intersectionality of gender, age, and other social categories can shed light onhow culture, social norms, and power dynamics shape the embodied experiences of olderadults. By acknowledging and exploring the significance of the ageing body, we can gain adeeper understanding of the complexities of ageing and work towards promoting moreinclusive and holistic approaches to gerontology.Performativity“The effect of gender is produced through the stylization of the body and, hence, must be understood asthe mundane way in which bodily gestures, movements, and styles of various kinds constitute theillusion of an abiding gendered self. This formulation moves the conception of gender off the ground of asubstantial model of identity to one that requires a conception of gender as a constituted socialtemporality.” (Butler, 1990).Gender performativity, as conceptualised by Judith Butler, highlights the role of repetitiveritualisation of gendered behaviours in reinforcing and developing our gender identities (Butler,1990). This perspective challenges the notion of gender as a fixed and inherent identity, instead82emphasising its constitution through individual, social, and cultural practices. In the context ofageing, examining the interplay between gender performativity and the ageing process shedslight on how gendered identities are shaped and negotiated in later life. This section exploresthe construction of gender performativity concerning ageing, specifically focusing on the femmeculture and middle-aged women's experiences navigating their gendered identities into old age.The notion of gender performativity emphasises that gender identities are not predeterminedbut are continually constructed through bodily gestures, movements, and styles (Butler, 1990).As individuals repeatedly engage in gendered behaviours, they create the illusion of an abidinggendered self. This framework enables us to explore how gender performativity intersects withthe ageing process and shapes experiences of gender in later life. In gender performativity andageing, discussions often revolve around the concept of "femme culture" and its significance inunderstanding the construction of gender-performative subjects as they age. Scholars haveexamined how the internalisation of beauty culture influences the formation and expression offemininity within the context of ageing (Walker, 2001). The negotiation of gendered identitiesby middle-aged women becomes particularly salient as they navigate societal expectations,cultural norms, and personal experiences of ageing.Studies have explored the intricate relationship between gender performativity, ageing, and theconstruction of the femme identity. Segal (2007) delves into the discourse of ageing and itsconnections to Medusa's curse, highlighting the cultural and societal pressures women face asthey age. The concept of being forever young, ingrained in beauty culture, shapes theexperiences of ageing women and influences their perceptions of self-worth and desirability.83By examining gender performativity in the context of ageing, researchers aim to deconstructgender types and expand our understanding of diverse gender identities beyond traditionalbinaries.Gender performativity, as theorised by Judith Butler, offers a framework to understand howgender identities are continually constructed through the repetitive ritualization of genderedbehaviours. When applied to the context of ageing, gender performativity sheds light on thecomplexities of gendered experiences in later life. The examination of gender performativityconcerning ageing often focuses on the construction of the femme identity, particularly amongmiddle-aged women navigating their gendered identities into old age.The interplay between gender performativity, ageing, and the internalisation of beauty culturereveals the influence of societal expectations and cultural norms on the experiences of ageingindividuals. By interrogating the performativity of gender in the ageing process, researchers aimto challenge fixed notions of gender identity and recognise the fluidity and diversity of genderexpressions. This expanded understanding of gender performativity in later life contributes to amore comprehensive exploration of ageing and gender within social gerontology.Sexuality, Sexual Identity, and GenderGender and sexuality are inseparable social categories; one cannot consider gender withoutsexuality, and vice versa (Westwood, 2014). engaging with sexuality helps to understand genderimportance and to undo the homogenisation of older adults, which is pervasive societally and in84research. Older adults are often treated as non-sexual (Bauer et al., 2007). According to Wardet al. (2010: 12), where there is funding to explore sexuality in this population, it tends to focus‘on (mainly men’s) sexual health with less information available on older bisexual and lesbianwomen’, leading to erasure of experience.Exploring sexuality in the context of ageing also provides insights into older adults' care andinterpersonal strategies. Toni Calasanti has extensively studied the interplay between gender,sexuality, and ageing, examining topics such as caregiving, labour, retirement, and inequality inold age (Calasanti, 2008; Calasanti & King, 2015; Calasanti, Slevin, & King, 2006). Although notsolely focused on care provision, Calasanti's work explores how gender identity shapes ourexperiences of ageing and impacts the quality of life in retirement (Calasanti & Slevin, 2007).Within gerontology, scholars have examined how gender and sexuality sociologically positionindividuals to age differently within care systems. Price (2008: 1344) argues that "for older gaymen and lesbians, dementia may become the hub around which other intersections of identityturn, rendering ineffective the privilege and carefully constructed coping mechanismsassociated with their other social identities." Understanding sexual identity is particularlyimportant in residential care, as these facilities are often heteronormative, leading to potentialchallenges for lesbian, gay, and bisexual individuals (Guasp, 2011).The literature on gender and sexuality in old age, particularly in residential care, haspredominantly focused on care workers' attitudes rather than residents' experiences andperceptions. Studies often mention sexuality without directly engaging with its implications for85older adults, perpetuating the marginalisation of these individuals. Furthermore, research tendsto rely on survey data and larger sample sizes, which limits the depth of gender analysis andoverlooks the oldest old and recipients of full-time care (Villar et al., 2015; Gleibs et al., 2011;Heaphy et al., 2003; Boyle, 2013a, 2013b, 2013c, 2013d; Freak-Poli, 2020).To challenge homogenous understandings of older adults and explore the complex interrelationof gender and sexuality in old age, further research is needed. By delving deeper into theimplications of gender and sexuality, researchers can contribute to a more inclusive andnuanced understanding of this population. Additionally, addressing the experiences and needsof the oldest and individuals receiving full-time care is essential for developing comprehensiveand meaningful support systems.Literature Review DiscussionThis literature review was a creative attempt to address an ongoing concern with a lack ofresearch on ageing and gender. In the first phase of this review, I overviewed literature toidentify conceptual themes about gender and how these are situated within “ageing studies”,an interdisciplinary project. In the second phase, I used four conceptual domains to searchrecent, empirical research to discover how and if these domains are being operationalised tounderstand the experience of older care recipients. Findings generally support that thesedomains can be useful in understanding how difference and identity matter in later life, butunderscore that considerable overlap exists and that they may more usefully operate incombination.86This literature review has some limitations which require discussion. My identification ofkeywords was guided by findings from a literature search involving high subjectivity. Thismethod risks leading the thematic overviews in directions that may not reflect other ongoingtrends in the literature. Using “intersectionality” or even “embodiment” as a conceptualkeyword for this search may be limited because some studies conducting an intersectionalanalysis might not use this term. Finally, I could only review literature produced or translatedinto English. My use of the ‘snowball effect’ in the conceptual overview meant that overlookingsome literature could be possible. Much of the literature used to frame and explore possibleconceptual themes is notably dated - this may be due to the divestment of interest in the fieldof ageing.Limitations considered in this review were able to point to and highlight many trends that hauntthe fields of “ageing studies'’, and to prioritise a review of literature which leans on empirical,qualitative findings, which may be peripheralised in other reviews on old age, gender, and care.The interdisciplinary nature of this project is a strength—no one domain addresses all of theconcerns and considerations brought up in this review. The width and breadth of topics coveredin a review on “care research” was another interesting finding. Care with and among olderadults can touch many aspects of life. Living well, belonging to particular identities andcommunities, manageing symptoms, and grappling with new and changing dependencies andneeds means that care can come in many shapes and forms. When looking at gender, age, andcare, there is a diverse, interdisciplinary body of literature. The diversity and breadth of thisreview can be seen as a limiting factor, but it is equally a strength: we need interdisciplinary and87collaborative perspectives and angles to continue understanding what it means to live well inold age.There are significant and valid critiques of each of the conceptual domains identified in thisreview, but when combined or put into communication, they may more successfully examinethe meanings and priorities of older adults in care research. As an approach, intersectionalityhas been critiqued for its complexity, the futility of an endless “et cetera'' of identity (Butler,1990), and the intangibility with which it can practically be operationalised in research (Hulko,2002). While these critiques are valid, an intersectional approach strongly responds to theburden of homogeneity that continues to trap ageing research. Areas of research that tendtowards an intersectional perspective on identity and selfhood in old age intersect withembodiment (Furman, 1999; Gilleard, 2002), narrative studies (Charon, 2006), and thelifecourse perspective (Laz, 2003). Meanwhile, viewing the ageing body as a cultural site candownplay physiological realities to such an extent that some authors have cautioned that theseperspectives may lean towards a cartesian dualism (Kontos, 1990; Gibson, 2000). A lifecourseperspective may ‘lock older people, especially older women, into rigid gender roles, which maybe contrary to their wishes at that stage in life’. (Hulko, 2004: 103). Moving beyond seeing one’sgender as an expression of a previous self can be aided by looking at embodied experience andconsidering an intersectional framing of experience and social location.Looking at gendered patterns of experiences helps to promote a humanised understanding ofthe well-being of older adults by reversing the tendency to de-sexualise and de-gender older88bodies (Gilleard, 2002) both in research and in healthcare practice (Furman, 1999; Jackson &Scott, 2001; Laz, 2003; Winterich, 2007). Existing literature on age and gender tends to rely on arhetoric of dependence and bolsters heteronormative cultural values. Care literature continuesto contribute to a gender-as-variable trend and does not use the complexity an intersectionalanalysis offers to understand individuals’ experiences. This review helps direct gender-in-careresearch to centre an in-depth understanding of the way individuals experience care in old age,thus informing more comprehensive and effective modes of care for older people.These conceptual domains will be important in analysing subjective and intersubjectiveexperiences within a care home context. In the design of this review, many issues came toawareness: a lack of research with older adults, a lack of work that centres care recipients’experiences, and over-simplified views of gender, to name a few. In placing these frameworks incommunication, I argue that taking an approach that intentionally and carefully combinesconceptual areas may be useful to highlight the experiences of selfhood throughout old age,keeping in mind the strengths that each conceptual domain may offer.89Theoretical FrameworksIn addition to introducing the theory selected to make sense of the data for this study, thischapter serves as an exploration of the rationale behind my decision to adopt amultidimensional approach, aiming to shed light on how the amalgamation of diversetheoretical lenses contributes to a fuller understanding of the complexities of this subjectmatter. This “theoretical sensitivity” supports that using multiple theories allows researchers toexplore the complexity of social phenomena more thoroughly and to develop a richerunderstanding of their research topics (Charmaz, 2014). This approach aligns with the idea thatsocial reality is multifaceted and that no single theory can fully capture its complexity. Eachframework selected offers a distinct perspective, honing in on particular facets of thephenomena under investigation.By embracing a range of theories, I hope to expose the intricate connections between emotions,societal expectations, physical spaces, and the quest for dignified care. Care homes are intricateecosystems shaped by a symphony of personal experiences, cultural influences, powerdynamics, and historical contexts. Acknowledging the complexity of this environment, I havechosen to adopt a multidimensional approach. This flexibility allows us to adapt our analysis tothe unique aspects of each case, enriching our understanding without oversimplifying thecomplexities of the care environment. This approach not only aligns with established qualitativeresearch methodology but also embodies a commitment to robust and comprehensive analysis.By incorporating insights from multiple theories, we not only enhance the depth of our90exploration but also ensure that our findings are firmly grounded in the complex realities of carehome environments.Each theoretical framework possesses a unique lens that illuminates specific facets of myresearch questions. By weaving together these perspectives, I uncover hidden interconnectionsand dependencies that might remain concealed otherwise. The exploration of affectiveeconomies through Ahmed's insights, the scrutiny of gender norms through Connell's theories,and the examination of humanisation guided by Todres and Galvin's framework all combine toenhance my insights. This collective approach reveals patterns and narratives that would eludeme if I were to rely on a single theoretical framework. Rather than isolating these theoreticalframeworks, I approach them as tools that contribute harmoniously to my analytical toolkit,helping to make meanings of the data. I intend not to pit one against the other but to blendtheir diverse strengths into a coherent narrative. I envision a narrative that interweaves theseframeworks, upholding the significance of each while fostering a collaborative synergy thatenriches my understanding of the landscape of the care home environment.I will delve into each selected theoretical framework in the following sections, illuminating itsunique merits and demonstrating its applicability to my research themes. This chapter aims toestablish a sturdy foundation for the following empirical chapters, underscoring why the fusionof multiple frameworks is pivotal in my quest for a richer and more comprehensive grasp of theintricate dynamics within care homes.91The Humanisation of Care FrameworkAs previously discussed, my findings are contextualised within the context of dignity andwell-being in care settings, utilising the humanisation of care framework (Todres et al., 2009).The framing of care and the perspective on caring are pivotal, as they directly influence policyformulation and regulations governing care provision. Consequently, our philosophy of caresignificantly impacts the quality of life experienced by both care workers and care recipients.This project is intricately woven with the aspiration to bolster and deepen a lifeworld-orientedapproach to care. This perspective, rooted in phenomenological and existential philosophies ofthe self and personhood, represents a cornerstone within the field of caring sciences (Todres etal., 2002).Within the spectrum of intersubjectivity, the potential for humanisation or dehumanisationemerges. Humanisation—embracing a specific viewpoint that explores the essence of beinghuman—constitutes an invaluable concept for analysing dignity and well-being. It has foundapplication in various studies concerning care (Galvin et al., 2018; Galvin & Todres, 2012;Hemingway, 2011). The tension between the lived experiences of patients and service users andthe culture and practices of healthcare has been the focus of humanised care theorists (Galvin& Todres, 2013). Elucidating this complex interplay, Todres et al. (2009) offer a theoreticalframework presenting eight dimensions of humanisation and eight dimensions ofdehumanisation:92Table 1 Eight Dimensions of Humanisation and DehumanisationThis framework facilitates an intricate understanding of wellness and care by embracingmultiple interwoven dimensions of human experience. Such a perspective aids incomprehending subjective concepts like well-being and dignity in diverse contexts. Thespectrum spanning from humanising to dehumanising across these eight dimensions becomesthe foundation for the methodology and analysis of this research endeavour. It is crucial toacknowledge that these "bipolar terms suggest possibilities along a spectrum that has to beconsidered in context" (Todres et al., 2009, 69). The attributes of humanisation are presented as"ideal" types, acknowledging that their attainment or desirability hinges on the nature of careprovided. Todres et al. (2009) aptly illustrate this complexity, particularly concerning individualsin intensive care requiring highly technological definitions and treatments for their bodilyfunctioning.Centring a Gender Analysis: Connell’s Gender and PowerThe understanding of gender as not solely an individual experience but also deeply shaped bysocietal factors suggests that relational gender theory may offer a more effective lens thancategorical frameworks (Connell, 2012). This perspective, as elucidated by Connell,93conceptualises gender as a multidimensional process entrenched within a complex network ofinstitutions (Connell, 2012). While this discussion primarily centres on interpersonalrelationships, it is crucial to recognise the role of labour and power in comprehending genderdynamics. Cathexis, which plays a central role in social interactions, extends beyond sexualcontexts to encompass meaningful relationships as perceived by participants. RaewynnConnell's (1987) framework assists in understanding the gendered experiences of dignity andwell-being by enabling the mapping of gendered practices and dynamics at both interpersonaland institutional levels. These pillars—division of power, division of labour, andcathexis—intersect and mutually inform one another, necessitating a holistic perspective on thediverse ways in which gender identity shapes our lived experiences. These pillars operatesynergistically to construct gender roles that perpetuate inequities (Wingood & DiClemente,2001). The gender and power framework proves valuable in examining the myriad ways inwhich gender norms influence and disrupt individuals' experiences, particularly in the context ofcare homes for older adults.At the societal level, gender structures are embedded deeply, altering slowly over time. At theinstitutional level, evident in care homes, these structures interact with lifecourse positionsshaped by external societal and cultural elements. Division of labour offers insights into retiringfrom gendered work and economic productivity implications. Division of power clarifiesauthority and governance linked to gender. Applying these concepts illuminates culturalimplications, variations in pension, and attitudes toward formal and informal care.94Lastly, cathexis aids in analysing power and labour's interpersonal unfolding. In the context ofintimacy within care facilities, existing work often maintains heteronormative assumptions,overlooking emotional intimacy. Cathexis unveils emotional connections, promoting a morehumanised approach to care. Overall, this framework enriches understanding of gender's role inthe care home.Connell’s framework can help us centre gender in our care exploration in the following ways:● Gendered Emotional Labour: Connell's theory of gender and power can help explorehow traditional gender roles influence the distribution of emotional labour within carehomes. Caregiving tasks and emotional responsibilities are often divided along genderlines, with women expected to provide more emotional support and nurturing care. Atthe same time, men might be assigned tasks considered less emotionally demanding.This gendered division of emotional labour can impact the affective economies withinthe care home and shape the quality of interactions between carers and care recipients.● Intersectionality of Care Worker Identities: Connell's theory emphasises the importanceof intersectionality, which considers how multiple social identities intersect to shapeindividuals' experiences. Gender norms interact with other factors, such as race, class,and age among carers and care recipients. This intersectional analysis can revealcomplex dynamics contributing to the affective economies within the care home,highlighting how different power structures intersect and influence emotionalinteractions.95● Power Dynamics and Emotional Expression: Connell's theory offers insights into powerdynamics and how they influence emotional expression. Gender norms might affect careworkers' and care recipients' freedom to express certain emotions. For example,traditional masculinity norms could discourage male carers from openly expressingvulnerability or nurturing emotions, while female carers might face pressure always tobe emotionally available. Analysing these power dynamics can shed light on howaffective economies are shaped by and contribute to reinforcing gender norms.● Agency and Resistance: Connell's theory also considers how individuals negotiate andresist dominant power structures. Care workers and care recipients navigate genderedexpectations and norms within the care home setting. Some care workers mightchallenge traditional gender roles by engaging in emotional caregiving regardless ofgender identity, while care recipients might resist imposed gendered expressions ofemotion. Analysing these instances of agency and resistance can provide a richerunderstanding of how affective economies are negotiated and potentially transformed.Affective Economies of Care: Cathexis, Abjection, and the Front-and-Back StageIn this section, I delve into the interrelation between cathexis, abjection, and affectiveeconomies, and how these concepts contribute to understanding the ways norms and valuescan shape our intersubjective experiences, and how gender norms specifically may impact theexperience of caregiving and receiving in the context of “Comfort Days”. These theoretical96frameworks collectively provide a comprehensive framework to discuss how gender normsimpact the complexities of care relations in a care home.Ahmed’s Affective EconomiesAt the core of our exploration is Ahmed's concept of affective economies. As introduced by SaraAhmed (2004), affective economies encompass the intricate and dynamic ways emotionscirculate, shape, and structure social and cultural spaces. Emotions are not confined toindividual experiences; they are collectively produced and shared, influencing interactions,behaviours, and power dynamics within society. Affective economies underscore thedistribution of emotions in social spaces. They will thus be a valuable framework to map theaffective quality of the experiences and interactions of care workers and care recipients in thecare home setting. In this study, where spaces were defined and often acted upon by theindividual participants (e.g., the care home was a closed community, and within this closedcommunity were several smaller and arguably more closed communities). By integratingAhmed's framework, we gain insights into the transformative potential of emotions and howthey move through the spaces and confines of the care home. I selected Ahmed to engage withtopics of intersubjectivity because this framework has a spatial element, helping to “see” theway intersubjective eddies may ripple and burst against the parameters of the care home space,which care home researchers have aptly argued serves as a Foucauldian “heterotopia”, a spacewhich is neither (Sayers & Brunton, 2019). Heterotopias are characterised by their capacity tohold multiple meanings and functions simultaneously (Foucault, 1986). The care home serves asa space of care, residence, community, and institutionalisation. This complexity can generate97intricate affective economies, where emotions are layered and interwoven across differentaspects of the care home experience.Through Ahmed's lens, we seek to comprehend the influence of empathetic engagement and itspotential for either humanising or dehumanising, care acts within the care home space.Additionally, a focus on the emotional elements of care helps to problematise a tendency toprioritise efficiency, standardised protocols, and task-oriented caregiving over emotionalengagement. These approaches can lead to a "dehumanisation" of care, where care workersmay feel pressured to follow strict procedures at the expense of building meaningfulrelationships with care recipients. This perspective highlights a potential tension betweenemotional engagement and institutional demands for efficiency.Cathexis: Emotional Bonds and Attachments in CareWhile initially focused on intimate relationships, Connell's concept of cathexis offers a broaderinterpretation that encompasses any meaningful connection. Cathexis involves emotionalinvestment and attachment, shaping power dynamics in relationships. In the care context, it isvital to residents' well-being through their connections with care workers, peers, and familymembers. By examining cathexis, we gain insights into power dynamics, emotional connections,and the quality of care within care homes. As Connell argues, Cathexis is shaped and influencedby gender norms and our relationship to them. Positive cathexis fosters an environment of trust,empathy, and respect, enhancing well-being. Conversely, negative cathexes can lead to isolationand frustration. Recognising the significance of cathexis prompts us to create inclusive98environments that prioritise empathy, respect, and meaningful engagement, thus improving theoverall care experience for older adults.Abjection: Challenging Norms and Identity in CareIn conversation with cathexis is Kristeva's concept of abjection, which highlights the rejection ofelements deemed "other" or "different” (Kristeva, 1984). Building upon the psychoanalyticframework developed by Julia Kristeva, abjection refers to the psychological discomfort andrepulsion experienced when encountering something that disrupts established boundaries,norms, or identity categories. Within care homes, abjection emerges when individuals resistsocietal expectations and stereotypes.Abjection, as elucidated by Kristeva, is a complex interplay between the self and the Other,manifesting as a visceral reaction to what is considered outside the bounds of acceptability. Thisconcept becomes a lens through which we can explore experiences of disgust or repulsion incare relationships. The discomfort associated with abjection may lead to the avoidance of careor, at the very least, impact the extent to which carers are willing or able to engage with thesocial reality of care recipients (Johansson & Holmes, 2022; Holmes et al., 2006). Challengingtraditional gender roles or expectations may lead to exclusion or marginalisation, and abjectioncan help us explore how interruptions in the “clean” or “pure” ideas of gender norms may leadto moments of confusion or repulsion. In the context of care, abjection has been explored innursing research to understand how interpersonal disgust can serve as a “rite of passage” fornurses providing bodily care (Montgomery, 2014).99Incorporating abjection into social care discussions reveals the influence of identity and powerdynamics. Abjection prompts us to go beyond the institutional constraints that may hindercare's emotional and relational aspects, and question the interpersonal elements as well (Rudge& Holmes, 2010). Kristeva's theory of abjection provides a profound theoretical foundation forunderstanding the emotional complexities involved in care relationships, pushing us to navigatethe intricate interplay between the self and the Other. Through abjection, we not only explorethe discomforting aspects of care but also uncover transformative potential in gender andsexuality discussions within care home environments. The application of Kristeva's abjectionbroadens our understanding of the intricate dynamics at play in care relationships, emphasisingthe need for sensitivity to the psychological nuances involved in the provision and reception ofcare.Integration of Cathexis and AbjectionCathexis and abjection are interconnected concepts that explore power dynamics, identity, andemotional investments within the care context. While negative cathexis and abjection mayinvolve negative emotions, they have distinct theoretical origins and implications. Negativecathexis entails investing emotional energy in something that triggers negative or aversivefeelings. Rooted in psychoanalytic theory, it relates to emotions like disgust, fear, anger, ordiscomfort. Negative cathexis shapes thoughts, behaviours, and attitudes, focusing on allocatingmental and emotional resources to something disliked.100Meanwhile, abjection refers to emotional responses when confronting elements that disruptboundaries between oneself and what's considered "other." It generates unease and repulsionin response to things challenging normalcy. Abjection encompasses emotions, bodilysensations, and psychological reactions. It pertains to transgressive experiences that threatenidentity and cleanliness. While negative cathexis focuses on emotional investment in thedisliked, abjection deals with emotional reactions to challenges to identity and norms.Integrating both concepts enriches the understanding of complex emotional dynamics withincare settings. Abjection's disruption of cathexis prompts critical reflection and new emotionalinvestments, particularly when confronting losses of autonomy or resisting labels as "other."Applying these concepts to gender norms highlights how emotional energy is invested inadhering to or resisting these norms. Affinity towards gender norms stems from conformity,fostering emotional bonds with socially accepted roles. Conversely, repulsion arises fromdiscomfort, leading to emotional distancing. Positive cathexis aligning with norms enhancesaffective economies, while abjection can occur when norms challenge autonomy, promptingreevaluation and transformation. Furthermore, the negotiation between affinity and repulsiontowards gender norms is influenced by intersecting identities like race, age, and culture. Theinterplay of cathexis and abjection within these dynamics shapes emotional responses. Thenegotiation between these emotions provides insights into gender norm dynamics and affectiveeconomies. Integrating cathexis and abjection enhances our comprehension of affectivedynamics, power relations, and transformation possibilities within care settings. The application101of these concepts to gender norms underscores their role in shaping emotions and interactions,ultimately contributing to a deeper understanding of the care environment.Goffman’s Front and Back StageErving Goffman's concept of "frontstage" and "backstage" is a framework used to understandthe presentation of self in social interactions (1961). Goffman's work is especially valuable forcomprehending the complex interplay of roles, performances, and impressions in various socialsettings, including the care home environment. Goffman's front-stage and backstage conceptsoffer further insights into care dynamics in the care home. The frontstage represents the publicand visible realm of social interactions, where individuals present a carefully constructed imageof themselves to others. This is where individuals enact roles, adhere to social norms, andengage in performances designed to meet societal expectations. Frontstage behaviour is oftencharacterised by a heightened awareness of one's presentation, as individuals strive to maintaina positive self-image and uphold the desired identity in the eyes of others.In the care home context, care workers and care recipients interact with each other and staff,visitors, and other residents within the front stage. Care workers might adopt nurturing roles,displaying empathy and professionalism, while care recipients might emphasise their need forassistance and gratitude. These performances are influenced by the care workers' and carerecipients' perceptions of what is expected in the care home environment. The backstage, onthe other hand, refers to the private and less visible sphere where individuals can relax, letdown their guard, and temporarily suspend their frontstage performances. It's a space102characterised by more authentic and unfiltered self-expression, as individuals are notconstrained by the need to conform to societal norms. In the backstage, individuals can bethemselves, share emotions, and engage in behaviours that might not align with theirfrontstage persona. These “unmanaged spaces” are the places where care workers can engagein these backstage behaviours (Bolton, 2005).Within the care home, the backstage might manifest in the private rooms of residents, staffbreak areas, or even in the informal interactions that occur away from the visitors' gaze.Residents and care recipients may feel less pressure to conform to their assigned roles, allowingfor more genuine emotional exchanges and expressions. The interplay between front-stage andbackstage in the care home setting is crucial for understanding the affective economies at play.Care workers often navigate the emotional labour of manageing their emotions and maintaininga professional demeanour in front of residents and visitors (frontstage) while seeking emotionalrelease and support in private spaces (backstage). Similarly, care recipients might performfrontstage to cope with the expectations of being a care recipient while seeking genuineconnections and understanding with care workers in more intimate settings (backstage).The care home can be seen as a unique heterotopia, where the boundaries between frontstageand backstage can become blurred due to the personal nature of caregiving and the proximityof residents and care workers. This blurring of boundaries adds complexity to the emotionaldynamics as care workers and care recipients navigate the roles they are expected to play andthe more authentic connections they seek to establish. Incorporating Goffman's front-stage and103backstage concepts enriches your exploration of affective economies by highlighting the tensionbetween public performances and private emotional experiences. This framework helpsuncover how emotions are managed, expressed, and negotiated within the care home setting,shedding light on the multifaceted nature of caregiving relationships. The front stage involvespublic caregiving performances, while the backstage represents private spaces of authenticity(Goffman, 1961). Integrating these concepts, we explore how care workers manage emotionsand empathy in caregiving.104Chapter Four: An Ethnographic ApproachAs covered in the previous chapter on the theory undergirding my investigation, I take aconstructivist and relational approach to gender, acknowledging that individuals' experiencesare intertwined with institutional frameworks and broader sociocultural and historical contexts.How can we explore such a complex and multi-faceted phenomenon? The ethnographicapproach, informally defined as spending time observing and ‘getting to know’ the contextualnuances of residents’ and staff’ experiences and their intersections with factors such as cultureand gender, will give rise to the data for this project. At the heart of this methodology lies theexploration of context, encompassing historical and cultural dimensions while embracing aprofound appreciation for relativism. It recognises the importance of understanding the emicperspective, whereby one attempts to understand individuals' viewpoints within their culturalframeworks.In the background section, I discussed that this study was born as a piece of a larger researchproject designed to deepen our understanding of the world of old-age care across variousEuropean contexts. My project, number 13 of 15 individual projects, was designed before I wasappointed as the researcher. Before my perspective gave flavour to this investigation, it wasalready tasked with 1. looking at gender and age and 2. doing so in an ethnographic fashion. Thechoice to use ethnography as a methodology is based on its ability to uncover patterns andprocesses that other methods, like surveys or interviews, may overlook. By immersing myself inthe residential care home through participant observation, I can better understand theresidents' experiences and perspectives on dignity and well-being.105The ethnographic methodology is rooted in anthropology, a discipline dedicated tocomprehending and articulating the intricate interplay between individuals' subjectiveexperiences and the broader social structures that shape their lives. Today, ethnographic fieldmethods are used in various disciplines, such as the caring sciences, as is the case with thisstudy (Kiefer, 2006). I endeavour to incorporate narratives, stories, and representations, aimingto identify and explore any contradictions between the lived and represented cultures withinthe residential care facility (Shapira, 2000). This dynamic process involves observing andinterpreting various forms of expression, including oral communication, behaviour, interaction,body language, atmosphere, and pertinent quotations from observed situations (McGranahan2018).One becomes the investigation tool in ethnography (Turner, 2000). One’s biases and preferencesshape how you move through your ‘field site’. In this project, I established rapport withparticular residents and members of staff, and this guided my inquiry. For example, I hadexperience caring for my grandmother at home before she moved into a private care home inher final few years of life. I came to this project with ideas about the choices families may make,the sacrifices residents may experience, and what might constitute a good or bad experience incare. By acknowledging that assumptions and values shape perceptions and interpretations, Imaintain a reflexive stance to mitigate potential biases as in the analysis of the collected data(Clifford & Marcus, 1986). In the ethnographic approach, this is not a detriment but anopportunity to deepen reflection and be transparent about how an interpersonal approach will106shape the findings (more on reflexivity later). Thus, in this research design the “tool” or locationof data is often in the interpersonal relationship (Whyte, 1999).Another important aspect of the ethnographic approach is the time spent in the field. Byspending time with a community and getting to know people, you can begin to view the normsand rules that shape that community's everyday experiences. Thus, there is a hybrid identity ofbeing both an insider and an outsider (Hastrup, 2004). The meaning-making we engage in dailynecessarily becomes a ‘given’. Being an outsider, you see these taken-for-granted meanings andstories we tell to make sense of our world as something novel. Then, once you becomeintegrated into the community, gaining an emic perspective (never entirely integrated, but atleast in the sense of becoming more familiar with what is expected and what is said about thenorms), contradictions emerge (Coffey, 2021). We move out to existing theory, other cases, andexamples to engage in the etic perspective (Geertz date). What can we learn about how peoplelive in this community and what stories they share to make sense of their lives? This is the heartof the ethnographic approach.Interpretivist/hermeneutic underpinningsI adopt an interpretive perspective drawing on hermeneutics as a philosophical foundation toexplore the intricate meanings and interpretations older adults in a residential care homeattribute to their lived experiences (Ricoeur, 1976, 1984). Ricoeur's hermeneutical approachcombines phenomenology, examining experience, with the interpretation of texts and107representations of experience, offering valuable insights for nurse researchers (Charalambous,2008).Ricoeur serves as a bridge between phenomenology and hermeneutics, focusing onunderstanding written texts as the primary goal of hermeneutics. His theory of interpretationencompasses language, reflection, understanding, and the self, which, when merged withcritical hermeneutics, facilitates gaining fresh insights and understanding from texts throughcritical interpretation.According to Ricoeur, ordinary language is meant for communication, while scientific language isused for argumentation. Both types of language are essential for fully grasping the meaning of atext (Ricoeur, 1976). The advantage of this movement between understanding and explanationis that it allows me to blend both types of language, resulting in rich and comprehensivedescriptions of the phenomena being studied. In ethnographic research, the “raw data”,primarily, in this project, field notes, is never completely raw, but it is already “partially cooked”(Madden 2017). Ricoeur talks about a movement between parts and whole of a text which ishelpful as we analyse and try to understand text (specific interviews in relation to all of thecollected data and also try to comprehend the text in relation to context).Ricoeur emphasises that language is more than just a system; it expresses our experiences andenables us to grasp our existence and engagement with the world. Language holds centrality inour lives as it reflects our impressions and experiences, shaping how we comprehend situations.108In this research project, I consider both the experiences shared by the residents and staff andmy own observations. I highly value language and expression as they reveal lived experiencesand the interpreted world. The process of fixing language through writing offers independenceand distance from the original situation, supporting analysis and interpretation of thephenomena under investigation (Ricoeur, 1984). To gain a comprehensive understanding ofresidents' meaningful experiences, I combine participant observation and interviews.Participant observation provides insight into the context of patients' lives, their interactions,and responses to health services. Interviews offer a deeper understanding through theparticipants' stories.Ricoeur's work connects phenomenology and hermeneutics, underscoring the significance oflanguage in comprehending lived experiences. Employing a hermeneutic approach, I aim todelve beyond surface-level descriptions and uncover the layers of meaning in the residents'experiences. By embracing an interpretive process that considers their cultural and historicalbackgrounds, as well as individual perspectives and interpretations, I seek to understand howexperiences are influenced by broader social and cultural contexts.In this context, language plays a crucial role in the investigation. As a researcher, I use languageto explore and understand new ideas. This happens as I interpret the data during its generation.So, I constantly switch between understanding the language and using it to explain what I havediscovered.109This approach also requires me to adhere to reflexivity in this process. My interpretations andbiases can influence the understanding and interpretation of the data. Through ongoingreflection and self-awareness, I strive to navigate the complexities of interpretation andminimise potential distortions or misunderstandings. Overall, the hermeneutic approachprovides a framework for me to interpret and understand the experiences of older adults in theresidential care home. It allows me to uncover the layers of meaning and significance attributedto these experiences, shedding light on the interplay between the subjective and the contextualfactors that shape their well-being and dignity. Ricoeur suggests that preconceptions can stillplay a role in interpretation, but they should not dictate understanding before engaging withthe text or data (Ricoeur, 1976). Instead, researchers need to qualify their preconceptionsthrough the process of interpretation, which involves continuously checking and validating theirunderstanding in light of the text (field notes, interviews) being used as data for the study.To sum it up once more, ethnographic data is descriptive and relies on detailed observation andinterpretation over an extended period. By living in the care home and becoming familiar withits culture, I can provide a rich description of the community and better understand its norms,values, and rituals. It is important to actively engage in ongoing discussions on care andcontribute to the field. The findings will enhance an understanding of lifeworld-led care and thehumanisation of care theory. Although the depth of description may limit generalisability, itprovides valuable insights into the experiential aspects of ageing and well-being in theresidential care setting. By employing this methodology, I endeavour to provide a texturedunderstanding of the lives, experiences, and gendered impacts on well-being and dignity among110residents in a residential care facility. The interpretive/hermeneutic approach, with its steadfastfocus on context, reflexivity, and the exploration of subjective experiences, serves as aninvaluable framework for this pursuit.Anti-Oppressive EthnographyI am in the ever more common position of using ethnographic field methods outside ofanthropology. Ethnography has come to mean many things - almost an over-utilised term andhas been picked up in areas outside of academia, such as marketing research. In theethnography’s trans-disciplinary—and trans-academic—usage, the ethnographer must be strictabout using the term. Traditionally, the ethnographer goes somewhere far away to discoversomething new, exotic—somewhere ‘other’ (Ahmad, 1997; Scott, 1992). The risk thatethnography others or exoticises cultures not native to the ethnographer are a critique whichhas long followed various approaches to ethnographic research design (Elie, 2006). Even withpost-colonial adjustments to problematise and complicate the self/other divide and to callattention to the exotic Self (Gupta & Ferguson, 1997; Ergun & Erdemir, 2010), ethnography is anact which seeks to define a group or culture to be studied, an act which can disempower if notcarefully designed.The design and implementation of this project are in conversation with this tendency and thetraditional anthropological design of ‘the Other’ in a few ways. One, I hope that with a focus onsubjectivity and humanisation practices, this project will be anti-oppressive, reflexive, anduseful to the research participants, thus operating in defence of ethnography’s potential to111contribute meaningful data in a contemporary, interdisciplinary project. Second, I intend toconsider the notion of ‘other’ throughout the study's design, implementation, and analysisphases to understand how we tend to conceive of the aged individual and the recipient of careas such. It may also be necessary to note my status as an early career academic.The methodology is inherently intertwined with politics, encompassing specific values andperspectives that necessitate subjective positioning (Young & Ackerman, 2001). In light of this,my research will adopt a synthesis of critical and feminist approaches to ethnography, aiming toaddress the complex issue of "othering" and align with the collective objectives of the (MSCA)INNOVATE DIGNITY Fellowship. Critical and feminist ethnographic literature has long grappledwith the power dynamics and exploitative aspects inherent in ethnographic inquiry (Elie, 2006),including the historical marginalisation and "othering" of women within ethnographic research(Mies, 1996). In this research, I seek to critically examine and challenge the tendency to "other"certain cultures or social groups by incorporating critical perspectives. It acknowledges the needto deconstruct prevailing assumptions and stereotypes, particularly concerning the experiencesof marginalised individuals and communities. This critical lens allows for exploring powerdynamics, structural inequalities, and potential exploitation within the research process.Additionally, by embracing feminist methodologies, I aim to highlight and address genderedpower dynamics within the context of ethnographic research. Recognising the historicalexclusion of women's voices and experiences in ethnographic studies, I strive to ensure theinclusion and empowerment of women as active participants in shaping the research process112and interpreting their narratives. This will not be a matter of sampling in a care home, aswomen make up a majority of care workers, and women make up a larger portion of care homeresidents. Instead, this will mean that in my data collection and analysis, I will be keenly awareof the patriarchal framings, which may peripheralise certain perspectives, stories, andexperiences.Wuest (1995: 129, cited in Hulko, 2002) provides three guiding principles of feminist research,which I hope will guide the design and implementation of this project:1. Knowledge produced by the research should be useful for the participants2. The research method should not be oppressive3. The research method should be reflexiveFollowing these guiding principles, I will overview the possibilities and challenges of taking afeminist approach to this ethnographic research project.The project must be useful: Ethnographic Outsiderness in health researchOrienting the field of health sciences and the caring sciences network to which this projectcontributes has required a level of un-learning around ethnographic research and subsequentre-orienting around interdisciplinary inquiry. In the healthcare field, along with the powerdynamics and gatekeepers specific to this arena, come new challenges and obstacles toconsider. Hemmings (2005) argues that healthcare and medicine need to receive more support113from social scientists; lack of insight offered by qualitative and social inquiry into care servicesleads to disastrous and harmful outcomes (Fadiman, 1998) and health disparities and outcomesof care have been shown to mirror issues of social inequalities (Rogers & Kelly, 2011). Thus,applying a social analysis to care is both necessary and ethical.The ethnographic methodology offers researchers a unique opportunity to immerse themselvesin the naturalistic setting of care work, facilitating a deep understanding of the contextualfactors shaping care delivery. This holistic perspective is invaluable for discerning the intricateinterplay of social, cultural, and organisational elements that influence care practices andexperiences. By engaging in prolonged fieldwork and participant observation, ethnographerscan capture the subtleties of everyday care practices and interactions, shedding light on thenuances of how care is enacted, negotiated, and experienced by both providers and recipients(Holloway, 2005). Through this lens, researchers can uncover hidden power dynamics withincare settings, exploring issues of hierarchy, authority, and control that may impact carerelationships and decision-making processes, uncovering what matters to residents (Galvin etal., 2020).Moreover, ethnographic research has the potential to promote person-centred care byamplifying the voices and perspectives of care recipients. By listening attentively to thenarratives and experiences of individuals receiving care, researchers can gain insight into theirunique needs, preferences, and priorities. This understanding lays the groundwork for the114development of more responsive and tailored care approaches that prioritise the dignity andagency of care recipients (Gavin et al., 2020). Noticing what matters can be subtle:It was late in the evening and everyone had gone to bed. I was having a cup of tea and chattingwith some care workers when I noticed that Rachel (pseudonym) was leaving her room. Rachelis a resident whose carers often prompt her to leave her room to have meals with everyoneelse, so I was surprised to see her coming out into the common area of the household so late inthe evening of her own accord. I looked at Lucy (pseudonym, care worker) and nodded towardsRachel, silently alerting her that she was up and about so late in the evening. Instead of going tohelp Rachel, Lucy smiled and explained, ‘She comes out on her own after everyone’s gone tobed. She’ll go through some mail by the lamp in silence for a while. I think she feels a sense ofrelief as if, finally, everyone has left her house for the day and she can relax. I love to see herrelaxed and comfortable in her home like that.I share this scenario to help highlight the value of an outsider's perspective in identifying newinsights into the care relationship. I better understood Rachel’s possible experience and feelingsabout the care home environment by asking the care worker to explain Rachel's behaviour. Thisillustrates the importance of approaching care relationships with a critical and open-mindedperspective. Care workers may become entrenched in their routines and ways of thinking andmiss essential details in their residents' behaviour and emotions. Bringing an outsider'sperspective can highlight these nuances and bring new insights, as well as uncovering expertise.Furthermore, this scenario also reveals the importance of creating a culture in the care homeenvironment that fosters well-being and comfort for the residents. Lucy recognised that Rachelfelt a sense of relief and relaxation when everyone had gone to bed, and she could have somequiet time alone. This demonstrates the value of understanding and responding to the uniqueneeds and preferences of each resident in the care home rather than treating everyone thesame. In conclusion, this scenario emphasises the importance of being attuned to the subtleties115of the care relationship and the value of bringing in an outsider's perspective to gain newinsights. It also highlights the importance of creating a care home environment that fosters asense of well-being and comfort for each resident and tailoring care to meet each individual'sunique needs and preferences.The logistics of conducting effective ethnographic research in a residential care setting dependon my ability to establish rapport and engage appropriately with the community beingresearched. I have the support of a qualified and experienced supervisory team, which includestwo nurses who have experience working both directly and in research with older people, whohave overseen my research and supported my work throughout the planning, research, andanalysis phases of this project. I will approach this project with as much preparation and rigouras possible to conduct proper research and ensure I have done everything I can to approach thiscommunity respectfully and minimise any potential harm.With the legal and ethical regulations associated with accessing recipients of care in theirresidence, accessing this community during a pandemic which has been demonstrated asputting older adults at particular risk has been a significant barrier to this project. Between thetime required to acquire ethical approval, the shifting demands on healthcare staff, the needs ofthe residential community itself, and my timeline and planning, there have been many variablesshaping the possibility of this project. Because this is a protected community, I have beenrequired to advocate for the potential benefits that this project may offer to participants toprovide an ethical justification for conducting this research project:116● The study is likely to yield findings which may be used to improve the lives of residentsnow and in the future.● I represent an added resource to enable residents to engage in meaningful activitiesthrough fieldwork, which took place in a time when social activity has been significantlyreduced due to COVID-19.● My participation in social activities during the fieldwork period may be of staffassistance, who will also be participants in this research project.● Contributing perspectives and experiences to this project may feel good: participantsmay enjoy discussing their values/meaning-makingFar before I began ‘proving’ my usefulness as an individual researcher, the fellowship of whichthis project is a component was required to navigate the gatekeeping of the EuropeanCommission—seeking and receiving approval for funding and support to engage in a collectiveproject on qualitative research on care and well-being among older adults speaks to theinstitutional value placed on better understanding our care systems for older adults. This is asystemic issue which requires collective action. In less protected communities and differentcircumstances, it may not be a requirement to explicitly brainstorm potential benefits toresearch to justify the risk of being there and collecting data. I am glad that I was asked toprovide these potential benefits, and I think that considering potential mutual benefits is anessential component of any research design.117Furthermore, ethnographic insights can inform practical interventions and policy initiatives incare work. By providing rich and nuanced accounts of care provision, ethnographic researchequips stakeholders with evidence-based recommendations for improving care quality andeffectiveness. From identifying areas for improvement to developing best practices andadvocating for policy changes, ethnographic findings have the potential to drive positivetransformations in care delivery practices and policies, ultimately enhancing the well-being ofboth care providers and recipients alike.Anti-oppressive Ethnography - critical & feminist influencesDuring the study, I encountered various challenges and concerns related to ethnographicmethodology. Navigating these complexities required a thoughtful approach, particularly in lightof the sensitive nature of the research topic. One of the foremost challenges I grappled withwas acknowledging and critically reflecting on my own biases and positionality. Recognising thepotential for ageism and other biases to influence the research process, I endeavoured toactively challenge these perspectives. This involved seeking out and valuing the perspectives ofolder individuals themselves, allowing their voices to shape and inform the research. It isimportant, also, to avoid ‘navel-gazing’, and make the study overly-focused on my own reactionsand attitudes (Holt, 2003).118However, reflection is crucial, not just in the analysis and writing stages, but throughout theentire research process. Creating a safe and respectful research environment emerged as aparamount concern. I was acutely aware of the power dynamics inherent in theresearcher-participant relationship and took deliberate steps to mitigate any potential forexploitation. Establishing clear boundaries, adhering to ethical guidelines, and prioritisinginformed consent were foundational principles guiding my interactions with participants.Moreover, actively involving participants in the research process was essential to maintaining anethical approach. By soliciting their input and feedback, I sought to ensure that their voiceswere not only heard but also actively incorporated into the research findings.Navigating these challenges required humility and a willingness to continually reflect on andrefine my approach. While striving to uphold the principles of ethical research, I remainedcognisant of the inherent complexities and limitations of the ethnographic methodology. Byembracing a reflexive stance and remaining open to feedback, I aimed to navigate thesechallenges with integrity and sensitivity. A feminist methodology also emphasises valuingdiverse perspectives and experiences. I used inclusive language, asked open-ended questions,and remained sensitive to cultural backgrounds and values. Additionally, I employed ananti-oppressive approach to participation by using process consent, particularly for older adultswith varying cognitive capacities. This person-centred approach aimed to reduce barriers toparticipation and ensure inclusivity for all willing participants.119Reflexivity and situatedness of the researcherAll researchers should be explicit about the politics of their research, as it is more logical to accept oursubjectivity, our emotions and our socially grounded positions than to assume that some of us can riseabove them (Ramazanoglu, 1992: 211).Ethnographic research inherently offers partial and incomplete truths, a perspectiveacknowledged and resisted by those who value clear verification standards (Clifford, 1986: 7).Embracing this partiality allows for representational tact in ethnography. In line with feministresearch praxis, I will approach my study reflexively and acknowledge my subjectivity(Ramazanoglu, 1992). This stance challenges traditional positivist views and emphasises theresearcher's role and subjectivity throughout knowledge-making (Kirby & McKenna, 1989;Lather, 1991; Ramazanoglu, 1992). It promotes an empathetic understanding of subjectiveexperiences by prioritising researching with participants rather than researching on them(Lather, 1991).As I embark on my ethnographic study in a working-class town in North England, I recognise thecomplex layers of my identity and experiences that inform my engagement with the researchsetting. Coming from a rural area affected by economic decline, I understand thesocio-economic challenges faced by communities undergoing industry shifts. This sharedeconomic context enables me to contextualise and empathise with the complexities of the locallandscape. Recognising power dynamics and potential insider/outsider tensions, it is the goal toapproach the research site with humility, acknowledging and interrogating biases. My white,American background may influence my interactions with staff and residents, and I am120committed to reflexivity in navigating these dynamics. I am looking at old age as a young personwho has not yet experienced old age. Understanding the community's economic context and itsresonance with my upbringing enables me to grasp the nuances of collective experiences andaspirations.Within the care home, I observe the intricate interactions among staff, residents, andmanagement, each with unique perspectives and motivations. Navigating these complexitiesrequires an acute awareness of power dynamics, cultural expectations, and individualexperiences. Throughout I strive to create spaces for genuine engagement and dialogue, valuingthe voices and stories of the residents and staff who have graciously welcomed me into theirlives. By fostering trust, actively listening, and acknowledging the diversity of experiences withinthe care home, I aim to co-create knowledge that challenges prevailing narratives and shedslight on the complexities of care and ageing.As a feminist researcher, I examine how gender shapes the dynamics and experiences within thecare home. By critically exploring gendered divisions of labour, power differentials, and livedexperiences, I aim to identify gender hierarchies, advocate for equity, and amplify marginalisedvoices within care contexts. This lens allows for a more comprehensive understanding of care,gender, and the socio-cultural fabric of the working-class community. Drawing from mypositionality as a working-class American woman, a first-generation university student, and afeminist researcher, I embark on this ethnographic inquiry committed to understanding andadvocating for the diverse experiences and needs within the care home environment. Through121collaboration, empathy, and an intersectional lens, I seek to generate knowledge that capturesthe realities of care in the working-class town and contributes to broader discussions on gender,power, and transformative care practices in society. Maintaining transparency, reflexivity, andacknowledging the situated nature of knowledge will guide me in conducting this research andensuring accurate and descriptive reflections throughout the process.Field MethodsAs a participant observer in the field, I actively engaged in social activities within the care homesetting, such as cooking, crafting, and attending various community events (Spradley, 1980).Participating in these social activities allowed me to observe and study the social interactionsamong residents, which provided valuable insights into their everyday lives and experiences. Italso played a crucial role in establishing rapport with the participants and the staff as I becamemore integrated into the community (DeWalt & DeWalt, 2010).While I did not participate in any clinical activities, my involvement in the social aspects of thecare home allowed me to develop a deeper understanding of the social dynamics andrelationships within the community. This immersion in the day-to-day life of the care homehelped me gain a more complete perspective on the experiences of the individuals involved.I diligently took field notes throughout my fieldwork to document my observations, interactions,and reflections (Emerson et al., 2011). These field notes were valuable for analysing andinterpreting the data collected during my research. They also facilitated the examination of how122my role as a researcher was being "naturalised" within the care home community, sheddinglight on the evolving dynamics and my positionality as an insider.Participant Observation and Interview MethodsI employed participant observation as the primary data collection method to uncover thepatterns, rhythms, and processes that might have eluded other research approaches, such assurveys or interviews alone. The success of this endeavour relied on my ability to establishrapport and respectfully engage with the community under study. Building on my prior trainingin ethnographic research methodology and experience working with adults in a clinical researchsetting, I am adequately prepared for the task. However, I also recognised the importance ofcontinuous learning and sought guidance from my experienced supervisory team, who providedvaluable insights based on their expertise in ethnographic research. To further enhance myunderstanding of researching adults with cognitive impairment, I attended a three-day trainingcourse on 'Ethics in Dementia Research' at Leuven University.I prioritised meticulous preparation before commencing the research period at BCU and thehost organisation. This included conducting a thorough risk assessment and undergoing a DBScheck to ensure the safety and integrity of the research process. Throughout the project, Ibenefited from the guidance and support of my knowledgeable supervisory team, including twoexperienced nurses with expertise in working directly with older individuals and conductingresearch in this context. By approaching this project with careful planning and a commitment to123rigorous research, I aimed to minimise potential harm and respectfully engage with thecommunity.Immersing myself in the field, I planned to spend a substantial amount of time at the residentialcare facility–engaging in ethnographic research necessitates a significant investment of timewithin the field site (Savage, 2000). Fortunately, I was offered the opportunity to reside in aprivate abode on the premises, allowing me to gain insights during regular hours, evenings, andweekends. The study was conducted at a not-for-profit provider of care housing in northernEngland. This care home was designed to cater to the changing needs of ageing adults,promoting a sense of community within and beyond the Houses which is where residentsprimarily spend time. The integration of community establishments such as cafes, hairdressers,and gyms aimed to foster connections between residents and the surrounding neighbourhood.Individuals could live independently or as couples, with various housing arrangements available.The research specifically focused on a residential care facility in North England, housing around100 residents in a combination of independent-living apartments and households.Participant recruitment was facilitated through collaboration with the residential care facility'sgatekeepers. After engaging in discussions with the chief executive, a plan for my participantobservation was established to foster trust and ongoing participation. Introducing myself to thecommunity involved gradual integration, including community-wide announcements andcommunication through residents' meetings and newsletters. This ensured that the managers124and the care staff were aware of my presence, allowing for rapport-building and transparentcommunication of my research intentions.I employed a combination of observational and interview-based data collection methods tocapture a comprehensive understanding of the community. I primarily focused on participantobservation within selected households through purposive sampling while engaging withresidents in apartments and community establishments such as the bistro, gym, or tea room.This design was influenced by the layout and structure of the care home, enabling me toexplore the spatial and temporal dynamics that shaped notions of home and community.All participants in the study met the age requirements, and inclusion was based on theirwillingness to participate. It was clear to residents that their decision to participate or withdrawwould not impact the quality of care they received or their engagement in social events.Conversations and interviews served as valuable supplements to the observational data. Iadopted an open-ended approach during the interviews, encourageing participants to sharetheir perspectives on their social lives and interpersonal relationships within the residence. Iremained mindful of the sensitive nature of specific topics, such as loneliness, depression, andisolation, respecting each participant's comfort level in discussing such matters.Conducting research within people's homes requires careful ethical considerations, which I’lldiscuss in further depth in the following section. I maintained ongoing communication with staffand residents to ensure minimal disruption to their daily routines and to address any signs of125distress or agitation. Collaboration with the residence's management allowed me to participatein low-risk social events without hindering the natural flow of community life. Transparency wasupheld as I shared my schedule with staff and residents, clarifying my intentions andwhereabouts. In adherence to safeguarding principles, I received comprehensive training toeffectively respond to any instances of abuse, harm, or neglect that might come to light duringthe research. I was well-versed in the relevant legislation, including the Human Rights Act andthe Mental Capacity Act, which underscored the importance of upholding the rights andwell-being of every individual involved.Reflexive JournalTaking daily field notes, coding, and writing memos on recurring themes helped structure myinquiry. It provided the opportunity to maintain a reflective voice in my analysis (DeVault, 1990),and to engage with an iterative framework of analysis (Srivastava & Hopwood, 2009). A practicaland measurable way I accounted for my subjective experience was through the reflexive journal(Kirby & McKenna, 1989). This provided a space to unpack assumptions, reactions, andreflections that I brought to the project and attempt to account for my 'conceptual baggage'(Hulko, 2002). My reflective journal started from the onset of this project, and I found it helpfulto track my development of this project and react to/account for the unforeseen changesthroughout my first year as a doctoral candidate in 2020. The research process was a journeyduring which I immersed myself as well as I could into the dynamic community of the residentialcare facility, humbly seeking to unveil the subtle intricacies and hidden dynamics that shaperesidents' experiences.126127Chapter Five: Ethnographic FindingsIn combing through my field notes, I found many stories worth highlighting, and I wanted towrite in a way that allowed these ‘stories’, these vignettes, to shine12. The process of mergingmy data with theory was not just a sequential step but an integral aspect of my methodologicalapproach, guided by the principles of constant comparison. This involved continually revisitingmy field notes, identifying recurring patterns, and integrating relevant theoretical frameworksthat provided depth and insight into the observed phenomena. The selection of theoreticalframeworks, such as Connell’s Gender and Power, Ahmed's Affective Economies, theHumanisation of Care Framework, and Kristeva's concept of abjection, was not arbitrary butbased on their applicability to the nuances of care relationships within the care home setting.These theoretical lenses illuminated the emotional intricacies and power dynamics at play,allowing for a multifaceted understanding of the care dynamics within the context studied.I do not wish to prematurely muddy the waters with my interpretation and analysis, but ratherto provide large pieces of text that showcase what happened - what was said, done, or not said,not done to represent residents' experiences best. But the act of representation is slippery.Many residents’ experiences are challenging to describe in one “clean” moment. Not everysignificant event I witnessed occurred in a narrative story arc. And my bias is already wrappedinto the notes from my research: in the act of searching, observing, and participating, I wasalready making choices of what to pay attention to, who to hear, to witness. This was based onrapport, participants’ capacity to communicate with me, my capacity to receive what was being12 Please see Appendix 4 Participant Information Table for list of all participants’ pseudonyms.128communicated well, and of course, on being in the right place at the right time.In Chapter 5, my aim was to strike a delicate balance between the ‘unfiltered’ narratives and theanalytical interpretation. The aim was to refrain from prematurely shaping the reader'sunderstanding and instead allow the presented stories, or vignettes, to organically convey theiressence. However, I am cognisant of the inherent challenge in faithfully representing residents'experiences, as not every significant event neatly fits into a narrative structure. The intricatenature of these experiences necessitates a multifaceted approach, akin to the layeredmethodologies often employed in ethnographic studies.In recognition of this complexity, Chapter 5 will feature ongoing discussions woven throughout,providing continual insights and interpretations. This iterative process will foster increasedflexibility for deeper exploration in Chapter 6. By adopting this methodological stance, I aim toenrich the clarity and coherence of the final analysis, ensuring a robust and comprehensiveexamination of the care relationships within the care home. This approach will extend acrossthe subsequent sections and into the following discussion chapter, aligning with the iterativeand reflexive nature inherent in ethnographic inquiry.Section 1: Case StudiesThis first section presents three case studies, each showcasing the experiences of people livingtheir lives in the care home setting—George and Julia, a couple, and two single residents, Orla129and William. I have chosen these cases due to the extensive time spent researching andinteracting with these individuals, as well as the valuable data they shared which directlyaddresses the guiding questions of this study. The choice to present these case studies as acentral piece of the study is rooted in anti-oppressive ethnography principles and feministmethodology, both of which advocate for centering the voices and experiences of marginalisedindividuals. I aim to critically examine the intersecting systems of oppression that shape theexperiences individuals living in care homes by challenging and complicating dominantnarratives and stereotypes surrounding ageing and care provision. This methodology prioritisesthe agency and autonomy of care home residents, acknowledging their lived experiences asvaluable sources of knowledge. Through constant comparison and reflexivity, I navigate thecomplexities of power relations within the care home, ensuring that my research remainsethically grounded and socially just.In adopting a feminist methodology, I acknowledge the importance of situated knowledge andstandpoint theory in understanding the experiences of care home residents. By centering theperspectives of these individuals, I not only highlight the structural constraints they face butalso give space to illustrate their perspective of how they navigate the care home environment.This approach underscores the importance of intersectionality in understanding the uniquechallenges of individuals within the broader context of institutionalised care. Ultimately,through the synthesis of theory and lived experiences, an anti-oppressive ethnographicapproach aims to challenge hegemonic narratives surrounding ageing and care, whileadvocating for more inclusive and equitable practices within the care home setting.130Section 2: Social Life in the Care HomeThe next section delves into social life and food practices within the care home, employing theframework of affective economies to scrutinise the underlying structure. Building uponexamining explicit gender norms, I delve into the concepts of cathexis and abjection, focusingspecifically on their manifestation during social events and meals. This chapter aims to unveilthe implicit ways in which gender norms shape interactions within the care home environment,particularly within the affective dimensions of food-related experiences.To better understand the intricate social dynamics, I draw upon Goffman's front and backstageconcepts in this section. By integrating insights gained from preceding chapters, I explore howfacilitated interactions, e.g. planned social events such as coffee and cake, bingo, or holidayparties, within the care home operate in conjunction with previously examined issues. Thisapproach provides a deeper understanding of the overall care home experience, shedding lighton the various ways in which social life and gender dynamics intersect.Section 3: Looking at Power & Gender in the Care HomeIn the final section of this empirical data chapter, I delve into the dynamics of power and genderwithin the care home setting, primarily drawing on Connell's framework. The main objective ofthis chapter is to provide a comprehensive contextual understanding of the operations of131gender and power in the care home environment. This analysis revolves around the concepts ofcathexis, aligned with Connell's ideas, and Kristeva's notion of abjection.I investigate how individuals react to and challenge societal gender norms, blurring the linesbetween gender expectations. Moreover, I highlight how individuals are either drawn towardsor repulsed by the gender norms imposed upon them, ultimately impacting their experiencesand identities.Through the organisation of these empirical chapters, my goal is to comprehensively show andanalyse power, gender, cathexis, abjection, and their interplay within the care home setting. Bydrawing on established theoretical frameworks and utilising case studies and observations, Istrive to provide a nuanced and insightful exploration of the complex dynamics shaping the livesof residents and staff in the care home environment.Section One: Three Case StudiesThis section presents three case studies that explore the experiences of four residents–onemarried couple, a man, and a woman. Case studies are a common method used in ethnographicresearch, which involves studying a particular group or individual to provide rich insights intothe experiences and perspectives of individuals within a particular community or setting. The132case studies were selected based on their ability to provide a rich and diverse perspective onhow different individuals navigate their lives in a care home setting.By highlighting the following three case studies, the aim is to offer a more layered and detailedaccount of the social and cultural dynamics at play within the care home. I also want to showmy own process and subjective orientation to the care home environment. I provide notes frommy reflective journal and explain my reactions and choices made while engaging with thesepeople’s lives. Sometimes this may look like an intervention of something dangerous orupsetting, other times it comes as a reflection after witnessing something. In some instances, Icite literature to show how some of the events and experiences I witness may relate to trends incare. I also point to how some of these findings “brush against” the theoretical framework I usefor this study. A deeper analysis and discussion will follow the case studies.The process of selecting informants for ethnographic studies is influenced by my subjectiveexperience of the care home and the residents. First, my biases and assumptions may shapedmy perceptions of who might be considered a significant informant. Establishing rapport withthe participants was a critical component of the selection process, as it was important to gaintheir trust and build a relationship over time. This was achieved through ongoing engagementand interaction, allowing me to better understand the participants' experiences, perspectives,and values.The selection of these cases was also informed by an intersectional analysis, which consideredfactors such as age, gender, ethnicity, class, and disability (Christiansen &Qvotrup Jensen, 2012).This allowed for a more complex understanding of the participants' experiences and helped to133highlight the ways in which different forms of oppression and marginalisation intersect andinteract to shape their lives. Each case study presents a unique and compelling perspective onthe experiences of old adults in a care home setting. Through a detailed exploration of theirdaily lives, relationships, and interactions with care workers and other residents, these casestudies provide a rich and nuanced understanding of the challenges and opportunities in carehomes and how individuals navigate these complex environments.In this chapter, I'll be diving into the individual experiences within a care home, connectingthese personal narratives to broader literature. The goal is to uncover deeper insights intocaregiving dynamics, power structures, and societal expectations. Each case study acts as a lensfor examining wider themes in the context of care, and I will integrate insights from existingliterature to offer a comprehensive perspective. This approach is grounded in theunderstanding that individual stories are intricately linked to broader socio-cultural, gendered,and psychological contexts (Ramazanoglu & Holland, 2000). By connecting specific case studiesto wider scholarly discussions, we aim to contribute to a more comprehensive understanding ofcaregiving within residential settings.134Case I: George & JuliaFigure 7 George and JuliaBefore I met George and Julia, I had heard a lot about them. These were the only residents I wastold about before coming to stay at the care home. In a meeting to orient me to the socialactivities at the care home before my fieldwork started, the current activities coordinator13 toldme that they are married and, with a slight chuckle, added that they often get into fights andrequire some support with the emotional demands of their marriage. She explained thatGeorge is “‘still with it’, mentally speaking”, while his wife has advancing dementia which bothfind very difficult to navigate. George enrolled himself and then acted as a consultee to adviseJulia’s enrollment in the study. Until recently, George and Julia lived in another downstairscommunity in the care home but were moved14 upstairs to a community that housed a few14 This was not the choice of George and Julia, but of the care home staff who felt George needed more socialisation.13 The Activities Coordinator later left the position without any notice and has since cut contact with everyone from thecare home–probably due to burnout.135single male residents who staff hoped might keep George company. They were described as a“lively couple” and attended the social activities organised by the care home, perhaps the mostof all residents. A few days later, I met George and Julia for the first time. Lucy, a care workerwho agreed to show me the household, introduced me to George and Julia sitting at a table inthe dining area.George was bald and was wearing a blue cardigan and wool trousers. He had wide hips andlarge hands, but he looked quite small, as if his body were attached to the skeleton of a muchlarger man (later, I would see old photos of George and Julia, confirming that they were bothmuch larger in the past). George wore glasses and hearing aids, and a Zimmer frame was parkednext to his seat. His clothing was stained and unkempt–some egg yolk on the front of hissweater, and his undershirt was sticking out the bottom, not tucked into his trousers. Therewere a few coffee or tea stains on his khaki trousers. He was sitting on a cushion - a small pieceof egg carton foam covered in stains from food. He smiled up at me and said hello in ahigh-pitched chirp. Next to him, Julia was wearing a clean, ironed dress and a pink sweater. Shelooked very tidy. Her lower legs were red and swollen, which caused her socks to hug her anklestightly, and the pink velcro slippers she wore were strapped tight around her swollen feet, thevelcro clinging desperately to keep them closed. Julia’s white hair was styled in a short bob, a bitunbrushed but still clean and looked recently cut. She held her eyes closed, both handsgripping the cane she had balanced against her knees. She opened her eyes and nodded hellowith a frown before closing them again. Lucy explained that George and Julia moved into thishousehold last week from a flat downstairs. I asked George if I may join them, and he said,136“Please!” and gestured for me to take a chair. I introduced myself, and George said, “Oh right,you’re the student”. I showed him the Participant Information Sheet and began to explain a bitabout the study, and he waved it away and said, “Yes, I read that. I will help you. What do youwant to know about us?”The staff who had introduced me to the residents was correct, George was gifted with the art ofchat. George wanted to hear much about America (“Tell us about America” became one ofGeorge’s catchphrases over the following months). He told me he and Julia travelled on a tourbus from Montreal to Philadelphia. He told me about their sights on the trip and that they hadalso been to Switzerland and France. George asked a lot of questions and shared a lot about hisexperiences: his job as a business owner, he and his wife’s involvement in the church, thecommunity of friends they had “back home”. His eyes grew wide when he got excited. He wouldmumble and speak quickly but was a very animated and engaged speaker. He laughed at jokesand would make many of his own.Julia sat beside him the whole while, frowning with her eyes closed. At one point, Julia wasasked if she would like anything else for breakfast, her bowl of corn cereal sitting untouched infront of her, and she declined. Instead, she pointed to George and explained to Lucy, who was inthe nearby kitchen, that he was “rather wicked, and I am quite cross with him. We’ve had afall-out, and I just can not understand why he’d do something so cruel to me”. Lucy turned tome and explained that George woke up later than usual today, and Julia could not find him, andshe grew slightly confused. Lucy told me that George and Julia slept in adjacent rooms and137would meet for breakfast in the morning, ending their days sitting together on the sofawatching television after dinner. As Lucy explained this to me, she used a loud, slow voice,petting Julia’s shoulder and winking at George. Though explaining their “normal” daily routineto me, she included George and Julia in the description, “is not that right?” or “sometimes wejust have an off day, don’t we”. I clumsily engaged in Lucy’s triangulation–thanking her for theinformation, while looking to George for confirmation (Julia’s eyes were still shut tight, ignoringus all). This was a balancing act with which I would come familiar over the next months, it feltstrange, but not unkind. A sort of dance through many intentional and polite gestures, anawareness of differing moods, a negotiation. It felt akin to getting through an awkward dinnerparty.Julia was now looking around and said to nobody in particular, she felt “very queer” being here.Lucy sympathised, petting Julia’s shoulder and telling Julia that she knows it must be hard to getused to a new House but that they were glad she was here. Lucy noticed that George waslistening intently, and she patted his arm, adding, “But he’s a handsome man, eh”, to which Juliaresponded, still looking off into the distance, “Well, he is certainly bald!” and she closed hereyes and crossed her arms again. Lucy removed Julia’s untouched bowl of cereal, now a soggygrey paste, and George asked her if he could have poached eggs. George was on a soft diet, heexplained to me, and he was not supposed to eat any foods that, “require much chewing”.Some minutes later, the carer brought George a bowl of chopped poached eggs, and shebrought Julia poached egg on toast, offering that she just try. Julia asked George where two138people were (I could not hear the names), and he impatiently said, “They’re dead!” and thenmouthed to me “She’s confused”, with wide eyes and a shrug.Navigating George and Julia’s different needs will become a common occurrence I witness in thefollowing months of fieldwork. Every care worker has their own style of mitigating the couples’different needs (they are two people, after all). Still, the goal is the same–to validate andsupport each of them despite their very different needs and perspectives. George oftenadvocated for Julia, calling a care worker over to get her a blanket, asking for someone to talk toher when she was upset, or asking me to do a knitting lesson with her. George strategised hisown incapability of caring directly for his wife by asking for things on her behalf. On the otherhand, Julia did not appear to be equally concerned with George’s needs. While Julia expressedmore psychic pain regularly, George was quite physically unwell: he often complained ofhorrendous pain in his back and “bum”. He carries around a grimy little cushion to soften thevarious surfaces that host his body throughout the day. He constantly winced from the painwhen we would talk, and he told me that it was very depressing to feel so hopeless in his ownbody: “Nothing can be done; they said so. I just have it like this now”.George frequently exhibited anxiety when Julia expressed distress, particularly when shedisclosed details about their shared life that he preferred to keep private. On one occasion, sheseemed fixated on a memory involving the theft of their money, asking, "Well, who were thosemen, those who took our money…" In response, George promptly hushed her and shifted theconversation. A few days later, he confided in me, revealing that they had been victims of fraud.139Someone posing as a church representative had deceived them, leading to the theft of somemoney.The following week, George, looking visibly upset, greeted me at the entrance of the House. Heshared that they had a heated argument that day, and he felt lost dealing with Julia’sunpredictable mood swings. Such complaints are often dismissed, with responses like,"Husbands… can not live with them, can not live without them!" as Lucy once quipped to adistressed Julia. Another time, she remarked, "Well, I know you bicker, but you've been togethera whole lifetime; I think that's something to be proud of!"In my reflections, I noted:This got me thinking about how a long-lasting relationship can sometimes become more of amarker of time than a dynamic contract between two loving individuals. The celebration oflongevity can obscure the fact that it's an ongoing negotiation between two people rather thana fixed entity.On another occasion, Julia playfully took George’s Zimmer frame, causing him anxiety. When heasked for it back, she retorted haughtily, "What? So you can be the only one using it? That’shardly fair." During my training on moving and handling, I learned that altering someone'swalking support can be legally considered elder abuse. The nurse conducting the training sharedan incident where she stacked zimmer frames against a wall with the intention to tidy up theroom. However, she was promptly informed that it was illegal and unsafe, instructed to returneach person’s zimmer frame immediately. While Julia may not have intended to neglect orisolate George, it prompted me to consider the seriousness of abuse and the importance ofunderstanding context. When viewed through cultural stereotypes, issues of abuse might be140downplayed. Reporting Julia's behaviour as domestic abuse does not appear to be a reasonablesolution. Instead, there could be an option to formally document and observe suchinterpersonal dynamics among residents, reducing the likelihood of issues getting lost amid theresponsibilities of care workers.—-Julia told me that she had knit this beautiful cardigan that she was wearing. I asked her if shewanted to teach me to knit, and she agreed. This plan made George very happy (“We old peoplecan teach you things, too!”), and he has been asking when we plan to knit since.One evening, when Julia was in a good mood I asked if she would give me a knitting lesson. Sheand George were sitting in their usual spot on a sofa under blankets. She was holding George’shand and joking with him. When Julia was happy, it was infectious - she would have a silly grinand loved teasing everyone. I came to say hello, and they told me about Greg, the young carer,who did some pushups for George earlier (“The man’s an athlete!”)I asked Julia if she wanted to give me a knitting lesson. “Yes, alright. We can see if I remember.”There was a basket of acrylic yarn and knitting needles in the household, and I went to get it.141Julia picked through the yarn and needles, explaining that we should find a thick, big needle forbeginners.Figure 8 Julia's knittingShe started knitting, showing me how to cast on. “Pearl, pearl!” jokes George, and she elbowedhim jokingly back (“He’s always trying to mix me up…”). Eventually, Julia stopped explainingthings to me and started knitting faster, now focused. She told me that her sister, Edith, knit herwedding veil. She tells me that her mother taught them both to knit as girls, and they madetheir own clothes before leaving school.While knitting, Julia spoke calmly and fluidly, sharing her memories of being a girl.142For about 20 uninterrupted minutes, Julia told me about her brother’s fish business, her andGeorge’s experiences at the church, and their friends in Scotland. Her face looked calm, and herfocus did not leave her knitting. Eventually, she explained, “So this is...this would be the sort ofedge of a sweater. If you wanted to knit further, we would connect this bit, you see its width,not length...we’d connect this to a larger pattern”. She handed me the knitting, and I tucked itback into the basket and told her we could hold onto it for our next lesson.All the while Julia had been giving me my lesson, George often peered over and smiled, lookingrelaxed and occasionally gazing at Julia with a look of admiration. I noticed that while Julia wasbusy knitting and talking, George’s body relaxed; he leant back into the sofa watching hisprogram, occasionally chiming in with a joke. When we stopped the lesson, he looked at me andheld his hands together as if to pray: “Please do that with her again. A lot! Please.”While I cleaned up the knitting, Greg dimmed the lights and drew the curtains. Julia and Georgesat together quietly on the sofa. I sat near them in a chair, not speaking either. Our programme,Summer Watch, came on (we had been watching it together every evening that week). BesidesGeorge occasionally asking me to clarify what was happening, the sitting room was quiet; themood was calm. On the programme, a man in Scotland hiked around. Julia said, “Oh, you haveto see Scotland. We will take you. We go in the camper van occasionally. Oh, do take ournumber, and we will arrange something. You can come to Manchester and stay with us”. Georgelooked silently bewildered at this, throwing his hands up behind her and mouthing “NO” to me,but Julia was calm and happy, and he did not protest. When the program was nearing its end,143Greg came in and said, “Are we getting ready for bed?” George became cross and said “No. Cannot you see that we are enjoying this programme with our American friend?!” he gestured atJulia who was sitting cosily under the blanket. Greg nodded and headed off to help someoneelse. “He always does this”, explains George, “and just you wait...when I go to use the toilet, hefollows me, catches me in my room and has me get into my pyjamas”. I nodded, not sure whatto say. Eventually, George did need the toilet, and as predicted, Greg followed him slowly downthe hallway.Ten minutes later, George returned in his pyjamas, shrugging at me. He smiled and rolled hiseyes. So much is met with complete awareness on his part that the care workers are not fullyrespecting his wishes or desires. As I gathered my things, Heather, a young carer, asked if theywere ready for bed. “No, just a little bit longer,” said George. He and Julia got cosy on the sofa,sitting together for a little longer.Interview with GeorgeI asked George if he would be willing to interview for my project the day prior. When I came tomeet him, he was sitting on the sofa, waiting. He looked up at me expectantly - “Are we ready?”I said yes and asked if he would mind coming to his room, where it was quieter “Go with it” heagreed.144I had been in George’s room once before when I helped him get to his bathroom. The room wasempty and undecorated, with a few framed photos on the dresser and belongings on the desk(electric shaver, magazines). He showed me a photo of him and Julia standing in a city street“That’s when we went to the opera!” They looked young, Julia almost unrecognisable, muchheavier and with thick brown curly hair. “Wow, look at you both,” I said, pausing at the photo.George told me that Julia had lost weight, “she is not eating”. I ask him if he is worried abouther eating. “She just gets too upset. She allows herself to - she does not know what she needsanymore. (shrugs) I can not worry too much about that” He carefully backs up to his mattressand plops down on the edge of his bed and I sit across from him on his desk chair.J: So [George], my first question is about when you moved to [Together]. Do youremember when you and [Julia] moved here?G: Got to think...yeah I’ll think in a minute. Silence...J: Was it a few years ago?G: Three years ago.J: Three years ago, okay. And when you first moved here, you first lived downstairs,right?145G: Yes, downstairs, below in the other one.J: Did you and [Julia] already have separate rooms, or did that happen later?G: Yes, we had separate rooms from the beginning.J: And how did it feel to live in separate rooms?G: A bit strange. Well, we stayed together for a bit at the start. But eventually, Istarted...I could not sleep. I could not get comfortable, so they asked if I wanted my ownbed. My own room. I said go with it.J: When you shared a room, did -G: They put two of these (pats bed) together - they sorted it for us. But then we went toour own rooms. I think they had the extra [mattress]. (shrugs)J: Did you decide to move here, or was there a situation that prompted the move into[Together]?G: There was a situation. We were both going well. I had a fall and had to go to hospital.So. She kept saying she was dizzy. She was dizzy, so I didn’t want to leave her alone. So146she came with us to the hospital. We could not leave her at home, and I wasn’t doingwell. I didn’t know what to do, so they did it.J: Do you mean your godchildren?G: Yes - they decided we should come here. They sorted it for us.J: And that’s a bit far, from [town 45 minutes away] to [this town].G: I’d say it is! (Smiling)J: How have you found it, living over here?G: I haven’t really been out. I don’t know the town. I haven’t seen anything...I don’t walkso well, you see. And she...she would not know. We stay here.J: Well, and in this year everyone is staying home, everywhere. (I point to my mask)G: Right. I forget (laughs)J: About the pandemic, do you mean?147G: Yes, well. I follow the news, I know it is happening, but I don’t think about it. It’s allnormal for in here, really.J: Okay. I’d like to talk a bit about what is working living here, and then about what is notworking so well, if that’s alright, [George]?G: Yes, that's alright. My godchildren. They can come on Saturdays. They help us witheverything. My phone, it needs a new SIM card in it. They haven’t sorted that yet...I cannot call everyone I know.J: Yes, I remember that you need help with this. It must feel isolating not to be able to callpeople.G: Yes. Isolating, very much, so yeah.J: Will they let you use the phone here?G: Yes, they let me. But then I have to wait for someone to come.J: I imagine that’s not easy.148G: I feel helpless. It’s easier to talk about what is not working, not what is working. (LongPause). I can not help her the way I’d like-George gestures behind him at the wall connecting to Julia’s room. Silence. His eyes aremoist, and he slouches a bit.G: Can we move on, please?J: Yes, of course. What about friendships? Have you made any friends while living here?G: Here? (he gestures to the hallway, looking surprised with eyebrows raised) I just knowpeople, can not say they’re friends.J: Hm, you’re still relatively new to this house. But downstairs, you lived there for twoyears.G: Yes, but that’s the same, really. I just know people. Not friends.J: And what about the staff?Silence - then looks to the door. George said quietly: can they hear this?149J: No. We are far down the hall.George glanced out the door then continued: Okay, well, they always say ‘later, later’.They don’t want to talk to me. So you have to wait a lot. I get very tired of waiting. Theyhave these buttons (gestures to the emergency alarm button on his wall), but that’s notfor...most things. Only falls.J: Yes, I see. My impression is, and please correct me if I’m wrong, that you have help foremergencies, but it’s more difficult for staff to find the time if you want something. Likeyour whiskers... (I am referring to his desire to get help with a shave. He has mentionedhis whiskers to me many times)G: That’s right. I can not get help with shaving very often. And I grow long whiskers. Ihave fallen about...10 times. They find me. I have this (gestures to the emergency buttonon his neck). That’s good. I don’t worry to be left. But ten times, I have been down there.Terrible.J: I’m really glad that you’ve gotten help when you have fallen. Would you say that youfeel safe here?G: Yes. (answers confidently and immediately) Sometimes I nearly fall out of bed. I knowthey will help me. I almost fall out of here, gestures to bed. I wish I had a larger one.150J: I was with you a few days ago, and we did ask the staff about the bed. (Julia has alarger bed) They said they could order a larger mattress if you’d like.G: Can they? I want them to. Will you ask?J: Yes, we can go together to ask if you want. [George], I just wanted to discuss one morething, if you’re still comfortable sitting there?G: Go with it.J: This question is about this last year during the lockdown. I’d just like to ask a bit aboutyour experience of the lockdowns.G: I just cope with it. I go with it. I can see my godson more now. During the lockdown,they can not come. Still, just once sometimes. They live close. I am glad we can see themnow.J: And yesterday, you went to the hospital by ambulance instead of car...G: No, taxi. A big taxi van. It wasn’t good. They strapped me in my chair. The bumpy ridehurt my bum.151J: I’m sorry to hear that. You mentioned that your grandson could take you to your eyeappointments before the lockdown.G: Yes, that’s right. Now we have this bumpy ride that they arrange. I was scared to gowithout [Julia]. They put a needle into my eye, you know. It’s terrible. And the taxi goesbump bump bump. Really hurts my bum, that.[George Interview - 2 June 2021]After this, the interview derailed into George discussing the ride yesterday. I thanked him andlet him know that I had stopped recording. I felt moved by George’s offering of somethinghonest and sincere, which appeared to be painful for him, and hopefully a bit cathartic. Heasked if I could help him shave. He had an electric shaver in a drawer in his desk; when I openedthe drawer to find it, it slid easily to the front, the drawer’s emptiness causing the thing to thudand echo. George did not have many belongings. I agreed to “spot” George but saw that hecould not get to his beard behind his ears and under his jaw. I took the shaver and slowly, gentlybuzzed the white whiskers. I felt nervous initially, not wanting to hurt George, but he moved hisneck slowly to angle his bony face towards the electric razor. George turned his headcompliantly, thanking me when I had finished.Getting his needs met was a constant struggle for George. For example, during a social dinnerevent, George expressed a preference for a glass of red wine. He politely asked Cara, a care152worker from his House, to fetch him one. However, another carer from a different House tookthe initiative to bring George a pint of beer while Cara was on her way. When George pointedout the mistake, the care worker cringed, suggesting, "But it’s a pub night; you don’t want a nicecold pint?" This scenario repeated twice more with different care workers overseeing the pubnight. It took three corrections before George finally received the desired glass of wine. Despitehis apparent annoyance while correcting the staff, he displayed a contented demeanour as hesipped and smiled upon receiving the correct beverage–so many slights to George’s individualpreferences are met with his sense of humour and willingness to “just go with it” (his words).This incident raises the possibility that the carers made assumptions about George'spreferences based on stereotypes associated with his gender and possibly his working-classbackground. It appears that they may not have fully considered his tastes and desires. Thissituation highlights how hegemonic masculinity and class stereotypes can inadvertentlyinfluence assumptions and actions towards individuals, even within the supposedly neutral andconsiderate environment of a care home setting. It emphasises the importance of recognisingand respecting individual preferences and avoiding generalisations based on gender and socialbackground.Stereotypes not only influence the types of care acts that may be most likely offered to Georgebut also contribute to a perception of abjection towards him and his care needs. I contend thatGeorge's inability to conform to traditional ideals regarding what a man of his age andbackground should require, and how care for an 87-year-old white Englishman should be153administered, exacerbates this sense of marginalisation. In the thesis introduction, Kate, a careworker who, based on my observations and impressions, displays a dedicated commitment tocare work, characterises George and his needs as a "bottomless pit."Contrary to this characterisation, my observations of George reveal a desire to maintainpersonal grooming, spend quality time with his wife in the communal areas of the House, andhave his individual preferences acknowledged. These preferences include wanting a glass ofmerlot during "pub night" or enjoying the occasional listening session of ABBA–nothing toowild. George's specific needs and desires hardly appear to be a bottomless pit of demands. Butthey sit just outside of the ‘script’ that makes care work efficient, a script which relies on a verynarrow set of norms to make sense of a person’s needs. A care home aims to offer full care,from existential to medical care, which is an enormous promise.—----The Halloween party was the first event since the onset of the pandemic allowing for a mixtureof residents from different communities. The dining area was decorated with orange and blackstreamers and paper masks. Fabric leaves and electric tea light candles decorated the tables.Julia did not want to come down, so George was seated with Max and Lucas. George put apaper cat mask on and grinned at me. When my attention was not sufficient, he began callingout to passing care workers: “Look! Look, I'm a cat!”. Everyone was busy sorting the meals anddrinks, and George was largely ignored. It was raining and already dark out, and I was anxious toget to the train station on time. But, though I intended to stop by the event for some quickgoodbyes, it quickly got busy: helping arrange a meal for a woman who had arrived late, helping154kitchen staff carry plates and drinks, and asking the kitchen staff for some thickener for George’schocolate milk. I lost track of time and realised that I had to leave immediately, or I would bestuck for some hours waiting for the next connection back to Birmingham. I rapidly saidgoodbye to the table. Max and Lucas bid me polite farewells. I stopped to say goodbye toGeorge, who seemed a bit down despite his silly cat mask antics. Maybe because Julia did notfeel up to joining: I do not know, I did not have the time to ask him how he was feeling. Heteared up, saying, “Please come back soon!”. I assured him I would, feeling guilty about ejectingmyself from the party with such urgency. I left with the sickening mixture of urgency to detachand guilt of turning your back on someone who just wants a bit more care and time.The next time I returned to the care home, George had passed away. He died in the hospital in‘’February or March’’ (as estimated by Jodie—so many changes here and so fast that deathdates are quickly misplaced). As I entered the care home, everyone told me about George, fromthe receptionist to a woman from administration whom I had befriended to the care staff in thehousehold. Everyone knew we had had a nice rapport and spent much time together. The lasttime I saw George, he cried as I left the dinner table, and I promised him I would come back; itwould not be the last time we see each other. What a foolish promise. When I came into thehousehold, Jodie, the young woman who worked in the kitchen, told me that when Julia askedafter him, they had been telling her that George was gone for the day.Julia had been wandering the hallways. Instead of her cane, she was now using a Zimmer frame.Her feet and ankles were more swollen than before, and the skin on her lower legs was scabbed155and infected. Her shoes were very tight, and her steps looked pained. Her lone silhouetteappeared smaller now, her rounded shoulders bonier, and her hair softer and whiter. Iwondered if she had lost much weight or just appeared more robust next to her thin George,with his hunched-over posture making him much shorter than Julia. Every hour that afternoon,Julia wandered back and forth along the long hallway, alone and searching.Today she was looking for her bathing suit. She was somewhere in a memory—telling me aboutthe swimming pool near her family’s home. We walked slowly along the hallway. She checkedthe doors, looking for something, but I could not tell what. She tried to open the door to thehousehold, which remains locked, and she muttered: “Tried that one before; they must notwant me to go in there”. I wondered if “they” refers to staff or her parents. Whoever they are,she knows somebody else has the final say about where she can go and when. She told me astory about being three years old and too proud to cross the street with her older sister, so sheapproached a police officer and grabbed his hand for help crossing the street. She laughedwhen telling me it was a lovely memory that made her smile. She told me this story six timestoday, pointing at the large photo of downtown as a reference to explain her family’s pub on thecorner across from the sweets shop. She seemed jolly, reliving this place in her mind—being achild living above her parents’ public house. She recounted being the younger sister to herbeloved older sister Edith, this topic teetering between nostalgia and agitation as she grewanxious that Edith had not been around. “Well, it’s only Monday. She might turn up yet”,encouraged Sam. I remember all the times George would grow upset at Julia’s inability, orunwillingness, to understand that her sister passed away last winter. He would remind her156harshly: “She’s dead”—just like that. Julia would get upset with him, thinking it was some crueljoke, or sometimes she would understand he was serious and cry about her sister’s death, theinformation as new as if it had just happened. I wonder if it is easier for Julia now without theneed to sync her reality with George’s.I had not heard her talk much about George, except once when a new resident, bald and tall likeher late husband, walked past, and she called for him, laughing and saying that he always walksright past her, that he never remembers where he is going. “That’s not [George], darling”, Samgently corrected, and Julia did not seem bothered by this: “Oh, yes, you’re right. Well, they havethe same head shape”. She then returned to telling me the policeman story. After dinner, Juliaate a cornetto cone. She admired her ice cream with a small, satisfied smile, twisting the cone,kicking her feet happily, lost in the bliss of this dessert. “That is just…perfect ice cream”, shemused to herself when she finished.This afternoon spent with Julia, as she navigates her newfound status as a widow, is a specificsnapshot that does not capture the entirety of her experience in coping with the loss of herhusband. It's crucial to clarify that this vignette does not suggest that Julia is "better off"without him. However, delving into the complex matrix of care that enveloped George and Juliawithin the confines of this care home, there emerges a theme that speaks to the tensionbetween maintaining a fixed identity and embracing the flexibility needed to let go and seek arenewed sense of presence.157Much like George, whose experience was hindered by the constraints of pressure to adhere to afixed gender identity, Julia, too, seems to grapple with the challenge of breaking free from alinear narrative of her life. The narrative encompasses not just the recent loss of her husbandbut also resurfaces memories of the loss of her sister and the broader context of her andGeorge’s social life in their hometown, as well as their physical connection with their churchcommunity. This observation highlights the intricate dynamics of identity, loss, and the strugglefor a sense of presence within the framework of care and support provided in the care homesetting.Case II: WilliamWilliam was a retired engineer from Manchester who had moved into the independent livingapartments in the care home with his wife a few years ago. After she passed away, and since hisAlzheimer’s began to advance, he moved into a room in the household. Staff informed me, inaddition to memory loss and reduced mobility (he was able to get around with a Zimmerframe), that William has depression and tends to isolate. William was a tall, serious man whocould be found in his room most of the time. His room was kept tidy and had a handful ofpersonal touches: a radio sat on his chest of drawers, some unhung paintings leaned against thewall by his bed, and a handsome portrait of him and his late wife sat on his wardrobe. Therewere also clinical elements to his room: a pile of adult diapers stacked unceremoniously on adesk by the bathroom, medications assembled in loose organisation, safety rails fastened to the158walls, the large bright SOS button near his bed. William would move from his bed to the chair inthe morning, where he would remain for most of the day, even for meals, where he’d hunchforward and use the storage compartment of his Zimmer frame as a small table. William’s roomlooked out on the quietest and most peaceful side of the property, a small grassy side-yard thatwent unused. He would gaze out of this window for hours, sometimes watching squirrels, othertimes seemingly lost in thought.Figure 9 Sketch of William sitting in his room, field notesWilliam was familiar with the staff, often greeting everyone with a friendly hello and even givingsome of the young girls nicknames. “Pocket rocket”, he called Cara, a young care worker withwhom he’d had a solid rapport. “Pocket rocket, huh? Has he always called you that?” I onceasked Cara, thinking that the slightly flirtatious nature of the nickname might bother her. ButCara grinned and told me she was glad he had a nickname for her. “He is a flirty old man”. Sheexplained that, even though he does not remember her name most days, the nickname shows159her that he knows her and has come to expect her to bring him his tea and medication everyday she is working.I think of the training about sexual harassment I had the month before when the nurse givingthe training told us about a young carer who would wear tight trousers to work, the skinnyjeans fashionable at the time. When a resident, “got a bit handsy and grabbed her bum”, shereported it to management. The nurse explained that though ideally, these instances would nothappen at all, there is “only so much you can expect” from certain individuals with reducedimpulse control. The girl was encouraged to wear clothing that would not so easily reveal herfigure and to approach the man in a way that would not give him access to grabbing her.Practically, dressing in a way which is appropriate for the demands of care work does makesense. When I worked as a mental health staff in a psychiatric institution, the list ofrecommendations was extensive: one should not wear a ponytail, it is too easy to yank, and nodangling jewellery or loose straps for the same reason. Avoid wearing t-shirts with images orwords that may trigger delusional thinking. Plain, modest clothing is best. I remember thisscared me at first, it made it seem likely that I would be grabbed and attacked every day on thejob. But over time, I came to understand that though none of the residents were violent withme, the preventative measures were as much for their benefit and safety as they were for mine- if a resident were to attack a member of staff they could be sent to a higher security institutionwhere their quality of life was likely to decrease immensely. Preventative before punitive actionwas the goal. But is the message that young women should not make themselves sexuallyappealing to old men the same as this—sexual assault is posed as a vocational risk. Through160these trainings, where we are instructed on how to be less likely to be assaulted, there is anacceptance that rape culture may not translate within the walls of a care home, where agency isquestioned.Perhaps it can be both a practical adaptation to the specific potential risks of caring for adultswho may lack impulse control (Wilkins 2015) or who perhaps have a history of sexual assault(Teaster 2007), and also yet another signal that this population is somehow viewed and treatedas ‘other’, perceived existing outside of the norms of society. Inadequate training andadministrative complications are cited as the most common reason behind underreporting ofinstances of sexual assault in care homes (Smith et al., 2018), but there is a cultural aspect atplay which may underpin these systemic shortcomings. The complacency with sexuallypredatory behaviour reaffirms that the residents are removed from and no longer require thesame socialisation standards as those active members of society15. It implies that to be a carehome resident is to lack accountability for your actions. It is the medicalisation (impulse controlbeing impacted by cognitive disorders in old age) of misogyny and predation.Part of this erasure of accountability means that residents may be treated as not quite a fullpeople. To call William’s use of a somewhat demeaning nickname sexist is not to say that he issomehow morally corrupt or less deserving of the best possible care at every moment. It just15 Though one should be sceptical about the idea that sexuality is neutralised in the 'normal' society. In many, if notmost, environments, women (and men–to an extent) would have to think about the sexualised perception of theirappearance and behaviour, and branding these contexts as 'abnormal' in comparison to the sterilised imaginary'normality' is dubious.The removal of residents from their native environment and subsequent placement in the totalinstitution may be the reason that the reproduction of this behaviour becomes socially problematic and a narrativearound these behaviours becomes responsibility of the institution: there is a decision to 'fix' his behaviour to theirethical standards through discipline, or let him be and manage these occurrences in other ways, such as wardrobechoices among carers.161means he is a complex human being who is a product of societal patterning. As a personality,William is polite, kind, and funny. I enjoyed the time I spent talking with him in his room, eventhough he does drop many hints that the sexist tint to his behaviour is not just a product ofbecoming the cliched “dirty old man” in his old age, but it is likely a much more consistent partof his identity. Once, he explained to me, quite proudly, that he had the pick of a few secretariesat his work before eventually deciding to marry his late wife. He explained that she was notnecessarily the prettiest nor the best cook (“truthfully, her cooking was mediocre at best”) butthat he felt she would make a nice housewife. I set aside my contempt for how Williamdiscussed women because I wanted to learn more.But was I holding him accountable? Was I, in turn, dehumanising him as an old man who lacksthe ability to be more discerning, a passive “product of his time”?(Reflective Journal)William had a few adult children who lived nearby. Like many other residents, he moved awayfrom the northern Manchester neighbourhood that he had called home for most of his life tothis small town because it allowed his children to visit him more easily. When I first came to thecare home, visits were still quite limited due to the COVID-19 pandemic. Residents’ families andfriends could call to book a time for an hour visit (they were never strictly timed, but this was away to ensure that many residents could have visits in a day) and come to sit in a small sittingarea in the reception of the care home. This sitting area was not particularly private norconducive to much more than having a small chat over a cup of tea. Between a nearby son and162daughter, William had bimonthly visits. I never accompanied William on these visits—hepreferred a quick escort downstairs and then to be left alone with his visitors, understandably.Once, William sat with his daughter in the common area until quite late, after dinner, which wasnot usual for residents as it conflicted with dinner and post-dinner preparations for bedtime.At around 8 pm, Greg (a young male carer new to the caregiving profession) went downto get William who had been visiting with his daughter. When they returned, Williamwalked into the sitting room, where we watched TV. He was glowing, with bright eyesand a big smile. He wore a nice button-up shirt, and a box of cigars and a ginger cake saton his walker tray. He was standing tall and waved at Sam and I. “Well, good eveningladies!” Sam asked if he’d like to go to his room (his usual choice) or join us in the livingroom. He responded, “Oh, I’ll join the people” in a cheerful voice. He sat near me in achair. I asked him about his visit, and he told me that he saw his granddaughter as well,who is 21 years old. “We sat out in that little garden in the front. There are some chairsthere, and a table. And well I had one of these”, he winked and opened a box to show me8 cigars still inside. “Special occasions, these. Granddad’s cigars”.William looked around, waving at Sarah, who politely smiled and nodded, and then helooked at George & Julia, sitting under a shared blanket on the sofa. I see him look atJulia, still sitting with her arms crossed, frowning. “Hello,” he said loudly in theirdirection, but they either didn't hear or didn't register that he was addressing them. As I163sit between William and the couple, I relay the message, telling George that William hasjust returned from a visit with his daughter. “Oh,” George raised his eyebrows andnodded. Then, in a hushed voice, George asked, “Who is that?”. I explained that weplayed dominoes with William just yesterday and that he lives in this household. “No,that wasn't him…” George said sceptically. “It is, you are housemates. I can introduceyou again if you’d like”. George shook his head and sat back on the sofa, looking at theTV.Greg approached William and loudly said, “You haven’t had your dinner! You shouldhave some food, won’t you eat something?” William declined, looking at me quickly, andGreg continued, “Oh, come on, just a bit of food, it will be good for you. You need toeat..”. After this, Greg winked at me, and I think that William noticed. “No,” repeatedWilliam firmly, frowning now. He sat back in his chair, his posture changing as heslumped forward and looked at the TV. I watched as his facial expression faded from thebravado he wore when he returned to something which could probably be mostaccurately described as dejection. He looked over at Julia again, a sort of nervous glance.Despite his refusal, Greg brought William a large slice of cake with whipped cream.“there you go, a nice piece of cake”. The plate sat untouched next to William as he sankinto his chair and watched TV silently. I looked at the cheerful cigar box, now sittingunderneath his untouched cake and looking a bit cartoonish with its bright colours, like acruel reminder of the contrast between William’s life among family and friends and his164life as a resident in the household. William says loudly, to nobody in particular, “I’m anold, decrepit man”, which Julia heard from across the room and chimed in, “Oh tell meabout it!” with a small laugh, her eyes still closed, hand resting gently on George’sforearm. William sat quietly for a few more minutes and then got up to leave, removingthe plate with the untouched cake from his Zimmer frame and setting it on the table nextto his chair. He slowly shuffled down the hall to his room without saying good night. “Weneed to get you your PM medications, sweetheart”, reminds Juliette, who is busyentering updates on the computer. “Okay, well you know where I’ll be”, replies Williamwithout stopping.(Fieldnotes, 2/6/2021)William’s body language showed how much confidence he lost in a matter of minutes of beingback in the household. He entered appearing happy and assured, but once he re-assimilatedinto the household all of that was quickly lost, and he shrunk, visibly, into his ‘role’, which heunderstood as a “decrepit old man”.Tonight I had a long chat with William in his room, during which Larry brings in dinner.Seeing the plate of food, William says “What the hell is that?!” It’s some mashedpotatoes, a bit of boiled green beans, and “mince and onion”—honestly, it does not look165very appetising. Larry looks very annoyed, closing his eyes while sighing, then putting ona ‘patient’ voice and telling William to try it (“You might like it!” patronising).When Larry leaves, agreeing to make William a sausage sandwich instead (visiblyirritated by his facial expression and the brisk pace of his walk out of the room), Williamapologises to me: “I am sorry. I don’t mean to be...fussy. I am fussy, I suppose. But I amused to food that… I can not pretend to like this”. I reassure him, “I can not force myselfto eat things I don’t find appetising either”, and he asks me if I think this is an“Englishman phenomenon”.Me: Do you mean, is this pickiness specific to English men?William: Yes, fussiness. They’re not like this in the wild, wild west surely...Me: I think it is universal to want to eat food you enjoy.William smiles: Just so long as I am not giving my people a bad image…Me: Are you worried about making a bad impression?William: No, well. I am not used to my life being…(he gestures at me and out thedoor-presumably towards staff)166Me: Does it make you uncomfortable that I am here?William: Nooo no, no. No, not only you. I just. It is not my own…(he trails off into silence)Me: Your own private space?William: Yes. But mmm...I can not ..William trails off. He was gesturing with his hands, and his hand now hangs, frozen inthe air. He slowly lowers it, looking off into the distance. We sit like this in silence for afew moments. William looks at me and smiles. I think he’s forgotten what he was goingto tell me. We change the topic and make small talk until his sandwich arrives, I leave sohe can eat in peace.(Fieldnotes, 30/6/2021)William was caught in a difficult situation–to appear masculine, as he said himself, “They’re notlike this in the wild wild west”, which means being tough and masculine, or to get his desiresmet, for a dinner he would enjoy. He shows awareness that he is “picky” and expresses someshame about this. Yet, despite the hit to his masculinity, he does ask for a different meal and167explains that he cannot force himself to eat something that he does not find appetising. Thus,desire competes with his ideal of masculinity, and he accepts that his behaviour does notuphold his own expectations for this, but interestingly, he makes it about culture. Englishmasculinity versus more rugged American masculinity, specifically, adding, “I don’t want to givemy people a bad image”. If I weren’t there watching, I wonder if he would have demanded adifferent meal and felt no shame about it. If so, this discomfort seems more about how hemight be perceived as less masculine.This came up again a few days later when I sat with a few residents during lunch. Havingrecently returned from a visit, William joined us in the dining room. Again, he did not like thefood offered, and Lucy fixed him a sandwich instead. “We men sure are fussy, aren’t we?” Hesaid to her, and she agreed, saying that her husband never wants what she cooks, and she saystoo bad! The residents at the table laugh at the idea of a wife and husband bickering overdinner—a familiar cultural trope.Giving up these tropes is common between carers and residents and seems to say: “See? Weare all the same here. We all have the same experiences”. And often, they fall along genderedlines, especially among heteronormative lines. But what happens when these tropes becomelived events, not just imagined scenarios, such as a male resident having “the hots for” (carer’swords) a female resident? Towards the end of my stay, William started to take an interest inanother resident, Susan, who has advanced dementia and does not speak very often. Susan hasvery friendly and bright eyes, and she often holds your gaze and likes to hold the hand of the168person sitting near her. She used to live in the apartments and staff have told me that she usedto be a very “festive and generous” woman who would buy jewellery for all of the staff and whowas very sociable and involved in the community. A few months ago, Susan suddenlyremembered the name of one of the kitchen staff and called her name across the bistro. A fewcarers told me about this occurrence and said they teared up because they “miss her verymuch”. One said: “She’s still in there, somewhere…” Because of how they remember her, thestaff are very attentive towards Susan’s clothing, hair, and makeup and she is always very wellgroomed. She is one of the few residents who go to the hairdresser weekly to get her haircleaned and styled.Lately, William has taken an interest in Susan. I first noticed when they were sitting together atlunch. Susan had grabbed William's hand, which took him by surprise at first, but he allowed it,and they sat holding hands. Lucy noticed and waggled her eyebrows at me, whispering: “Oohlook at the new romance..” A few days later, at a cafe event, which Susan always attends,William came as well. This surprised me because he never agrees to attend the events outsidethe household. As a carer helped him sit across from Susan, she said “Now look, this is not acandle-lit dinner for two, you hear?” She and another carer giggled. William didn’t respond. Iimagine that making light of his desire could be quite embarrassing for William.--The next day, I walk into the living room to see Wiliam sitting on the sofa (strange, he isnever out of his room during the day, only occasionally in the evening), and Susan is169sitting next to him in a recliner chair, in her usual spot. They’re holding hands. I see Lucy(carer) watching carefully while she chops vegetables at the counter. William slowlyworks his hand up Susan’s arm, caressing her, and he gets near her breast. I feel panic! Idon’t know exactly what to do, but I tense up, ready to intervene. Lucy walks over andcasually says, “Oh [William], did you drop something? Don’t worry, dear, I can help you”,and she moves his hand away, pulling a blanket over Susan. Again, his hand slowlymoves up Susan’s arm. I look at Susan’s face, unsure if she minds or is uncomfortable.She is smiling, looking at William. Again, when his hand gets above Susan’s elbow, Lucycomes back around, “Oh [William], are you helping Susan cover herself up with theblanket? Thank you but we are here to help her with that. You just relax”, she again tucksthe blanket over Susan’s torso and arms.I quietly ask Lucy in the kitchen how long this has been happening. She tells me that it’sbeen just recently. And then, “It’s always her. Every time there is funny business, it’s[Susan] involved. She’s a male magnet…”(Fieldnotes, 21/7/2021)Victims of resident-to-resident sexual abuse are more likely to be older (Teaster, 2003),widowed or single, and have some physical or cognitive disability. Deeming her a ‘male magnet’demonstrates some ignorance of the statistical likelihood for Susan to become a victim or an170unwillingness to “call it like it is”. The impulse to sweeten the narrative around certain events(“my husband is fussy too”) is common in residential care (Kittay, 1999). This can arise from avariety of factors, including a desire to preserve the dignity and self-esteem of the carerecipient, to shield them from the harsh realities of their situation, or to alleviate the careworker's own discomfort with difficult circumstances. It can also help carers avoid losingempathy for residents who may behave in ways which are difficult to accept, or to diffusetension between parties (Bei et al., 2022)A while later, Linda (care worker) brought tea around to the residents. William glanced at me afew times. He called Lucy over, sitting at the counter watching over Susan, and said “I thinksomeone’s forgotten to put sweetener in” (He always takes his tea, no milk, two sweeteners,and I have never seen Linda mix this up!) Lucy took his cup and walked back into the kitchencorner to the cupboard. While she was gone, he grabbed Susan’s arm, this time a bit faster andmore robust. Susan, not expecting this, slumped sideways. I stirred, unsure how to bestintervene. My heart, I noticed, was racing a bit, and I felt a surge of adrenaline. Again, Williamglanced at me. I am sure he knew I saw his tea-trick, and he paused, looking at me.Before I said anything, Linda said, “[William], sir, I’m sorry but that will not do. You will hurt herback if she's pulled all sideways like that”. She squats to be eye level with William andcontinued, “You can hold hands, I think that's lovely! But you can not be pulling her like that.What are you up to, anyway?” He shook his head as if to say nothing, and he went back toholding Susan’s hand.171I think about how Lucy handled the situation differently than Linda had—that her passivehinting helped stop William without shaming him, but he didn’t stop pulling at Susan's arm untilLinda spoke to him directly, addressing his behaviour in a calm yet firm way. Lucy remainedsubtle, avoiding any direct communication with William or assumptions about his intentions.Meanwhile, Linda ‘levelled’ with William, and this is when he stopped pulling on Susan (at leastfor the time being). Lucy is a young woman while Linda is middle-aged. This may say somethingabout the power afforded to women within hegemonic masculinity: older women tend to beless sexualised and thus may feel more comfortable addressing potentially predatorybehaviours. Linda has much more experience in residential care, and she may know that directcommunication is more effective and more respectful of William. Pretending to not know whathe’s doing ignores that William is acting autonomously and devises a strategy to shirk offsurveillance so that he can act as he wants. Gauging consent and facilitating appropriate sexualor romantic behaviour between residents is complicated, and watching the different ways inwhich Linda and Lucy attempted to confront William’s advances towards Susan may in part bedue to training, but I’m certain that their instinct also comes from the lived expertise of being awoman in a culture where unwanted advances are commonplace and where to move throughthe world as a non-cis-male you are likely to develop a strategy to avoid or escape thesebehaviours.Later that evening, in my room, I thought about my own bodily response to watching Williamgrabbing at Susan, and I wrote in my journal:172I honestly don’t know how I would have dealt with that situation had I been alone with them. Ifelt worried for [Susan], but I also felt some kind of pity for [William], that to attempt to accessintimacy he had to try to distract the women in the kitchen and had to grab at a woman who,though engaging in some friendly behaviour such as hand holding and smiling, did not seem tounderstand [William]’s intentions. The entire situation left me feeling sad.(Reflexive journal, 21/7/2021)Discomfort with his role as a care recipient in a care home runs through many of William’sexperiences, and this discomfort is often navigated, understood, regulated, and sometimesmade starker by masculinity. For example, when feeling shame about struggling to accept thecare home menu, William explains his role as a care recipient as less of a man, forfeiting someof his ideals around masculinity to ask for what he needs and wants. In another case, hisattempt to seek intimacy with another resident who appeared to lack the capacity or awarenessto consent made carers question his masculinity by openly joking about his behaviour. It is oftentreated as funny or even cute when old people demonstrate romantic or sexual desire. Underthis infantilising humour may be a feeling of repulsion and abjection from the carers. Thisrepulsion is bound up in ageist attitudes which de-sexualise the elderly, which can be not onlyhumiliating for William but potentially dangerous for Susan if the situation is not recognised forthe intrusion that it is. Similarly, William's perceived failure to adhere to a masculine idealseems to incite feelings of self-disgust. Even in my own reflections, I say that I have felt some173kind of repulsion about the situation between William and Susan. Yes, to witness someonepotentially victimising another person will likely waken feelings of disgust or shock in anysituation, but it seemed to have a particular flavour of repulsion that this was happening in acare home where a widower was making advances on a woman with whom he’d never had aconversation and whose name he did not know.—-The last time I sat with William, I had dropped in to say goodbye before leaving. We looked atold photos of Piccadilly Gardens on my phone from “before they messed it all up”. Williamfondly told me about the many times he’d go to meet his friends on a weekend in front of theWoolworth’s department store. I asked him if he ever missed going to Manchester. “Those daysare…that’s done. I am here”, he shrugs. I wince a bit, realising that my question was a bitinsensitive. However, William didn’t seem to mind the question, and he continued telling meabout Woolworth’s fire and how ugly they made Piccadilly Gardens. Before I left, he showed mesome new CDs his son had brought. I noted that one of his paintings, previously proppedagainst the wall by his bed, was hung behind him. He tried to tell me why he owned thatparticular painting, but it was difficult for him to complete his sentences, so we left that storyuntold. I thought about how gently William allowed the past to slip away, how peaceful heseemed about it.The next time I came to visit, William had passed away. In my reflections, I wrote:174Before anyone told me about his death, I saw William’s portrait on the mantle (where theydisplay every resident after they pass away) and my heart sank. I had so many questions Iwanted to ask him. The last time we spoke, we sat together in his room as he intelligently musedabout his experience with memory loss. He told me that he has always relied on his intellect,mind, as an engineer, and just as a personality - he lived in his head. “I am sick of living uphere!” he said with a smile. He said that he was trying to live in his body more (“though that hasits own aches and pains”), and he was listening to jazz as a way to reduce anxiety over hisinability to remember, to connect thoughts, an idea, I think, which his son offered up. I grewquite fond of William, and he was one of the people I was looking forward to meeting again onthis visit. I wish I had come back to see him sooner…I hope he passed gently.(Reflexive journal, 15/6/2022)Our short relationship was a mere moment in William's decades of different experiences: onesmall snapshot from the last summer of his life. A snapshot heavily shaped by our identities,which bellowed loudly in the chasm separating our lives: I am a researcher, a younger woman,an American from a rural, working-class background, and he, the one being researched, awidower, a retired engineer, and Englishman from upper-middle-class Manchester, a man withsome views on women with which I wholeheartedly disagree. Yet, there was a relationship that Ilike to think was authentic in its small way that existed beyond those categories. When gettingto know William, I found something elegant about how he would look directly at the memoryloss, reduced mobility, and brain fog he described increasingly experiencing at the end of his175life. He seemed to treat his ageing process as a curiosity, to find something meaningful in hiscondition. He would say that he was learning not to rely so much on his mind, to instead relaxinto daydreaming, watching television, or hearing jazz music. William seemed to loseconfidence in his capacity to show up, as he had known himself for the majority of his life, toresist moving forward into a new form of masculinity. It’s tempting to wonder if it could be saidthat William’s discomfort came more from being a man than from being old. Of course, it’simpossible to isolate the two; they inform one another inextricably. However the task of clingingto the ideals of being perceived as masculine weighed heavily on William’s interactive life in thecare home. Furthermore, the problem was not only about how William thought he should bebut also how he could practise himself. There is no neutral correct way to practise oneself, toexercise agency; he tried to find a way to do it that was meaningful to him. If not masculinity,there would be another repressed mode of behaviour, so the problem is not masculinity assuch. Still, the way it can intersect with the conditions and context of the care home rendersWilliam’s identity unstable and abject. Through various situations, William oscillated from theconfident man who gave young carers nicknames and enjoyed a cigar with his family on asummer evening to the ‘decrepit old man’ who sat, bored and stifled, in the care homehousehold.176Case III: OrlaI first met Orla outside one evening, locking my bicycle up in the care home's garden. Orla had astern-looking face, peering up at me from her wheelchair. She had bright short white hair, worea dark wool coat, and had a thin blanket covering her legs. Orla’s clothing and combed hairlooked well-kept, and, despite her initial sternness, she had twinkling, inquisitive eyes. A careworker from Orla’s community, Sarah, introduced us politely: “Have you two met? I think Jaymewill come to spend some time with us in a few weeks”. I stood and chatted with the two in asmall shed next to the bicycle racks. We all gazed at the parking lot, watching the asphalt slowlygrow darker with the gentle summer rain.Both Orla and Sarah were smoking cigarettes. Orla sat in her wheelchair with her blanket overher lap while Sarah sat on a short, plastic footstool next to Orla. The stool height positionedSarah’s head to reach Orla’s shoulder. This may be one of the few instances in which Orla, whoalways used a wheelchair, sat higher than those around her. I usually detest the smell ofcigarette smoke, but here it felt comforting—somehow juxtaposing the clinical smell of thecleaning products and latex gloves that filled the care home. Orla joked, “We are the rebelliousstudents”, and both laughed. Orla looked calm as she flicked the ash from her cigarette, Sarahsitting at her side. I noticed that Orla appeared to possess an air of confidence which stood outas unusual for a resident. She was also one of the few residents of the communities that I wouldever see outside past dark.177Before meeting Orla, I saw her from the window of my own apartment, which faced the backgarden, as various care workers would push her out to the little shed, Orla holding their littleplastic smoking stool on her lap. Orla would later become one of just three residents whoprovided informed written consent to participate in the study. I eventually inducted Orla intomy study when I came to her House, which houses quite a few non-verbal residents who requirehigher levels of care. This community became a personal favourite, as the staff are lovely, andthere is a harmonious, inclusive atmosphere. Meals are often friendly, the staff are veryrespectful to all residents, and it was explained to me that though this community houses amajority of residents who are nonverbal and require a high level of daily care, Orla is probablybest suited for this household, as she likes to be left alone. Described to me as “cagey” by Sarah,Orla never attended the social events put on by the care home. Orla promised me an interviewearly on but avoided the subject whenever I would bring it up to her until I eventually gave upon the idea.Orla is an Irish immigrant, a retired nurse, a widow, a mother of two adult sons and agrandmother of one young boy. After immigrating in the 1950s, Orla lived and worked in a smallneighbouring town which, in the 1950s, was a thriving industrial town known for being a majorcentre for textile production. The 1950s was also a time of significant social change in England,with the end of World War II and the introduction of the National Health Service (NHS) and thewelfare state. Many people from Commonwealth countries came to England during this periodto help rebuild the country and fill labour shortages in industries like manufacturing andhealthcare. The 1950s was a time of increased immigration from Ireland to England, as many178Irish people sought work and better living conditions (Maye-Banbury, 2016). The Irishcommunity in the region was particularly strong during this period, which is how Orla came tomove to England with the encouragement of her aunt who had known others who movedthere. During the 1940s and 1950s, there was a shortage of nurses in the UK's National HealthService (NHS), and the government actively recruited nurses from overseas to work in the NHS.This led to an influx of Irish nurses to the UK, including Orla. However, despite being welcomedby the state for their English language and cultural similarities, Irish immigrants generally faceddiscrimination and hostility in the UK during this period. Orla told me she remembers peoplemoving away from her on public transport and women at work treating herself and Irishcolleagues as “less than others”. Irish immigrants were often seen as a threat to British jobs andculture and were subject to discrimination in employment and housing. Despite thesechallenges, many Irish immigrants, including nurses like Orla, were able to build successful livesin the UK, and many stayed past retirement. I asked Orla if she had made friends with otherIrish nurses, but she said she married quickly and did not spend much energy socialising. Shemaintains contact with family in Ireland and is one of the few family members who left to findwork elsewhere.Orla's Irish Catholic identity shapes her experiences and interactions within the care home,which intersects with other aspects of her identity, such as her gender and age. Orla took aliking to me, which gave me a welcome sense of belonging, especially in the early days offieldwork. I shared a bit about my own Irish Catholic grandmother, and Orla may have initially179found a connection with me through our shared heritage. “She’s a good Catholic girl, helpingwith the dishes”, she’d sometimes note as I stood at the sink to help wash cups. When she saidthis, I felt slightly uncomfortable, both at being called ‘girl’ as a woman in my 30s and cringing atmemories of my Catholic father growing weary of my tomboy behaviour and commanding meto behave ‘more ladylike’—memories of gender norms which jumped up at the mention ofbeing a “good catholic girl”. But Orla was producing her ideals around the intersection of genderand religious or cultural background, placing me in her context and bringing me into her senseof the world. Orla’s rapport with me speaks to how residents connect with care workers basedon these personal elements, and these connections affect their experiences in the care home16.Orla’s sense of humour had been apparent since our first meeting:me: We met last month before I came into your household. I was unlocking my bike outback; you were smoking...Orla: I remember! I remembered hearing you are American. And wondering why you’d behere. (laughs)me: You’re the only person I have met out back. Do other residents smoke?Orla: You know what, Jayme? It is just me! I’m the only smoker in the building…16 In fact, as I will mention again, my outsiderness was often used as a source of connection with otherresidents, some of whommoved just 20 km to live in the care home. This raises the question of who is deemed“insider” in a community built up of people frommany diverse backgrounds.180me: Do you smoke often?Orla: No. Just before breakfast. And then after. And before dinner, usually. Then in theafternoon. Well, and before tea. And then a few more times in the evening. Breaks up theday a little. I do it for something to do. It’s something to go and do and get some freshair..I smile: Yes, cigarettes are a great way to get fresh air. (maybe this was rude! But Orlahas a sense of humour and reminds me of my Irish Catholic grandma..so I assume I knowhow to make the appropriate level of a friendly jab.)Orla: (laughs) Well, no. But I can not stop everything. I have to keep doing some of thethings that…(trails off into silence) the things that give me life. Otherwise, it’s just...this(gestures again to the room).me: Well, I like your little smoking shed.Orla: We call it the rabbit hutch (both laugh).[Fieldnotes 21/6/2021]181The carers seem quite fond of Orla and will take turns going with her down to smoke. I havenoticed that they will offer the chance to one another (“You seem tired, do you want to take abreak, go down to the hutch?”) Some of the carers smoke themselves, and thus time theirsmoking breaks with Orla’s. She carries a little stool on her lap when she goes down as the carerpushes her into her chair. The carer will sit on the stool beside her in the rabbit hutch. From thewidow, it looks sweet, two women hunched over in a tiny house. They often discuss their planwith Orla, including her in the decision process (e.g., not talking over her as if she is not there: “Ican go down in 10 minutes, Orla, does that work?”) I imagine that this activity helps Orla feelsome amount of agency, and as she said it gives her something to do and breaks up the days.Additionally, the act of smoking as care, and synching their smoking habit with Orla’s, adds atexture to Orla’s care plan.The little tweaks to Orla’s care set her apart from most other residents in this household. Thestaff say that Orla is “very set in her ways”. They tell me that she is not interested in the carehome's social events and prefers to be in her room on her iPad17, smoking, or sitting in thedining room. They never prompt her to attend anything, as I have seen them do with otherresidents. Orla has a silver tea set which staff always prepare for her, and she does not havemuch of an appetite, usually preferring a simpler meal than whatever has been prepared, oftenjust toast and beans. The care workers never prompt her to eat more or eat differently than sheprefers.17 Orla is one of the only residents I meet who has use of social media. Social media has been shown toimprove mental well-being among older adults experiencing isolation associated with social distancing(Brook & Clark, 2020).182It’s lunchtime on Household 3. Everyone is eating, and aside from some chatter betweenOrla and me, it is quiet. The janitor and a woman in charge of finance came into thehousehold to look at the dishwasher. They addressed a staff member and stood near thedining room tables while residents ate. They went over to the kitchen for a while to speakand then when they left- they nodded to me and said thank you to the room generallywith a wave. Orla waved towards me and said “You see, this is something I have an issuewith. They don't say hello. And I find it quite rude for people to enter the house withoutsaying hello. Even residents who may not speak... should receive a hello. At the veryleast. It’s just bad manners.” I agreed, “Yes and it’s your home”, - “well exactly. Exactly.It’s our home, and they shouldn’t come in, especially during mealtime, and not addressus as people”.[Fieldnotes]Later, I heard Orla passionately relaying the story to a staff member. Orla demonstrates effectivecommunication in expressing her needs within the care setting. She employs humour as acommunicative tool, playfully saying things like, “I thought you might be tempted by the excitingoffer to take me to the toilet” or urging action with a humorous tone, such as, “Stop talking somuch and do your job—now take me to the loo.” This approach not only communicates herrequests but also adds a lighthearted element to potentially sensitive situations, fostering apositive and engaging interaction with the staff.183In addition to her use of humour, Orla interjects in conversations, occasionally correcting staffgrammar or chuckling at their remarks. Interestingly, she does not seem to expect a directresponse or interaction from the speaker. Instead, her interjections appear more like reactionsto a radio show, where the enjoyment comes from participating in the conversation withoutnecessarily seeking engagement or acknowledgement.Orla's communication style not only serves as a means to convey her needs effectively but alsoadds a distinctive and engaging element to her interactions with staff. This sophisticatedapproach to communication reflects her ability to navigate social exchanges with a touch ofhumour and a unique interaction style.Orla's primary source of social interaction seems to be with the care staff, revealing aconnection built on effective communication and shared moments of humour. However, herliving situation presents an interesting contrast. Orla shares the house with another residentnamed Danielle. Initially, the care home's plan was for Orla and Danielle to be companions.They both moved from Ireland to the region at the same time and age, with the hope that theywould click and keep each other company. Unfortunately, it turned out quite differently, as theycan not stand each other and maintain a noticeable distance. I remember one instance when Iexcused myself from Orla's company to greet Danielle, and she humorously quipped, "Youbetter bring a cushion to sit on; that woman can talk…." This remark highlighted the strainedrelationship between Orla and Danielle.184I also faced challenges connecting with Danielle. Despite being a staff favourite due to herpassion for Manchester United, which adds a lively touch to social events, some aspects ofDanielle's behaviour create complications. Her occasional racist comments and expressed trustissues with women, stating, "Men are honest. Women can not be trusted," contribute to theintricate social dynamics within our shared living space. This adds a layer of complexity to thevaried and, at times, conflicting interpersonal relationships in our care home setting.During a visit several months later, I was delighted to witness a positive change in Orla's routine.She had started going out with her sons since the care home had "opened up." Excitedly, sheshared details about a charity walk she participated in a nearby town, emphasising that hersons had pushed her wheelchair throughout the entire event. This experience showcased Orla'sproactive approach to meeting her physical care needs at the care home while actively seekingconnection and socialisation through her family and friends outside its confines.Orla's ability to maintain connections and engage in activities beyond the care homedemonstrates the importance of personal agency in seeking social interaction and fulfilment,even in the context of a care facility. Her experience highlights the potential for residents tostrike a balance between receiving necessary care within the care home and maintainingmeaningful connections with their broader social circles if their circumstances allow. In the caseof George and Julia, and of William, this was not possible, either due to having outlivedimportant connections, or for being relocated to access residential care, and thus alienatedfrom the surrounding community.185Section Two: Social Life in the Care HomeDuring my time at the care home, even amidst heightened health concerns and limited socialinteractions, the staff made sure to organise one or two care home-wide social events each day.These gatherings usually took the form of a mid-morning coffee hour or an afternoon tea time.Occasionally, there were exercise classes or games like bingo. Now and then, we would have aspecial event, such as an outdoor concert, a multi-day summer Olympic games event, or a groupgathering to watch an important televised event, like the 2020 Olympics. These social eventswere typically held in the venue or the cafe and involved one to four members of a household.It took me a little while to notice that the small group of regular attendees tended to be theonly residents interested in participating. On average, daily events attracted anywhere from twoto eight residents.Over my stay, the regulations changed, and events were opened up to include multiple Housesat a time. This would allow members from different Houses to interact with one another.However, unless heavily encouraged and facilitated by staff, resident interactions betweenHouses were limited. Here is an example of such an event from my field notes:During the coffee hour, a quiet atmosphere filled the room. Rachel sat with her hands folded inher lap, gazing out the window at the rain. The care worker, attempting to initiate conversation,remarked, "Look, Rachel, she has a lovely sweater on. Julia knits, don't you, Julia?" Juliaresponded modestly, muttering something about her knitting skills being a thing of the past, "alifetime ago." Rachel remained silent but turned to observe Julia and her sweater.This afternoon, House 1 was invited to a tea event. I accompanied Kelsey downstairs, joininganother household in the bistro. Max, Kelsey, Julia, George, and Susan participated in theactivity. The bistro staff beautifully arranged the table with delicate saucers, tea plates, andtiered cake trays. Each resident was given a choice between tea and a latte, accompanied by a186cupcake and a slice of lemon cake. Unanimously, everyone opted for the lattes. I sat besideKelsey, who appeared content, while Susan quietly savoured her treats, wearing a smile.As we settled into our seats, another group from House 4 joined us, mingling with our House.Max and Julia engaged in conversation with a lively woman. Max, visibly elated from his recentouting, smiled throughout the event. Julia, on the other hand, insisted on dividing her cupcakeinto thirteen slices so that she could share with everyone, despite our explanations that eachperson had their cake. George, understanding her tendency to stress over sharing, discreetlymoved her cake aside. Julia expressed her happiness and commented on the delightful weather.Approximately twenty-five minutes into the event, Susan dozed off, prompting me to call for carestaff to assist her back to the household. Hearing this, Max also expressed his desire to returnhome. A care worker asked if I could stay with Julia and George and accompany them when theywere ready to leave. Kelsey, too, decided it was time to go home. I remained with Julia andGeorge, periodically waking George as he unintentionally fell asleep with coffee in his mouth.Julia reflected on the social dynamics, remarking, "They seem a bit awkward, unused tosocialising, don't they?" She said that it is important to see “how honest the children are”.George mouths “confused”, but I think I know what she means.When we got up to leave, Julia holding my hand and using her cane to walk, and Georgeshuffling ahead of us with his Zimmer frame, Julia gasps and hits George’s shoulder: “You didn’tpay!” He assured her it had been sorted.In this example, we see how a simple tea event can have different impacts on residents. Itshowcases the challenges of providing person-centred care, where understanding eachresident's unique needs and preferences is crucial for their well-being and engagement. Theconcept of front stage and backstage, as explored by Erving Goffman, is evident. During thecoffee hour and tea event, residents engage in social interactions on the front stage, facilitatedby the care worker. Julia's knitting skills and Rachel's previous experience with knitting arebrought up as topics of conversation, representing their roles and identities in this front stageperformance. However, in the backstage, Rachel's lack of response suggests a more withdrawnstate of mind. The need for care staff support becomes apparent when Susan falls asleep,requiring their backstage intervention. In several instances, I have observed care staff socially“propping” residents up to meet the social expectations set by an event (e.g., trying to start a187conversation between Julia and Sarah). Meanwhile, Julia shares her observations and musingsabout the social dynamics and the honesty of children, which is the perspective she shares withtrusted individuals outside of the main social event.Furthermore, Connell's concepts of power and gender also help to make sense of the dynamicsof this event. The care worker holds a position of power as they initiate and facilitateconversations, exerting influence over the social dynamics on the front stage. Care staff'sinvolvement in manageing unexpected situations, like Susan falling asleep, highlights theirpower in providing necessary care and support18. The conversation revolving around knittingand Julia's former skills exemplify gendered stereotypes associated with traditional feminineactivities. The participation of Susan, Rachel, and Julia in the tea event reflects gendered rolesand expectations within the care home context. Additionally, Connell's framework considershow gender norms influence the roles individuals occupy within institutions. Therefore, the careworker's role in initiating and maintaining social interactions may be influenced by genderedexpectations associated with caregiving and nurturing roles, as suggested in the passage.An Evening at ‘Home’My intention with this section is to show the way social life typically played out in the Housecommon area during the evening, after dinner and before bedtime, when residents would beencouraged to sit together in the sitting room, usually watching some television. I witnessedthat the evening social hour would serve a few purposes: the care home identified that18 This reflects Connell's notion of power as not only hierarchical but also relational, with individualsexerting influence over social dynamics.188socialisation is important for residents’ holistic well-being, care workers would be busy doingone-on-one evening care tasks (more clinically focused care, or changing into pyjamas,medications, et cetera) with individual residents in their rooms and it was more convenient, andmore secure, to encourage residents to wait together, and culturally, sitting and watching sometelevision in a sitting room gave a sense of normality, and perhaps continuity. What I witnessed,however, was minimal interaction between residents. A few, namely George and Julia, woulduse the sitting room to socialise, but most would avoid it altogether, or tolerate the occasionbased on care worker encouragement or invitation. The following details one of my earlyevenings with the first House with which I spent time, “House 1”.When I entered House 1 that evening, the residents were finishing their dinner, or as they calledit, “tea”. Susan and Lisa, two residents who had a nice rapport, sat at a table in the dining room,engaged in conversation and appeared content. Kate and Lucy, two of the care workers on shift,were at the adjacent table, occupied with charts while having their dinner. Due to thepandemic, care workers were no longer allowed to dine together with the residents. Kate's dogwas present, sleeping at her feet. In the living room, George, Julia, William, and Sarah werepresent. George seemed a bit frustrated because he could not hear William and Julia, who weresitting on the sofa together. When I offered to help George move closer, he declined, statingthat he was comfortable where he was: “Just go with it”. Sarah sat in an armchair, frequentlyglancing towards Larry in the kitchen. I inquired if she needed anything, to which she replied,"No dear, I'm just being nosey." George and Sarah had finished their dinners, but Julia was stilleating her sandwich and crisps. William's plate remained untouched. Julia expressed concern to189Lucy about William's lack of eating, pointing at him and exclaiming, "He hasn't touched hismeal!" Lucy reassured her that William would eat when he was ready.Larry, a young male carer from London who was encouraged to take a job in care work to gainacceptance to a Master's program in Sociology, was also worried about William's lack of foodintake. He checked the residents' daily intake on the electric medical system–software on iPadsand phones that the care workers use to log medications, food, liquid intake as well as otherclinical elements of care provision–and decided to offer rice pudding as a dessert to increasetheir calorie intake. Everyone accepted the offer, except for William who still did not touch hisfood. Later, Larry offered William hot chocolate and cake. By the end of the evening, Williammanaged to eat half of his cake. Julia was disturbed by this, stating, "He's not eaten anything! Ijust feel really sorry for him."While everyone was having their pudding, I took the opportunity to greet Max, who wasreclining in his lounge chair in his room, the door open. He was watching Star Trek and having aglass of wine. I had seen him earlier during a visit downstairs and asked how it went. He wasdelighted and pointed to a photo of his granddaughter, sharing that she had visited with her dadthat day. He proudly mentioned that she was 12 years old and doing well in school. Max’s roomwas full of personal items–family photos adorning the shelves and a heart hanging from themirror reading, "Love you to the moon and back."Max's room felt more like a home compared to other rooms, as he utilised the space forrehabilitation to eventually leave the care home. It was intriguing to observe the varying190atmospheres in different rooms, ranging from homely to clinical. For example, William's roomhad minimal furnishings with only one painting. Additionally, some rooms felt like commonareas where residents spent most of their time, while others felt more private. I noted that Iwould not enter Susan's room to speak with her since she was usually in the common areathroughout the day. I asked Max if he wanted to join us in the sitting room, and he shook hishead vigorously as if to say: absolutely not. “I’m happy here”, he gestured to his room.Tonight I was told that a new resident just arrived at the household - an English man who hadbeen living in Spain for several years before returning to England due to the need for additionalsupport. He was flown in and had to undergo a 10-day quarantine in his room. Upon his arrival,he brought along unmarked medications or medications labelled only in Spanish, without anydosage or instructions. Kate took on the task of deciphering the medication details and beganmaking calls to gather support. She mentioned that she needed to consult with the nurse toseek assistance and also tried to reach the on-call GP. As a result, only two staff members wereavailable for the evening medication administration and helping residents change and preparefor bed. In the meantime, I offered to stay in the living room and keep the residents companywhile the staff carried out their caregiving duties.It was a sunny evening, and the sunset poured in through the windows in the dining room. Itwas gorgeous and bright in the space, and I noted this to the residents. There’s a balcony but Ihave not yet seen it being used. I wondered how long residents have gone without beingoutside. I asked Lucy if anyone goes outside and she told me that Sarah has in the past, but notrecently. I asked George if he ever goes outside and he said no, the air is too chilly and he191prefers to be in. In the living room, Julia attempted to communicate with George, but hestruggled to hear her. He asked me to act as a translator, relaying a few of Julia's messages tohim. Julia expressed her concern about when they would return home, fearing they wereoverstaying and being impolite. George assured her that everything was fine, and Julia appearedsatisfied with his response, reclining back on the sofa.Sarah excused herself to use the restroom, which seemed to worry Julia. Throughout theevening, Julia displayed a certain level of anxiety, persistently expressing her worries aboutWilliam and his untouched dinner. She held the belief that Sarah and William were married andrepeatedly inquired about the whereabouts of their spouses. The staff members respondedwith statements like "they aren't here" or "they've passed away," causing William to visiblyflinch at times. The staff members faced challenges in determining when to correct residentsand when to allow for "untrue" statements. During training, they were instructed not to correctresidents, but this could become complicated in social scenarios where multiple individuals heldvarying beliefs. Inevitably, someone's truth would be negated.At one point, Lisa approached Sarah, greeting her and taking a seat next to her on a stool. Theyheld hands and shared giggles. Lisa mentioned that she was waiting for her mother to come andpick her up, prompting Sarah to inquire about her whereabouts. Lisa proceeded to describe, ingreat detail, the directions to her childhood home. Shortly afterwards, Julia asked Sarah if sheneeded any help getting home, to which Sarah sternly replied, "No, I live here, and I have livedhere for 3 years."192It was fascinating to observe how residents interacted with one another and respondeddifferently depending on the circumstances. Sarah, for instance, seemed inclined to go alongwith Lisa's ideas while simultaneously correcting or avoiding Julia. This disparity in rapportappeared to be more about the feelings involved rather than the actual words exchanged. Lisatended to be easygoing and inclusive, especially when discussing her mother or reminiscingabout her childhood home. In contrast, Julia tended to exert control over others. This behaviouroccasionally put off other residents as it generated a sense of anxiety and intensity.Susan had retired to bed, so everyone remaining in the common area had gathered in the livingroom. Julia and William occupied the sofas, both appearing quite sleepy. Sarah settled into achair, also displaying signs of drowsiness. However, Lisa seemed unusually restless, wearing afrown and expressing concern that her mother might be worried. I sensed that she could sensethe difference in the atmosphere tonight and was seeking the presence of Kate, who was stillbusy sorting out the correct medication instructions for the new resident. Meanwhile, Larry andLucy went into individual rooms, assisting the residents with their bedtime preparations.Eventually, Larry asked George to accompany him to George’s room for help changing into hispyjamas. Upon returning, George winced, sharing his struggles with nerve pain in his lowerback. He lamented the lack of access to in-person medical attention, as telehealthappointments were the only option available. He expressed dissatisfaction with theeffectiveness of the cream he was using, stating, "It makes me sad, enduring so much pain."George mentioned having an upcoming appointment for his eyes, where he would receive aninjection. He described it as an awful experience, adding with a touch of sadness, "I don't193recommend growing old; it's about as fun as a needle in your eye." He referred to himself as a"soft man," although Julia overheard this and laughed, contradicting his self-perception. Juliaappeared anxious, so I approached her and initiated a conversation about knitting. I asked if shecould teach me, and she laughed, agreeing but explaining that it was too late for that night. Thisinteraction seemed to bring joy to George, who informed the staff multiple times that his wifewould be "teaching our American friend how to knit!" He found solace in witnessing Julia in herrole as a teacher once again.Lucy, the lead care worker, came over and took a seat beside me, emitting a sigh of weariness.She disclosed her plans to transfer to the bistro soon, having served as a care staff member inthe household for an impressive nine years. Lucy's mother had multiple sclerosis, and she hadbeen her full-time care worker, receiving payment since she was sixteen. After her mother'spassing, she began working at this care home when it was owned by another company. Being acare worker had been her lifelong occupation. She expressed her fatigue, particularly amplifiedin the past year, and her desire for a change. She hoped that transitioning to the bistro wouldoffer a shift in pace and intensity while allowing her to continue utilising her interpersonal skillsand maintaining daily interactions with the residents. Lucy emphasised the busyness of theirenvironment and expressed gratitude for my presence, as the staff often lacked the time forextended conversations, especially on evenings like this one, with unexpected occurrences.Lucy checked something on her phone, prompting Julia to inquire, "Do you think you couldsurvive without that thing? Very queer, those! I don't think you could go without it anymore."Lucy ignored Julia.194I informed George of the score, unfortunately revealing that his team had lost. He shrugged anduttered, "Win some, lose some," accepting the outcome. He then expressed his gratitude for mypresence, remarking, "You have made my day, just being here, hanging out with us elderlypeople."As George dozed off in his chair, Julia playfully woke him, exclaiming, "George, you are asleep!How rude! You can not sleep here." Unaware of her words, he continued to slumber.The night staff arrived, signalling the end of my shift. I bid everyone good night. Julia becameteary-eyed and requested that I accompany her upstairs. She tightly held my hand, tearfullyexpressing her love before shedding a few tears. This emotional display provided insight into heranxiety and heightened emotional state, particularly considering her recent loss of her sister.Kate pulled me aside and thanked me for staying, saying she did not know what they wouldhave done without me. There is such a heavy load on the care staff!Leaving, I pondered how to contribute to the care home community. Having spent five days inthe household, I started noticing intriguing patterns. The experience was strange—both heavyand light. I continued to wonder about William not eating, contemplating whether it stemmedfrom insecurity about his motor skills or if he had forgotten how to eat. The lack of direct accessto care plans made me feel awkward, observing and talking to residents but unable to providemore direct support. This brought attention to the distinction between 'expert' clinical care andintuitive, spontaneous care.Residents seemed to crave conversation, but carers were often too busy. Reflecting on thestaff's hard work, I realised the lack of opportunities to pause and process recent events. Thehouse had lost seven residents in 2021, and some had lost family members, yet daily life didn'tnecessarily reflect this. I wondered about the countless moments of dignity and humanityresidents expressed daily. Although residents were beginning to visit friends and family once aweek, I questioned if this could compensate for what they had been through. The departure of195some of the best and most experienced staff due to burnout added to the complex dynamicswithin the care home. From my reflective journal, that night, I write:I also think about how it will be difficult to leave this household. Julia and George are goingthrough a lot right now and they appear to need some extra support. It feels a bit unfair tosupport them for a few weeks and then leave, creating perhaps a pattern or dependency just tocut it. However I hope that in this few-week period, I am helping a bit with Julia’s bereavement.George has a lot to manage with his wife's dementia and his physical well-being. I also thinkabout the residents with whom I have spent less time (Susan, Lisa). Maybe I should even out thetime I spend interacting with residents, but it’s also a natural process to see who wants to talk tome and who in the household is interacting.When reworking my field notes to write this section I find it very interesting how familiaritymakes certain details ‘invisible’. After months of spending time with this House, I ceased tonotice the specific dynamics of individuals, after learning more about William’s depression Istopped finding it strange when he refused meals. I stopped asking about the balcony. In fact,by the end of my time in House 1, I stopped noticing the balcony. It became a sort of non-space.This phenomenon underscores the transformative power of habituation and the gradualnormalisation of once-noteworthy aspects within a familiar environment. As aparticipant-observer, the evolution of my perception towards these elements within House 1serves as a poignant reminder of how extended exposure can render certain details 'invisible,' aprocess that warrants thoughtful consideration in the context of ethnographic research.196Luis, the resident who came from Spain that night, and who later enrolled in the study, was thefirst resident to engage with the balcony, which excited and enlivened care workers, who hadalso begun to ignore the potential for the balcony to add quality of life to the House. Luisinitially demonstrated a keen interest in gardening, earning admiration from the staff. Theyexpressed delight in his dedication, with one care worker mentioning her fondness for him andeven offering to bring compost from her garden. During my interactions with Luis, he shared hispassion for rejuvenating the neglected balcony garden, emphasising his long-standing affinityfor spending time outdoors. The staff appreciated the revitalising impact he brought to thehousehold. However, over subsequent visits, it became evident that Luis' enthusiasm forgardening waned, culminating in an observation where he spent an entire afternoon in his roomwith the door closed.At a social dinner event, encouraged by care staff, Luis appeared fatigued and less engaged thanbefore. When asked about the garden, he expressed a lack of progress, mentioning that therewasn't much happening with the plants. Contrary to his previous vibrant demeanour, Luisrevealed a shift in preference, opting to watch films alone in his room instead of tending to thegarden. When questioned about his apparent loss of interest, he admitted, "They said they'dbring soil, but I didn't have enough, and it's...it's easier this way."While contextual factors and the passage of time could influence Luis' change in mood, hisacknowledgement that gardening had become less natural and convenient suggested a moredeliberate shift in his activities.197Food & Eating in the Care HomeFood and meals emerged as a central theme in this study, highlighting their multifaceted role inresidents' lives at the care home. Beyond serving as a basic source of nutrition, food carriessignificance in providing cultural identity and preserving heritage. However, within the carehome environment, meals often took on a medicalised and impersonal nature. Despite this,they presented an opportunity for residents to share their culture and establish socialconnections. Food acted as a dual-purpose entity, serving both as a unifying element and apotential site for control, order, rebellion, empowerment, or disempowerment. The process ofpreparing and cleaning up around meals became integral to care workers' daily routines,offering structure to the residents' lives (Lowndes et al., 2018)The tension between institutional and interpersonal care was palpable in the serving andconsumption of food. This tension is reflected in Gilleard and Higgs's (2015) observation thatmuch of the literature on ageing emphasises the productive potential of older adults ratherthan acknowledging their lived experiences as desiring, performing, and resisting bodies. Thisquote prompts a consideration of how the older adults in the study negotiate their bodilyageing within the specific social context of the care home.The social and cultural dimensions of bodily ageing become apparent in the observationsrelated to food, meals, and eating. The act of food consumption, or resistance to it, places thebody at the centre, often rendered passive. Moving beyond a corporeal understanding of198ageing, Gilleard and Higgs (2015) propose viewing the ageing body as a social actant—an entitywith the agency that shapes and is shaped by its social surroundings. This perspectivechallenges the notion of the ageing body as a passive object, highlighting its active role in socialinteractions and cultural norms. Alternatively, considering ageing as an embodimentunderscores the ageing body as a co-constructor of its own identity. Here, the ageing body isnot merely a physical entity but a dynamic embodiment shaped by multiple social, cultural, andhistorical forces. This perspective enriches our understanding of how the ageing bodycontributes to and is shaped by broader cultural and historical narratives surrounding ageingand old adults. Expanding further, acknowledging the body as a social actant and a vehicle ofsocial agency emphasises its active role in shaping broader social norms and attitudes(Haraway). This perspective underscores the reciprocal relationship between the ageing bodyand the social forces that influence it.A meal with SusanKate asks me if I can sit with Susan, who is having her dinner. I sit down and greet Susan, seatedat her usual spot, alone at a round dining room table near the kitchen counter. Unlike the others,adorned with a royal purple cloth, this table is bald shiny laminate, since Susan often spills foodand staff has grown weary of changing it after every meal. Susan is agitated, looking aroundwith wide eyes, and she grabs my arm hard, her nails pressing into my skin. Susan’s thin,dyed-red hair has been recently curled, with lots of hairspray holding it in place. She is wearing,as usual, a nice bright pink top with pearls, deep pink lipstick, and rouge. She smiles at me, and Icarefully remove her hand from my arm. Her gold and beaded bracelets jingle as I carefully set199her hand down. Susan has beautiful, bright eyes, and she sometimes looks like she rememberswho I am, a sort of wide, surprised expression, fading to relief and then wide again.Whenever I sit with Susan, we hold so much eye contact that it is nearly uncomfortable, andthere is a lot of touching and grabbing, as if she is searching for who I am. For a moment, nowand then, she gasps, and her smile deepens, and I wonder who she might remember in the linesof my face. I feel inconvenienced by the masks in these situations, as Susan often looks deepinto my eyes, her eyebrows furrowed with anxiety. I want to smile, to potentially ease her mindfor a moment. Susan often starts talking, “You know - !” or “Well, I’ll say..” and trails off. Theseshort conversational starts happen repeatedly, and she often seems so impassioned bywhatever she is going to say that I hold my breath and wait, captured each time by her energyand intensity. Impatience is an element of this dynamic, the experience of summoning patiencewith Susan’s tempo was, in my experience, a care act (Roitenberg, 2021).Today is my task to help Susan finish her meal, which carers have previously demonstrated byguiding her hands to her utensil, verbally reminding her about the food, and simply sitting there,keeping her company so she does not have to eat alone. I help cut the food into smaller piecesand talk a bit about the meal—it is a mash with ham and gravy and some boiled broccoli. Iwonder if this resembles a meal Susan would have prepared for herself. It does not look veryappetising to me, the ham is so pink. But I do not say that. Instead, I say, “Would you like somemash with a bit of ham? does not that sound nice?” The words feel a bit foreign coming out ofmy mouth. I had previously felt sceptical of care workers saying similar things about similar200meals. But the silence feels uncomfortable, and I feel the urge to vocalise what we are doing sothat I am not silently shovelling food into Susan’s mouth or guiding her hand to do the same. Ihope that I might help her remember the food, and understand what we are doing heretogether, and words are, at least for myself, a guiding lantern. It takes Susan a long time to eat,sometimes she uses the spoon, sometimes her fingers, and she allows me to lift bites to hermouth.We take many breaks. Susan drinks some juice, which is always offered during meals to increasecaloric intake. We smile at one another, she gasps and has the revelatory expression ofrecognising an old friend for a moment. We repeat. We sat there together for about an hour,making eye contact, smiling, some bits of conversation, and lots of trailing off. I genuinely likeSusan, and I don’t feel particularly bothered by the task of keeping her company, but even so, Ifeel myself summoning patience for the task. It is slow, and loops around repetitive words,actions, and feelings—it feels like we are trapped in a time loop. I notice that I feel a sense ofaccomplishment when Susan manages to eat more, not only for her well-being (of course this),but also because I know we are closer to finishing the meal and that this means we can moveon…to what exactly? I am careful not to rush her due to my impatience with the tempo.Eventually, Susan’s mostly cleared plate (she wasn’t interested in the broccoli) is whisked awayby a watchful staff member when she has no interest in the remaining bites. I hear, “She ate thedinner and a cup of juice as well”, for the logging. There are bits of food around Susan’s place,and I wipe them up with her napkin. I ask if she enjoyed her dinner, and Susan smiles. When the201ice cream comes, plunked down softly by a silent, smiling carer, Susan cleans her bowl in a fewminutes, entirely focused on her spoon and bowl.Kate comes over and greets us, and thanks me for sitting with Susan, noting that the ice creamwent by much more quickly than the dinner and adding that at this age, any calories are goodcalories, and they’re just glad to get her to eat enough food in the day. Kate lightly pats Susan'sshoulder as she explains this, and Susan smiles a bit, saying, “Oh, hello!” Susan has some icecream on her hands, and I wipe them with a napkin. Kate gently wipes Susan’s mouth and handswith a warm, damp cloth and asks if she’d like to go to watch some tele while unlocking herchair and moving her toward the living room area.I think about this phrase: any calories are good calories, and how it was used last week by Evanwhen he was prompting residents to eat some pudding or some hot cocoa with whipped cream.Sarah was surprised at the offer, asking, “Not for me, why?” and Evan pressed on, saying, “Oh itmight be nice a little hot chocolate with some cream on top.” Evan often prompted residents toeat something sweet, with whipped cream added on top, as he checked the caloric intake foreach resident in the evenings. The notion that any calories are good seems to say that olderbodies, and sick bodies, are somehow other bodies which thrive on different subsistence. Sugaris notably not a healthy form of calories, but it is featured in many of the meals I witnessed atthe care home. William is diabetic and takes his tea with two alternative sweeteners, but he,too, is offered cakes at night. I am no dietician, but I once asked Evan how William can have202coconut cake with cream, yet he is not allowed sugar in his tea. “Oh, he can have some! And hehasn’t eaten much at all today. He wasn’t pleased with the options for dinner”.As was illustrated in the previous chapter, William is vocal about his food preferences, which cansometimes irritate staff, and he notices himself as an inconvenience (“I’m a burden”, he onceexplicitly said after refusing a meal of curry). He often opts for a ham and cheese sandwich,often the final resort when residents aren’t interested in the meals. Also, for those not in syncwith meal times—like Lisa when she was on medication that made her sleep through mostmeals. Watching Lisa, set up with a late-night dinner box of a sandwich, crisps, and some freshfruit, tucked in with a tray on the sofa, felt different from William in a similar position, sittingrigidly, eyeing his sandwich suspiciously after being through an emotional debate over the hotdinner options for that evening. Unlike Lisa, who accepted her dinner gratefully, William’ssandwich acknowledges a battle lost or won, but not in the way he’d hoped. A subtle deflationof his attempt to command his environment or just to ask for something that felt like home.Flexibility is something that the household scale allows for, at least marginally: food is storedon-site, and fixing an impromptu meal is only a matter of popping into the refrigerator andgetting a bit creative with the ingredients on hand. In these moments, where flexibility andadaptation are required from both the resident and the care staff, care can take a more organicform. The institutional form is softened to something more organic, more human-shaped. “Weall work with what we’ve got, don’t we?” Kate once asked Julia as she fixed her late-night snack.That we felt genuine, something stronger and more improvised about that collective sense of203survival together. Otherwise, when seen as a request to do extra work, care acts may elicit acolder response, as I saw with Evan and William when William sent his dinner back for asandwich.Preference and Norms: “You just sit there and eat your soup”Jean is a relatively new resident, having moved into the care home just last month because shehas family nearby. She is a tall woman, and she stands up straight and walks quickly. She was aschoolteacher and possessed a teacher-like authority. She is southern—her accent stands out,and the staff sometimes repeats how she pronounces some words out of amusement. One staffmember, Kevin, explained to me that she is ‘posh’, with a grimace. Jean is an intelligent, curiousperson and she often asks many questions. She seems to be quite confident, and wants tounderstand how to live among the other residents: she asks where people are when they’reaway on appointments, she tries to help herself with the things she needs, and she asks staffquestions about the schedule. Jean carries a purse (indicating that she may not yet feel athome). She often misplaces her purse, and many of my early interactions with Jean have takenplace while helping her find it. She does not remain in her room, and will sometimes lay on thesofa and take a nap, kicking off her shoes and slinging her feet up on the arm of the sofa.Something is charming about these naps, they cause the sitting room to appear like a room in areal home, especially in the week I first meet Jean, when there is a summer thunder and rainstorm, and residents are huddled around the TV to watch the 2020 Olympics.204Today Hannah made turnip soup for lunch. Edith wanted sugar in her soup. She was quite clearthat it was sugar she wanted, but the staff collectively did not think this was normal, and theydidn’t accept her preference:Hannah guided Edith over to a setting for lunch: “Here you are, love, I made you some nicesoup”. A steaming bowl was waiting for Edith. It was a rainy afternoon, and soup seemed a veryappropriate, cosy lunch.Edith sat down and looked at her soup: “Sugar. I need a bit”.Keith: No, that’s soup! You want salt.Edith: No I don’t. Oh, not a lot! I just want a little sugar here.Keith: (brings over salt) here, you want this.Edith: Is this sugar?Keith and Leah: yes! That’s sugar.Edith pours some salt into her palm and licks her finger to taste - “no, that is salt! I know whatsalt is. I want sugar. Just a bit.”Keith brings the sugar over, shows her, and says “THIS?”Edith nods and takes the canister. She is not given a spoon, so she looks around, grabbing the lidof the sugar container to try to scoop a bit out.Keith: No no no silly, that’s not right. You don’t put sugar in soup.Keith takes away the sugar. Edith finishes her soup silently.Moments later, Edith wants a napkin. She gets up to grab the paper towel roll from the kitchencounter. Leah comes over and says in a scolding, but kind tone “Edith...just ask for what youwant and I’ll bring it to you”. Leah hands Edith the napkins. Edith says thank you and takes themback, but notices there are more than she wants/needs, so she comes back to hand the extrasback. Leah says “Edith, just leave them at the table, we’ll take care of it. You just sit there andeat your soup”.205Preference and taste are negotiated situationally. It is seen as something quite normal, usefuleven, in establishing rapport and engaging care which is customised to each resident. Knowingwho likes vinegar with their chips, for example, is seen as a charming, even enjoyable, aspect ofliving in a community, a step in building familiarity. When preference contradicts a sense ofwhat is normal (sugar in soup), this is met with scepticism or even discomfort. The emotionalreaction to expectations being unmet, surprise, or contradiction at the site of a meal evokes thecultural value held in the meal. The ordered meal relates to all the other ordered systems whichare associated with it. Kristeva's theory of abjection may be useful to further understand theinteractions between Jean and the staff regarding her desire for sugar in her soup. Kristeva'stheory posits that abjection refers to the separation of the self from things that are consideredtaboo or unacceptable by society. In this case, sugar in soup may be considered abject by thestaff, as it goes against their cultural norms and expectations. However, Jean's persistence inasking for sugar highlights the potential for subversion of societal norms and the power ofindividual agency. Jean's desire for sugar in her soup challenges the staff's cultural expectationsand forces them to confront the abject, while the staff's refusal to give Jean sugar in her soupcan be seen as an attempt to enforce societal norms and avoid the abject. The staff's insistencethat Edith wants salt, despite her clear request for sugar, can be interpreted as an attempt tonormalise her desire and make it more acceptable within their cultural framework. The staff'sreaction to Jean's request for sugar also demonstrates how abjection can be enforced throughsocial interactions. Keith's dismissive and condescending tone towards Jean, as well as hisattempt to take the sugar away from her, highlights the power dynamics at play in this situation.Additionally, the staff's response to Jean's request for a napkin can be seen as an attempt to206maintain social order and avoid the abject. Leah's scolding tone towards Jean suggests a desireto control her behaviour and prevent her from engaging in actions that may be seen asunacceptable or abject. Overall, the interactions between Jean and the staff demonstrate someof the complex ways in which societal norms and expectations are enforced and challenged.Kristeva's theory of abjection provides a useful lens for analysing the power dynamics at play inthis situation and how individual agency can subvert cultural expectations.Clinical and Cultural Adjustments to MealsLeah is a young carer in her late 20s who has been working for this care home for 10 years. Sheprefers working in the kitchen and says she is skilled at preparing food for residents on a softfood diet.“The trick is, you have to make it look like something you might eat”, she explains, focusing on acheese sandwich made of two crustless rectangles of white bread sandwiching a small mountainof white grated cheddar. She is misting the sandwich with a spray bottle of water until it issaturated. “Want to try?”, she grins at me. I shake my head. Leah explains that she takes pride inhelping residents eat well. She tells me she is periodically asked to make soft diet sample disheswhen new staff are being trained. “We are asked to try them, you know…we should all eatwhat we feed everyone”. Leah grimaces and laughs: “You should see the girls’ faces! Uuuuhh!”I have seen Leah pay careful attention when providing meals many times. Ruby, a temporaryresident, told me that she felt very cared for when Leah explained how she plans to adapt each207meal to her soft food diet before serving her and again when she delivers the meal to Ruby inher room. (“She takes care, says, today we blended the vegetables into a stew and layered ithere with a mash…it does not [come as] such [a] mystery”) Ruby usually lives in her housealone and has a few carers come in to deliver food and heat her meals when she is there. I metRuby once in the summer and again while she was on another temporary fall stay. In thesummer, she reported feeling very happy with the care at home, but later, in the summer, shecomplained that carers only quickly discussed the food, and she felt again that she may as wellhave been at home: “They come and go, in and out, not much visiting, aside from checking onmy food. Well, they’re busy, I know that..”In this scenario, Leah's role as a carer can be seen as maintaining order and control within thecare home. Her focus on providing meals that are visually appealing and nutritious for residentson a soft food diet demonstrates a commitment to upholding the norms and expectations ofthe care home community. However, Ruby's complaint that carers only quickly discuss the foodand do not engage in meaningful visits with her suggests that there may be a sense ofdisconnection or separation between residents and carers. From a Kristevan perspective, thissense of disconnection or separation can be seen as a form of abjection, as Ruby may feel castout or excluded from the larger social order of the care home. Similarly, Leah's role as a carermay be seen as one of enforcing the boundaries of the care home community by maintainingthe cleanliness, hygiene, and dietary standards that are expected of her. This can be seen as aform of abjection, as it involves identifying and expelling certain elements seen as impure ordisruptive to the social order.208Aside from soft and liquid diets which are medically necessitated, there are daily meal ritualsadjusted for each resident. The flexibility depends on if carers have the time to cater to uniquerequests if one’s habit is contextualised in the care home if it helps carers ensure everyone iseating enough. Though many residents eat the daily menu without much issue, there are ofcourse customisations. A few examples of standing customisations or rituals to residents’mealtimes:Orla uses her own silver tea set, which staff always prepare for her just so she is set for one ather table. She has little appetite, usually preferring a simpler meal than whatever has beenprepared (e.g., toast and beans). She rarely eats the hot menu, except fish and chips, on Fridays.The care staff never prompted Orla to eat more or eat differently than she prefers. As a sort ofsecond breakfast (after an early morning bowl of cereal) George often eats four poached eggs ina bowl. He would often quietly ask me if it was greedy to eat four eggs. I once asked him why hefeels greedy, and he replied simply, and with a shrug: “It’s a lot of eggs. But they say yes!”.Meanwhile, Max always takes his meals alone at his recliner chair in his room, both lunch anddinner, accompanied by a glass of red wine, which he stores in his room. He rarely finishes hisplate. He tells me that he does not like the food very much.Luis stores bone broth packets in his room, fixing himself a broth in a little styrofoam cup withhot water from his bathroom sink. His daughter sends him these packets. He says it’s for hishealth. While William often prefers to eat in solitude. He takes a long time to eat, sometimesforgetting how. He benefits from occasional help from care staff but says he prefers to be alone209so that he can focus. He sits in his chair, using his Zimmer frame as a table. Eating appears to bea laborious task for William, also because the Zimmer frame table is quite low and does notallow for clumsiness—the slightest mistake may result in a glass of juice upturned on the carpet.He claims to be fussy and often opts for a sandwich instead of the hot menu. He tells me thathis wife always cooked for him and that she was not a particularly skilled cook.Then there is Theresa, who always sits near Matthew during meals. Matthew often thinks he isat a restaurant with his wife (who lives at home) and asks, “Did we get the check, dear?”.Theresa will steal a peck on the cheek meant for Matthew’s wife. This imposter game plays outmost days. Meanwhile, Julia refuses to eat on “bad days” when her mood is low. She reportsfeeling “too upset” and finding it difficult to swallow. She is often bothered by others not eatingsimultaneously and always bothered when I am not eating. She finds her husband’s soft fooddiet “queer”, often picking at his food with her fork. Julia says she is not a fussy eater and likes“all English food”. She usually sits with George, who always eats. Across all of these examples,we can see that meals are a site for individual preferences to be catered to, where care workcan be personalised and adapted.“Well, at least we’ve had a nice cup of tea!”During group events, food is often at the centre of the conversation. It is a convenient topic, itengages with tactile and sensory experiences as well, and it can be an easy topic for those who210do not have the confidence or apparent capacity to discuss more abstract concepts. It’ssomething that anyone can participate in: we all eat, and you don’t need to have much incommon to discuss food. In other words, food is often a perfect topic for small talk. Most socialevents involve providing a hot beverage and a small sweet snack. Aside from the daily coffeeclub, held in the care home cafe, and the afternoon tea events, the activities are also verytea-and-coffee-centred. The activity itself often appears secondary.We are a small group of five huddled at a large, kidney-shaped table, and the bingo game isfalling flat. Barry, a temporary resident here on respite while his wife is away, is engaged, butmost are not paying attention. Jeanette is trying hard to engage everyone in the conversation.She puts on some Elvis and dances, wiggling in her chair and smiling. “[George], don’t you wantto dance?” But now he’s a bit preoccupied: Julia is upset with George, having thought the roomwas his newsstand until he tells her he does not own it and they have moved from their home.Her feelings hurt, and she sits tensely with her eyes closed. Exasperated with his wife, Georgesays, “Well, this was a bust”, shrugging. Jeanette hears this, and says: “Well, at least we’ve hada nice cup of tea!”Offered as a platitude, Jeanette’s response also highlights the cultural value of sharing a cup oftea as the central force of social activity. As an outsider, I quickly learned the power of a cup oftea, and tea brewing became my favourite ritual in the household. It is an immediate source ofcomfort, a small nudge of care, which you can offer nearly anyone at any time. I quickly learnedthat when someone is upset, it is almost always appropriate and welcome to fix a cup of tea.211Learning everyone’s preferences is a small gesture of care. I sometimes learned the way aresident takes their tea before I memorised their name–definitely before getting to know thempersonally. Nearly an initiation process, memorising the various tea configurations served as akind of map for each household: no milk, two sweeteners for William, lots of sugar for Julia, nosugar but plenty of milk for George, not too hot, in a large, heavy brown mug. Lisa will have onelump, one small splash of milk, and preferably in one of the pretty tea cups, always with asaucer… At first, carers would confirm that I knew how each resident likes their tea. Eventually,they stopped checking. I’d assimilated (I take my tea one milk, one sugar), at least insofar as thetea provision was concerned.I enjoyed fixing beverages for residents. It was an easy way to feel useful, to do something in thename of care. It was a small gesture of respect to remember how one takes their tea, a tangibleoffering. A hot cup of tea bought time: a reason to visit with some of the quieter residents, toknock on their door and have a few minutes of conversation. It’s how I got to “chin wagging”with William, how I could try to comfort Julia when she became upset or offer George somemoments of peace when he was trying to calm an upset Julia. I think of Silvia, who at 104 yearsold, sees the benefit of the care home:“You’re new here. You can just sit by me, and they’ll bring you a coffee and a biscuit. You don’thave to pay for anything—just for the hairdresser downstairs” pulls out her wallet and showsme—empty. Silvia looks up at me with wide eyes, waggling her eyebrows, looking as if she’s letme in on her little trick.212Silvia often asked for biscuits and coffee, waving me to her chair. She didn’t always wantcompany or to chat, but she seemed comforted knowing someone was there, waiting for her towaive them and ask for her coffee.“The boundary between meals and drinks has meaning”, explains Mary Douglas19, who, in anexhaustive attempt to etch the coding of meals, argues that there is an intimacy hierarchy:those who share meals share drinks, but those who share drinks, do not necessarily sharemeals. Those who share tea do not necessarily share soft-food dinners.The interruptions of COVID-specific health guidelines punctuated meals, shaping and starkeningthe divide between care receiving and care provision. Carers were not allowed to eat at thesame tables as residents, diminishing the household's sense of collectivity. I eventually stoppedeating my meals during mealtimes, as it brought on confusion and frustration for me to eat atmy table. It was easier to not eat and to be with the residents while they had their meals. Mealtimes were a structuring force, helping make sense and order of the days, the waiting, andpreparing just as important as the eating, then the cleaning. The washing up after a mealsignifies that rest is deserved (for residents at least). The focus on maintaining cleanliness,hygiene, and dietary standards can be seen as a form of abjection, as it involves identifying andexpelling certain elements seen as impure or disruptive to the social order. The sense ofdisconnection or separation between carers and residents can also be seen as a form of19 Douglas, M. (1972). Deciphering a Meal. Daedalus, 101(1), 61–81.213abjection, as it involves excluding or casting certain individuals from the larger social order ofthe care home.Mealtime can be understood through social relations, mutual recognition, and the shared careexperience. Leah's focus on preparing visually appealing and nutritious meals for residents on asoft food diet reflects her commitment to upholding the norms and expectations of the carehome community. Her concern for the residents' well-being demonstrates her investment in theshared care experience, highlighting the importance of social relations and mutual recognitionin the care home environment. However, Ruby's complaint about the lack of meaningful visitswith carers suggests a potential sense of disconnection or separation between residents andcarers, which can be seen as a form of abjection.The daily meal rituals of residents, such as Orla's use of her own silver tea set, George'spreference for four poached eggs, and Max's habit of taking his meals alone in his room with aglass of wine, can also be seen as forms of individual expression within the shared experience ofcare. These rituals reflect the residents' autonomy and personal agency in the care homeenvironment, highlighting the importance of mutual recognition and respect between carersand residents. Care is, argues Nigel Rapport, to ensure that one’s ‘personal preserve’ staysintact, that, for residents’ autonomy is not infringed: that so far as possible, and for as long aspossible, the elderly individual maintains not only his or her abiding authorship of over his orher life-project(s) but also authority, determining the course of that life and the trajectory of itsbecoming” (Rapport, 2018).214Overall, Ahmed’s “Affective Economies” provides a useful framework for understanding thecomplex social relations and shared experience of care within the care home environment. Thedata suggest that focusing on mutual recognition, social connection, and individual agency canhelp promote community and belonging among residents and carers. Meanwhile, Kristeva'stheory of abjection could complicate, or add texture to Ahmed's framework by adding a layer ofanalysis that focuses on how individuals and groups are excluded and marginalised within thecare home community. How people make you feel matters. This intersubjectivity positionsdifferent residents to receive different levels of and forms of care, based on preferences, norms,and biases that eddy between the care worker and resident.Kristeva's theory of abjection highlights how this order and control can result in the exclusion ofcertain individuals and groups from the larger social order of the care home. For example,Ruby's complaint that carers only quickly discuss the food and do not engage in meaningfulvisits with her could be seen as a form of abjection, as she may feel cast out or excluded fromthe larger social order of the care home. Similarly, Max's preference for eating alone in his roomwith a glass of wine could be seen as a form of abjection, as he may feel that he is not fullyincluded in the communal meals and social interactions in the care home. Additionally,Kristeva's theory of abjection emphasises how social norms and boundaries are enforcedthrough the exclusion and rejection of certain individuals and groups, which is then reinforcedover time. Leah's role as a carer, for example, can be seen as one of enforcing the boundaries ofthe care home community by maintaining the cleanliness, hygiene, and dietary standards that215are expected of her. However, this enforcement of boundaries can also result in the exclusion ofcertain individuals or groups who do not conform to these standards, such as Max who rarelyfinishes his plate and complains that he does not like the food very much. Or the dismissal ofcertain preferences, such as a bit of sugar in soup.Overall, Kristeva's theory of abjection can add a critical perspective to the theme of food andeating in the care home by highlighting how the maintenance of order and control within thecare home can result in the exclusion of certain individuals and groups from the larger socialorder.Kristeva's theory of abjection helps to highlight how the unique mealtime practices of theresidents in a care home can be seen as deviations from the normative expectations ofcommunal meal experiences, but also how these practices are tolerated and accommodated tovarying degrees. That, “modernity can allow others into its community of strangers as long asthey give up the signs of their concrete difference”, (Ahmed, in Chanter & Ziarek, 2005, 98).Max's practice of taking his meals alone in his room and Luis's use of bone broth packets fromhis daughter are also forms of abjection that deviate from the communal meal experienceprovided by the care home. That they are both single men may play into the tolerance of thesedeviations from the expected mealtime behaviour. Theresa and Matthew's restaurant roleplayduring meals and Julia's refusal to eat on "bad days" also represent abjection, as they deviatefrom the normative expectations of behaviour during mealtimes in a care home setting.216Section Three: Power & Gender in the Care HomePower dynamics in caregiving are influenced by various factors, including gender norms andsocietal structures. Within these macrostructures is a reproduction of traditional gender roles,with women and their work in caregiving often being subordinated (Johnson, 2023). This cultureperpetuates inequities in power between men and women, as highlighted by the theory ofgender and power. The sexual division of power reinforces these inequities and is sustainedthrough social mechanisms, such as the abuse of authority and control in relationships (referredto as 'power over').In the care home, the concept of power takes on a complex nature. Despite their crucial role,carers often lack job status and autonomy empowerment. This lack of power was particularlyevident when vaccines were made mandatory. One carer expressed frustration, stating, "I canbarely live on this paycheck, and I can't even decide what goes in my body." As a result of suchimbalances, many carers across the country chose to leave their jobs in response to themandate. There is an inherent tension between the subordination of gender and the powerdynamics between carers and care recipients. Carers generally possess power over residents,often influenced by surveillance measures to enhance safety. For example, using digital recordsto monitor food and drink intake may pressure carers to encourage residents to consumehigh-calorie desserts in the evenings. This power dynamic is enforced by higher authorities suchas management, governmental guidelines, and Care Quality Commission ratings, and it tricklesdown to impact the relationships between carers and care recipients.217“This is not...it is not home, is it?”The following is a conversation with a temporary resident, Joan, whose husband passed awayand has since had a progressive amount of home care to stay in her house. By leaving the fullconversation intact, the nuances of Joan's worries and the way she intertwines themthroughout our discussion are highlighted. This approach allows readers to observe how Joannavigates her concerns and relates various subtle details of care as she contemplates whetherto continue living at home or to transition to a care home setting. Joan is childless and has aniece who helps her with her affairs. Joan’s dilemma, whether to remain at home with homecare support or to move into the care home permanently, touches on many themes and issuespeople face when entering residential care. Joan's story relates to power and gender dynamicsin the context of her decision-making about residing in a care home. The narrative Joanprovides sheds light on the intricate interplay of power and gender roles (Connell, 1987). Joan'sdilemma involves her negotiation of power dynamics in her relationship with her niece, whoplays a pivotal role in organising her care. The gendered expectations and responsibilities withinthe family structure, as seen through Joan's reliance on her niece, add depth to the explorationof power dynamics. Furthermore, Joan's expression of independence and the social aspects ofthe care home raises questions about how gendered expectations influence choices regardingliving arrangements for older individuals. This inclusion serves to illuminate the nuanced ways inwhich power and gender intersect in the decision-making processes of elderly individuals incare contexts.218This afternoon I went to say hello to House 3. This House has a few empty rooms and isthus the household which receives the most temporary residents who come to stay for afew days to a few weeks’ time. I expected to see some new faces and hopefully some oldones. Walking down the hallway toward the common area, I passed a few rooms. I saw anew resident in bed sleeping on the left, and on the right, I was surprised to see Joansitting in an armchair gazing out the window.Joan had been here during the summer for a few weeks after a short stay at the hospital.She is a 95-year-old woman who lives alone at her home in [the town] with the supportof meal delivery services and daily home care visits. Her husband passed away two yearsago, and she has been navigating care with the help of a social worker and a niece wholives nearby.I pop my head in and say hello, and she ushers me in. Her room is empty of decorationsas she is only here temporarily. There are a few dishes on the desk. The TV is playingwomen’s football, muted.I greet her: Hello Joan! I didn’t expect to see you here. Do you care for a chat?Yes, dear, come in, here you can… (pats at the chair at the desk). I pull out the chair andsit in front of her. I see that she has a half-finished plate of lunch.219Me: Are you finished eating? I can come back when you’re done with lunch..Joan: No, no I could not finish all of that. It was lovely though, those girls, they alwaysmake sure that my meals are tasty. They always come in and tell me how they plan toprepare my dish, and then it is not just... Well, I know they put in an effort. Lovely girls..Joan is on a soft-food diet, and her meals are usually blended or finely chopped whichcan be unsightly. She has praised the kitchen staff for being mindful of letting her knowwhat she’s eating and paying attention to the seasoning and texture.Joan: Have you eaten?Me: Yes - thank you. I just came for the weekend and didn’t expect to see you today. I’mvery glad, but is everything alright?Joan: Oh yes. Well, I was back in the hospital, something with my stomach. I have beenhere a few days…Me: Ah, I’m sorry to hearJoan: That’s alright, I’m feeling better. (gestures at a plate of food)220Me: When we met in July, you were here for the first time for a few weeks, right?Joan: Yes dear, yes that’s right. Two weeks. And you! Well, you just come and go as youplease, do you? (said playfully)Me: (her asking me about my whereabouts gives me the opportunity to re-introduce thestudy and my role) Yes, I am a student, a researcher and was staying here over thesummer talking to residents and seeing how the care home is. I am doing a researchproject on daily life in this care home. Do you remember that we signed a form for you toparticipate?Joan: Yes.. you are from America, is that right? The nursing student.Me: (I don’t correct her because she’s accurate enough) Yes, so now I’m back, just to sayhello and see how things have been going. And you and I have had some wonderfulchats, so I am happy to speak to you again as part of my project. Is that alright?Joan nods.Me: So you’re feeling better now? That’s good.221Joan: Yes, yes better, well the thing is… she has to arrange things a few weeks out,maybe a week..Me: Who does?Joan: My niece has to book the carers you see? Some of them don’t have their own car,they share rides or something, and it takes some days for [niece] to organise everyone.Me: The home carers?Joan: yes, they come, and on Mondays and Wednesdays I prepare the washing, I get thelaundry ready for them. One comes at breakfast, and one comes at lunch, and they put inand then take out.Me: A good system!Joan: (Laughs), yes well, I like to help to set it up. It keeps me (points at her head)Me: it keeps you active, and involved?Joan: Yes. It’s my house, I should do what I can...222Me: So now you must let your niece know when you want to go home.Joan: Yes, but well. I should think about whether I should go there or stay.Me: You’re deciding if you will stay here?Joan: Yes, I think [niece] is getting older, and it’s a lot to manage… (Joan’s speech isslower, more thoughtful and she is wringing her hands. She’s frowning and lookingdown)Me: That must be a tough decision to think about.Joan (Looks at me) Yes. (a few seconds pass) Well, they live here, don’t they? (gesturestowards the common area, I think referring to the permanent residents). In the morningthey come in to help me, and I think they’re surprised to find me dressed and ready. I goin there (gestures towards the bathroom) and I get my clothes and then I come sit here. Iam dressed and ready for the day. I think they are surprised when they come to help me.Me: You think the carers here–they’re surprised at your independence?Joan: Independence! (she claps and her eyes light up) That’s the word. Yes, that's it. Ineed to walk…my knees…I have to use these (patting her knee) Well, I go for a walk223sometimes, nothing much, just out to the reception room, and sometimes they look, theyare not well. I am quite fortunate, to be (points at her head)I nod. Joan continues: Well, yes I help the carers at home. I get the things prepared forthem, the laundry, cleaning...I think it helps. But now, I am not sure. I think [niece] isgetting older, she has her own affairs...do you - is your mother alright?Me: Yes, she’s in her 50’s and fortunately quite healthy, it will be a while until we need tomake these decisions. But everyone must make them at some point, don’t they?Joan: (nodding) That’s right. [My husband] was fit as a fiddle...he died, you know.Me: I remember hearing about him this summer... sounds like he was a great man. Didhe live at home until the end of his life?Joan: No - the Hospital.Me: But before he went to the hospital, he was at home?Joan: Yes...yes well we could not drive. We didn’t use the car, but we managed ok. Welived well. Comfortable. [Niece] was good in school, she passed the certificates for twouniversities - and she said well [they are] too expensive. [Husband] said that if she can224work as hard and do well, we can pay her way. We did - we paid it all. She went touniversity…Me: That’s wonderful. What did she study?Joan: Banking (Smiles, looks at me)Me: Wow. And how lovely that you’ve taken care of her.Joan: Thank you! (she says proudly, with a big smile) But she is getting older now...Ishould decide. By tomorrow. Maybe the next day…(wringing hands)Me: Has someone asked you to make this decision, [Joan]?Joan: No, no. But with the time we need to arrange everything, well it has got methinking.Me: You mentioned independence before, are you worried about losing independencehere?Joan: Not really... As I say, I can dress, care for myself in the ways I need...but…(pausesfor a few seconds) This is not...it is not home, is it?...225They say you can have visitors but (her voice cracks a bit) Joan turns to gaze out thewindow.We sit silently for about 30 seconds. Joan is wringing her hands nervously, looking off inthe distance, thinking. She looks very worried, frowning with a furrowed brow.Because I have spoken with Joan before and am familiar with her communication style, Iexpect she will share more if I wait for her to speak rather than ask a new question. Sheis a reflective woman who tends to elaborate, or sometimes repeat, information that shefinds important.Joan suddenly breaks the silence: the carers at home are too short.Me: You mean they don’t stay for very long?Joan: No - in and out. They are very busy, I understand that, but it is so short. Then I satagain. They come, they’re nice really, but yes it’s just...short. (She shrugs)Me: Would a possible benefit of living here be that you have more company throughoutthe days?226Joan: Of course, and the girls are lovely, they come in to see me. [male carer] always says‘hello gorgeous!’ (smiles)Me: And do you go out to the common area to meet other residents?Joan: No. I don’t really...I don’t know them. It’s not...Me: What do you mean?Joan: We don’t talk. (her tone is a bit shorter, and she waves her hand dismissively. I cansense that she is not interested in discussing peer relationships here)A carer comes in to take the dishes, apologising for interrupting and asking Joan if she’shad enough. Joan apologises for being unable to finish her lunch. “s’alright, love. It wasa pretty large portion, wasn’t it?” As the carer leaves she says loudly to another carer“she did well - she ate about half, but it was a lot there on the plate”. If Joan is botheredby this, she does not show it.Joan turns to me: So anyway, I have to decide.Me: I’m sure it is difficult…227Joan: Yes, it is.Me: Have you spoken to your niece?Joan: [Niece]? Yes, and the social worker. She is also short sometimes...I think she’sprobably very busy. (Joan looks very concerned, brow furrowed and a deep frown. She’slooking at me. She gives me a small smile, her hands still wringing, and she looks verysad…)The narrative provided by Joan offers valuable insights into the experiences of older individualswithin institutional settings. Joan has the financial capacity to choose whether to stay at home,hire carers to help her, or pay to live in the care home. She has a family member who helps herwith her affairs and a social worker to support her. She also expresses loneliness, isolation, anda sense of fear for the unknown of her future. She highlights the social element of the carehome, that she may have more interaction here but does not want to lose the independence ofliving at home.Joan's mention of her niece's role in arranging carers and her concerns about her niece's abilityto manage her affairs highlights the significance of familial support networks in caregiving anddecision-making processes. This aspect underscores the broader theme of gender roles andresponsibilities within care homes, where familial relationships and gendered expectations playinfluential roles.228Moreover, Joan's discussion of her interactions with carers and her perception of their limitedavailability emphasises the importance of social connections and companionship for care homeresidents. Loneliness and isolation emerge as common concerns, underscoring the need toconsider the social dimensions and the quality of interpersonal relationships within theseinstitutional settings.Joan's expressed desire to maintain her independence and her hesitation about leaving herhome reveal the complex interplay between autonomy, identity, and the concept of "home" forolder adults in care. Overall, this glimpse into the dynamics of the care home experience fromJoan's perspective addresses issues of gender, family dynamics, social connections, autonomy,and the search for a sense of belonging and familiarity.As Joan grapples with the decision of whether to stay in the care home or continue receivingsupport at her own residence, her narrative illuminates the intricate dynamics of familialrelationships, power, and gender roles within the context of care. Now, shifting our focus toanother resident, Silvia, we encounter a vibrant personality who, at 103 years old, bringshumour and liveliness to the care home environment. At 103 years old, Silvia is funny - vulgar,quick-witted, and outgoing. Some care workers refer to her as “firecracker”. Posted on the doorto her room is a large photo of herself edited to look like an old western wanted poster, reading“WANTED” and featuring her portrait in sepia behind jail bars. I have heard a lot about Silviabefore having met her due to the humorous anecdotes she provides staff.229I sit with Silvia for the morning, making small talk (truly, it’s very difficult for me tounderstand most of what she says, but she asks me if I have children, am married etcetera) she tells me about working in the factory, about her son who is 80. “You’re newhere. You can just sit by me, and they’ll bring you a coffee and a biscuit. You don’t haveto pay for anything - just for the hairdresser downstairs” Silvia pulls her wallet out of thebag, fastened to her zimmer frame, and shows me - empty.Silvia worked in the textile industry, and she has had a “long, hard life”. She often seems towelcome the support of staff, asking for extra cookies or chocolates. She appears to ease intothe culture of the care home quite comfortably. She is always in the common sitting roomduring the day, plays dominoes with staff, and will sit and chat with almost anyone who passesher recliner.Jen, the only carer Silvia will call by name, brings Silvia some chocolates. “They have ginin them,” she says loudly, as Silvia is nearly deaf. Silvia replies, “JIM?! I DON'T KNOWHIM!” the carer laughs and opens some of the chocolate with Silvia and eats it with her.They sit laughing and joking together for a while.Silvia is a working-class woman from the local region. She does not have ‘power’ in terms ofeconomic status or hegemonic gender identity, but her capacity to speak the local slang, and belovable by staff (many of whom are from similar backgrounds) does give her the power to230strategise her care in a way that works well for her. But she also expresses a sense of fear andisolation.I get up momentarily to help hand out tea, and she says, “I like you being here. Pleasedon’t leave me”. A bit later, she says: “I am old. The doctor looked at me here (gesturesto stomach). I just don’t want to die!” She says in a near cry, grasping my hand. And, “Mymom and sister died - now it is only me. I’m the only one left”Silvia lacks traditional sources of power such as economic status or conforming to hegemonicgender identities. However, her ability to connect through local slang and endear herself tostaff, many of whom share similar backgrounds, empowers her to strategise her care effectively.Despite this apparent agency, Silvia also reveals a profound sense of fear and isolation. Duringmoments of vulnerability, she expresses a plea for companionship, voicing her concern aboutmortality, especially after the doctor's examination. In a poignant revelation, she shares theloneliness of losing her mother and sister, leaving her as the sole survivor in her family. Silvia'snarrative paints a complex picture of empowerment and vulnerability intertwined in the fabricof her ageing experience.As we engage with the diverse experiences of residents in the care home, we encounter varyingperceptions of agency and control. Lucinda, with her keen observations of the bustlingintersection from her room, shares an intriguing perspective on privacy and the gaze of others.Yet, her narrative also unveils a sense of detachment, as she speculates about items in her room231being strategically placed by an unseen authority. This notion of an external influence shapingresidents' lives echoes in other residents' comments, like Orla's nonchalant remark about thepurpose of a projector in the dining room. These narratives collectively shed light on aprevailing belief among some residents—a belief in a mysterious "they" who, intentionally ornot, govern certain aspects of their lives within the care home.Today, Lucinda is sitting in her chair, looking out the window. She has curlers in her hairand is wrapped in an oversized robe. We look out the window, and she explains that sheloves her view (she’s in a street-facing room on the front corner of the building andoversees a busy intersection). “I can see everyone, but they can not see me. I don’t haveto worry that they will think I am strange”. I ask why they would think she’s strange andshe replies “Well, just an old woman watching them...it’s a bit strange, no?” I say that Ilike to watch people too and agree that it is an interesting view. She says she likes towatch the children come home from school and to watch the buses. We sit and commenton various things that we see for a while.I gesture at her hair and tell her I haven’t seen curlers in a long time. “Yes, they’reold-fashioned, probably”, she says. She pats her head and asks if I can help her removethem. I take them out, and she asks for a comb. After combing her hair, which is nowvoluminous, I ask if she’d like to see herself in a hand mirror. “What for? I don’t need tosee. Do I? Well (pats head), does it look strange?” I say no, it looks nice. And she settlesback into her chair, looking at me like I have just said the most bizarre thing in the world.232She shows me her purse, a small leather bag filled to the brim with receipts, papers, andother things. “You can tell it’s a gorgeous bag, good stitching, it will outlast me”.Lucinda has some photos on her desk, presumably of family. I point them out, askingabout the people in the photos. She only seems to recognise the photo of her and herhusband. She tells me his name and a bit about their wedding. I ask about the otherphotos of the children and she tells me, “oh well they must have put them in here, youknow, the people who own the place. They are...for decoration probably. To liven theplace up!” (indicating that she does not feel the space is her own)There is a TV there near the photos we are looking at, and she saysLucinda “I don’t know what that is”Jayme “It’s a television. Do you ever watch television in your room”Lucinda “No, not that. It is not a television (laughs at me). They probably put that in hereto–I don’t know. Watch over me so I don’t fall, must be.”Jayme: “You haven’t used that before?”233Lucinda “No. No, I have not seen it. We could ask them about it. They probably installedit”Lucinda says, “They probably installed it” indicating that she is aware someone is watching her,and making decisions for her. Similarly, a few weeks later, there is a large projector in the diningroom and Orla, who has never expressed any ‘paranoid’ thinking, says, “Oh maybe that is athingy to watch that we are being COVID-10 safe in here”. The casual tone with which sheexplained it surprised me, and I think further illustrates the tendency for residents to assumethat there is a “they” shaping their lives, that to live in the care home is to give away a certainlevel of freedom and right to information about what is going on.The care sector is characterised as a gendered sector often labelled as "unskilled," leading toliability issues and increased surveillance of carers. Even in pre-pandemic years, the sectorexperiences a high turnover rate. Carers face pressure to perform emotional labour beyond thetangible requirements of their job, which can ultimately result in burnout. The capacity toprovide emotional labour is finite, while the demand for it seems endless. Kate, whom Iintroduced earlier, exemplifies this situation as her generosity with time and emotional energyputs her at risk of burnout.The concept of labour as self-management introduces complexities to the notion of care being aunidirectional act from care worker to care recipient. Self-management practices may beimposed differently on residents based on their gender identities. For example, women may beexpected to engage in a certain level of self-care to demonstrate being a "good resident," while234men may be expected to be useful or autonomous in different ways. This may look like aresident disengaging from regular activity to maintain an image of autonomy, such as withWilliam, a man who is developing Alzheimer’s and who has expressed feeling ashamed of hischange in the ability to eat:I drop a tea by William’s room, who is sitting in his chair. I say hello, and come in for aminute. “No TV or music, eh?” he says no, that he needs quiet because he is “working onthinking”. He tells me that he has been diagnosed with Alzheimer's and says that thehardest part is being aware that his thinking is not the same, which can be veryfrustrating. (“I have lived by my mind, by my thinking. I can not live in that anymore”; “Iget lost sometimes”)Lunch is almost ready, and I ask him if he prefers to have lunch in the dining room or inhis room (he is always in his room), “I notice that you often eat in your room”. Williamexplains that he often eats in privacy because he can focus better on himself and getsembarrassed. He said: “You have to choose between doing it well, or being with others”.He said, “it can be lonely, but I can not do it well”. I ask “You don’t want to makemistakes in front of others?” to which he replies, “Yes exactly”.I ask him if he’d like me to stay with him while he has lunch, and he says he does notmind. When the food comes, he does not touch it...so I offer to go for a while and comeback to bring him a hot tea, and he begins eating when I’m out of the room.235William cares about appearing together and does not want people to see him forgetting how toeat. He has told me that he feels disturbed by the changes in his cognition.During the lockdowns of the COVID-19 pandemic, family members were not able to enter thehouseholds. When regulations loosened, families could come into the household and supportthese tasks, adding value to residents’, carers’, and families’ residential care experience.This afternoon, Lisa’s daughter is in the household. She speaks warmly, familiar with thestaff on duty today. She has come in because she is worried about Lisa, who has beenprescribed antibiotics for a recent chest infection, making her very drowsy. Lisa hasn’tbeen well enough to make her regular visits.Lisa’s daughter brought in some fresh flowers and a box of new shirts for her mother andtold carers that the shirts must be ironed or she won't wear them. “I can do it!” She thenremoves an ironing board and begins ironing her mother’s shirts. It’s a lovely scene, withLisa’s daughter doing domestic chores, making it look more like a home. Lisa is dosing ina chair nearby, unaware that her daughter has visited. Her daughter comments that theboard could use more padding “This thing is a bit ragged - do you use this?”.Eventually, Lisa wakes up and says she needs to use the toilet. She looks down the halland smiles, her eyes set on her daughter standing at the ironing board, busy ironing her236shirts. She points, smiling with surprise, and the care staff says “Yeah, that’s yourdaughter! She’s here!”. Lisa goes to her room to use the toilet, and her daughter wrapsup the ironing and joins her, the two stay in the room to visit for a while. I see themsitting together at the window, laughing, the new shirts laid out neatly on Lisa’s bed.Tasks can help make one’s experience more natural and can give value and purpose to one’s rolein the care home space.It’s about 9:30 PM, Household 2 is quiet. The lights are dimmed, and there is a calmevening energy. I am talking to Vivian, who shows me photos of her dog on her phone.Rachel comes out of her room and sits on a chair in the corner. She takes her mail fromher walker and looks through her letters. Rachel is often withdrawn at meals, and doesnot seem to engage with staff or residents. Tonight she looks more natural: her posture isrelaxed, and she wears a calm, focused expression on her face as she sorts her mail.Vivian sees that I’m watching Rachel, and she explains “Oh yes, she only comes out of hershell late at night when everyone is in bed. She feels relief, as if finally all of these peskyguests have left her house and she can unwind for the day”.237Whether true or not, I like Vivian’s explanation for Rachel’s nighttime ritual. There is a low lampon, and the space feels quite home-like. Rachel, who often appears shy and anxious, lookspurposeful, focused, and relaxed.Emotional labour, intricately woven into every facet of care work, plays a pivotal role in shapingthe dynamics of the care relationship. Defined as the concerted effort invested in manageingemotions, both one's own and those of others, emotional labour takes centre stage inresidential care work (Lopez, 2006). An illustrative example unfolds in the pairing of Kim andKrys, where emotional intelligence and an understanding of residents' needs create aharmonious care relationship.Kim is a small, energetic middle-aged woman who manages the medications. She is verytalkative and friendly, and I immediately liked her. She has a very positive communicationstyle with residents and is always busy, but her work seems very efficient and thorough.This afternoon, Kim offers, “I’m going to go feed Krys if you’d like to join me”. I do, Ihaven’t met Krys yet. We go into Krys’ room. Krys is a young-looking black woman withbig, searching eyes. Her hair is tied into braids, and she is wearing a clean whitenightgown, lying in a bed angled up slightly so she can comfortably look forward. A knitblanket covers her feet. She has photos of her family in her room, some stuffed animalsand decorational figurines on the shelves, a map of Jamaica and a few paintings on thewalls.238Kim explains that Krys communicates with her eyes and the movement of a hand, so Imake sure to stand in Krys’ line of vision, and Kim introduces me, speaking into Krys’ ear.I smile and wave hello. I look for a sign of permission on her face, but I’m not sure.Kim explains that she will give Krys a dose of paracetamol, water, and her lunch and getsbusy administering the liquids through Krys’ feeding tube. Kim loudly and clearly explainseach step to Krys (“Now I’m going to give you some water, love”) and explains that theymeasure everything out to the mL. As she helps Krys, she pats her hand and uses a verykind voice. “She is very hydrated, we are happy about that, her skin is so lovely - not dryat all, this gives me a bit of pride that we can keep her doing as well as possible”, thenturning to Krys, “aren’t we darling”. Kim gently pets Krys’ arm. Krys has a small tear ather eye, which Kim dabs. Kim explains that Krys is very religious - Jehovah’s Witness - andthat it is very important for her to watch the services. She says Krys’ family streams themfor her on her iPad weekly. She has also contacted her family via the iPad during COVID.“Krys misses her family, it’s been hard in the lockdowns, hasn't it?” Krys looks down andaway from us. Kim says that Krys has a sister who lives nearby and calls Krys daily.Kim explains that Krys will move her left hand if she feels uncomfortable and that sheconstantly watches her hand while feeding and administering Krys’ medications. After afew focused minutes, she says “Ok, all done. We will be back later, dear”, with a pat on239Krys’ arm. I say “Goodbye, it was nice to meet you”, before leaving her line of sight &hoping so much that I haven’t made her feel uncomfortable by being there.Out in the hall, I ask how long Krys has been here. “About a year. She has MS and was ina previous place, they were administering the foods and liquids really quickly, making hersick, I think infection. She was in very poor condition when she came here. She had aseizure and lost what was left of her functioning. We obviously want to care for everyonewell, but her story breaks my heart, so I take great pride in giving her the best possiblecare”.I ask Kim how long she’s worked in care. “Years. I watched my father-in-law receivehorrendous care from in-home workers. Once a woman came and made him undresswithout a curtain, then snapped at him to hurry up because she hadn’t had breakfastyet. I told her to get her things, have her breakfast and not return. That indignity mademe realise that care is something I want to do. Now it is my life. Everything else falls intothe background. Being a carer defines everything I am”.Kim has a praxis of care which she finds empowering, this helps her to make sense of her role.Kim's approach to emotional labour is evident in her positive communication style, friendliness,and attentiveness towards the residents. She demonstrates an understanding of Krys' needs,such as positioning herself in Krys' line of vision to facilitate communication. Kim's ability toeffectively communicate with Krys through her limited means of expression, along with her240gentle and kind gestures, exemplifies her skill in emotional labour. Kim's dedication to providingquality care is highlighted by her thoroughness and efficiency in administering medications andfeeding Krys. Her use of a positive tone, verbal reassurance, and physical touch demonstratesher commitment to creating a caring and supportive environment for Krys. Kim's pride inensuring Krys' hydration and overall well-being reflects her emotional investment in theresidents' welfare, emphasising the emotional labour involved in care work.Additionally, Kim's understanding of Krys' religious beliefs and the importance of watchingreligious services showcases her attentiveness to the individual preferences and needs of theresidents. This understanding and accommodation contribute to the emotional connectionbetween Kim and Krys, as well as the empowerment that Kim derives from her role as a careworker. Kim's personal narrative reveals her motivation for pursuing a career in care work,stemming from a negative experience her father-in-law had with inadequate care. Thisexperience propelled her to become a care worker and defined her identity. Kim's praxis of care,the integration of theory and practice, empowers her and helps her find meaning in her role asa care worker.The analysis of Kim's case emphasises the significance of emotional labour in care work and itsinfluence on the care relationship. Kim's compassionate approach, attentiveness to individualneeds, and personal investment in providing the best possible care contribute to her sense ofempowerment and fulfilment in her role as a care worker. Furthermore, the meaning Kim241attributes to her role helps her to “find dignity in dirty work”, to take a narrative of purpose in arealm of work which is often defined by exploitation (Stacey, 2005).Another compelling facet of care motivation emerges through the presence of a favouriteresident—Lisa. She is from [the town] and speaks like a local, often making carers laugh. She isfunny and often acts very soft and gentle, speaking in a soft voice, playing with the baby dolls,and asking about her mom. She has a cute smile and is often polite and grateful to the staff forhelping her. Lisa's popularity serves as a motivating force, fostering a sense of joy and fulfilmentamong the care team as they engage in providing assistance and companionship. Herpreferences also make sense to the staff; they can understand an older woman wanting to wearher pearls and dress well. Lisa also has four daughters who are very involved in her care andfollow up often to ensure Lisa has what she needs.It’s around 8 AM, and the carers are in rooms helping residents get dressed. Lisa comesout in her nightgown. I say good morning, and she says hello and takes my hand. I ask ifshe’d like some breakfast and she nods. I lead her to a dining table and bring her tea andjuice. She says thank you, still quite drowsy and begins to drink her tea. Emma comes outand asks her if she’d like toast and a banana and starts preparing this for Lisa.Lucy approaches Lisa with a smile, singing “Good morning, darling!”. Tousling Lisa’s hair,she adds, “You’re due for a hair appointment today, love”. Lucy wraps a blanket aroundLisa’s shoulders. Lisa smiles and says something I can not hear, and Lucy laughs.242Lisa is still having breakfast in the dining room, and I refresh her tea. She is talking lightlyabout her mother, pointing out the window and smiling. I clear her plate, and she thanksme.Lisa goes to her room to dress with Lucy, Diane is working on the computer, and Emma ispreparing lunch - crisps, cold cuts, and sausage rolls. Emma, Diane, and I chat lightlywhile the household is quiet, with only G&J and Susan in the living room.Lucy comes out laughing saying that Lisa wanted to sunbathe. I look, and she’s sitting ina chair in a little sunlight in the corner of her room with her eyes closed. Lucy tells methat she will get her up for lunch later, and then she has an appointment at thehairdresser.After lunch, Lucy gets Lisa ready for her appointment, applying lipstick and spraying Lisawith perfume (“She likes to look presentable, she’s quite vain, really!” with a small laughand a smile). Lisa says she wants a different sweater, and Lucy obliges, smiling andpatiently helping her select a different one.In stark contrast to the uplifting stories of care motivation and favoured residents, the reality forsomeone like George reveals a different facet of the care home environment. George, strugglingwith everyday tasks like shaving and facing challenges with personal care, stands as a poignant243example. Despite his evident need for assistance, he often finds himself overlooked or met withreluctance from the care team.George's experience highlights a crucial aspect of care dynamics — the vulnerability of thosewho may not fit the mould of a 'favourite patient’ (or, in this context, ‘favourite resident’) (Leeet al., 2016) His dependence on care contrasts sharply with his emotional resilience, as heshoulders the majority of the emotional labour needed to support his partner, Julia. Thisnarrative underscores the complexities within the care home, where varying degrees of supportand attention shape residents' experiences, revealing a spectrum of care that extends beyondthe stories of cherished favourites.Amidst the variety of care relationships, a subtle but significant pattern emerges — instanceswhere care workers unintentionally "talk over" residents. The demands of caregiving taskssometimes overshadow the experience of residents. In these moments, the focus shiftsprimarily to the practicalities of care, potentially neglecting the individual's unique journey andperspective. This subtle phenomenon hints at the challenges inherent in balancing thefunctional aspects of care with the deeply personal and subjective experiences of those beingcared for.It’s late, around 8 pm, and the only resident in the reception room is Silvia, who iswincing. She waves me over and explains that her feet are itching very badly. She tellsme that it hurts. I ask Vivian, who is busy with medications if there is something I can do244to help Silvia. She shows me a cream that Silvia can use, and I kneel in front of Silvia andtake off her slippers and socks. I put some cream on her feet. Silvia allows me to put hersocks back over her lotioned feet, and I pat them gently to reduce the itching. Silviamouths “Thank you”, still wincing.Vivian comes over and explains: “All old skin gets so dry. You get to an age where it isincurable. Sometimes the residents find a cream that seems to work, then they get morefrom the doctor, and it stops working. There is no miracle cure. And sometimes She(points to Silvia) gets bad dry skin on her back. Very bad” Silvia is listening, frowning. Ican not tell how much she understood, but I feel awkward talking about her body in frontof her as if she is not there.Sometimes this talk-over can be explicitly shaming and inappropriate, which shocked me tolearn that is quite common:The janitor greets Silvia and has a chat with her - telling her about her family and herwork as a cleaner. Silvia asks her for a coffee and some cookies, which the janitor getsfrom Marcus. Silvia goes back to sleep. The janitor comes to chat with Marcus, Theresaand me and says she would not want to do care work, but she loves talking to theresidents. “I could not do the diapers. I can do babies, but I can not deal with adults”.“Oh, you’d get used to it. They’re just big children,” says Marcus in front of Theresa. If245Theresa notices, she does not show it, but I wince at this being said about her in front ofher.The interaction involving the janitor, Marcus, Theresa, and myself offers a rich context forexamining gender norms and age dynamics within the care home. Marcus's commentcharacterising the residents as "just big children" reflects a perception associating vulnerabilityand dependency with childishness. This aligns with Connell's theory of hegemonic masculinities,reinforcing the traditional division of caregiving labour along gender lines. In contrast, thejanitor's statement about being unable to handle adults, specifically their needs for diaperchanges, hints at a potential experience of abjection, in line with Kristeva's theory. Thisemphasises the discomfort or repulsion associated with certain aspects of care work,particularly intimate care for older adults (Twigg, 2011).Moreover, the exchange highlights the significance of social connections and conversationswithin the care home. The janitor's engagement with Silvia's request for coffee and cookiesexemplifies the creation of meaningful interpersonal connections beyond formal care duties.The conversation among the janitor, Marcus, Theresa, and myself also illustrates the socialdynamics within the care home, reflecting Goffman's theory of dramaturgy. Marcus's comment,perhaps unintentional, can be viewed as a performance of a specific role and assumption aboutthe residents, while the narrator's wince signals an awareness of the potential impact onTheresa's feelings and dignity.246Finally, the janitor's statement about enjoying talking to the residents emphasises the affectivelabour involved in creating meaningful social interactions and emotional connections. Thisaligns with Ahmed's theory of affective economies, underscoring the importance of socialengagement for both residents and staff members. Overall, this analysis highlights the intricateinterplay of gender norms, age, social interactions, and affective dynamics within the carehome, emphasising the performative nature of gender roles as discussed by Butler's theory ofgender performativity.Shifting to the Theory of Gender and Power, cathexis refers to the social norms and affectiveattachments dictating how men and women should express their sexuality and adhere totraditional gender roles. This influence extends to intimate interpersonal relations and theemotional energy attached to objects or desires. When considering desire and abjection indiscussing intimacy, this layer helps us comprehend the complexity of the sexual division ofpower at the interpersonal level and may illuminate how societal gender norms differ on aninstitutional level within the care setting. Examining how subordination of residents/recipientsto care providers complicates gender divisions in the care home space, the layer of cathexisbecomes crucial. As repression and desire are no longer solely in the control of the individual,shaped by ageist attitudes towards the ability of these individuals to experience desire andrepression, interpreting gender expression for these individuals becomes more nuanced. Thislayer deepens our understanding of how gender norms manifest institutionally within the carehome context, reflecting the intricate dynamics of power, desire, and gender expression at play.247Theresa is 62, and she appears quite young. She wears long and straight hair, and often wearsblue jeans and sandal shoes. There is something about those shoes - they are the kind youmight wear to the beach and are nearly the opposite in function and practicality from theoften-worn orthopaedic sneakers or velcro-on slippers seen on her peers’ feet. Theresa is oftenvery helpful and curious with staff, offering to wipe counters and verbally checking on residentswith a quick, “You okay?”. She seems to, particularly like Matthew, the only resident she knowsby name (an absolute rarity between residents). Matthew often needs some support finding hisroom in the household. I have seen Theresa help Matthew several times, sometimes holding hishand as she walks him to his door. I have seen her sit near him at the end of meals, wheresometimes he thinks she is his wife and kisses her on the cheek:Theresa has been finished with lunch for about 30 minutes. She is wandering around,commenting on various things in the room. I asked her if she wanted to play cards, butshe declined. I notice that she keeps looking over at Matthew, who is slowly having hismeal. After he finishes, Theresa goes to sit next to him. “Darling, I think we should pay,” Ihear him tell her. She leans towards him, and he gives her a kiss on the cheek. “Nice, thatwas,” he says cheerfully, about the meal. She coos at him, saying something quietly that Ican not hear. They sit together for a while, smiling and talking.Marcus, the kitchen staff, has warned me that they need some ‘supervision’ because they havebeen found in a room together undressing. (“He has a wife, but thinks sometimes that she248(pointing at Theresa) is his wife. He has whipped out his willie. We just have to keep an eye onit”.)Today, Theresa and Matthew are sitting together at a table after breakfast while Marcusprepares lunch in the kitchen. Theresa asks if Matthew is cold, seeing that his arms arecrossed over his chest. Matthew says yes he is cold. I hear this, and I fetch him a jumperand he puts it on, with a bit of help from Theresa and myself. He is concerned withstraightening his collar. I say it looks smart and he smiles.He has a runny nose and walks to get tissues from the counter - something I have seenhim do for himself many times. Marcus says “What do you want? '' in an impatient voice.Matthew says he needs a ‘hankie’. “We haven't got any hankies in the kitchen” Marcusscoffs, and then, “Here, have one of them” hands a piece of paper towel.Matthew takes the napkin, walks away, and walks towards another resident's room.Marcus says loudly “That’s not your room!” Theresa hears Marcus and gets up to helpMatthew. She holds his hand and asks where he wants to go. “No! You cannot go in theroom together!” Marcus yells. “You” - he points to Matthew. “Get your hands off ofthere!” Matthew’s hands are near his trouser buttons. I think he needs to use the toilet.“You” he points to Theresa “get away from him and come sit down” he points to herchair. Theresa looks confused, still holding Matthew's hand. I feel compelled to intervene,249so I offer to help Matthew find his room “You need to use the toilet?” I show Matthewwhere his room is, and he uses the bathroom.Theresa returns to sit at the table looking tense. I try to engage her, but she does not want totalk. For the rest of the meal, Theresa is not speaking to anyone or responding much to the staff.She wants to take lunch in her room today. One carer explains that she will go through phaseswhere she just wants to be alone. I wonder if her interaction with Marcus and Matthew, whereMarcus reprimanded her for trying to help Matthew, has anything to do with this.Marcus took Matthew’s words literally, saying they do not have ‘hankies’ rather than assessinghis needs and why he might be at the counter. He appeared to already be frustrated withMatthew and to already assume that the situation would escalate, rather than waiting to seethat Theresa may just be helping her housemate. Gender norms influence power dynamics,emotional connections, and performative aspects within the care home. The incidentexemplifies how implicit gender norms shape interactions and perceptions, impacting caregivingdynamics and emotional relationships among residents and staff. The integrated approachprovides a richer understanding of the complex interplay between gender norms and othersocial factors in the care home setting. Examining gender dynamics in the care home throughConnell's power and gender framework reveals how gender norms influence power dynamics,labour distribution, and emotional connections. Implicit and ingrained gender norms shapeinteractions, influencing task allocation, decision-making, and perceptions of authority.250Extending Connell's framework, exploring cathexis and abjection through Kristeva's theoriesdeepens our understanding of how gender norms are influenced by societal expectations.Gender norms create pressures for conformity, evident in practices like maintaining cleanlinessduring meals, upholding societal norms related to femininity and caregiving. Simultaneously,residents' unique meal rituals challenge traditional gender norms, expressing individualautonomy. Examining affective economies and the implicit ways explicit gender norms shapeinteractions highlights the emotional dimensions of gender in the care home. ApplyingGoffman's front stage and backstage concept, gender norms play a crucial role in understandingthe performance of gender in the care home. Front-stage interactions reflect and reinforcegender norms, aligning with traditional roles. Backstage interactions reveal negotiation andpotentially subversive aspects where individuals may challenge or deviate from expectedgendered behaviours.This chapter has presented several descriptive accounts making up the daily goings-on ofComfort Days. This is to understand the multifaceted dynamics that shape the lives of bothresidents and care workers. From witnessing the heartfelt commitment of care workers like Kim,who invest emotional labour into their roles, to empathising with the trials faced by residentssuch as Silvia, George, and Lucinda, whose narratives convey a blend of vulnerability andresilience. Throughout this exploration, I've observed how gender norms and age dynamicsmanifest, as evidenced by moments like Marcus's patronising remark about older adult carerecipients being no different than young children. These instances have provided glimpses intobroader societal constructs, power dynamics, and the delicate equilibrium between251dependency and agency within the care home. Reflecting on these narratives, it becomesevident that each contributes uniquely to the meshwork of caregiving dynamics in this carehome. These stories, whether inspiring or challenging, underscore the importance of fostering acare environment that transcends mere routine, acknowledging and validating the distinctexperience of each resident.252Chapter 6: Discussion and ConclusionAs I explore the experiences of care workers residents and care workers, my aim is to offer adeeper understanding of the lived realities within the care home, and to explore theimplications of these findings on the future of care work. In this pursuit, I have drawn upontheoretical foundations from various scholars such as Julia Kristeva, Raewynn Connell, SaraAhmed and Erving Goffman to make sense of the data. These frameworks, spanning abjection,cathexis, and front-stage and backstage behaviours, provide a comprehensive lens throughwhich to analyse the power structures, gender norms, and emotional intricacies embeddedwithin this care home environment. Beyond the theoretical, this discussion embraces acommitment to ethnographic thinking, recognising the value of immersing myself in the dailylives of care workers and residents to provide rich data. Ethnographic inquiry adds depth to thisexploration, allowing me to uncover subtleties, cultural variations, and the often unspokeneveryday rituals that shape the experiences of those involved in care work.Before overviewing the various pathways of theoretical interpretation of the findings, I wouldlike to offer a reflection on care, in the first section of this discussion chapter, “Caring Care”. As Inavigate the complexities of care work, the concept of "Caring Care" emerges as a guiding light,helping to keep a focus on care relations central in my analysis. Rooted in the humanised carevalue framework, "Caring Care" serves as a beacon, reminding me of the intrinsic worth anddignity of every individual involved in the caregiving process. Through the lens of "Caring Care,"I approach my research with a sense of empathy and compassion, recognising the importanceof fostering genuine human connections amidst the institutionalised routines of care provision.253This value framework guides my interactions with both care workers and residents,encourageing me to listen attentively to their stories, concerns, and aspirations.In applying theoretical frameworks such as Kristeva's abjection, Connell's cathexis, Ahmed’sAffective Economies, and Goffman's front-stage and backstage concepts, "Caring Care" serves asa touchstone, grounding my analysis in the lived experiences of those involved in caregiving.Each theoretical lens is interrogated through the lens of "Caring Care," allowing me to criticallyexamine how power structures, gender norms, and emotional landscapes intersect with thefundamental principles of compassionate care. Moreover, "Caring Care" facilitates an insightfullook at care relations, encompassing not only the practical tasks and routines of caregiving butalso the emotional labour and affective exchanges that underpin meaningful caregivingrelationships. This perspective aligns closely with the humanised care value framework, whichemphasises the importance of recognising and respecting the unique needs and preferences ofcare recipients. By integrating the concept of "Caring Care" into my analysis, I ensure that thestudy remains firmly rooted in a human-centred approach to care provision.With this foundation in place, I will then move onto the integration of theory with findings.Through ongoing interactions and observations, I sought to grasp the nuances of everyday lifewithin the care home, allowing themes and patterns to emerge organically from the data.Rather than applying preconceived theoretical frameworks during analysis, I maintained areflexive stance, allowing insights to arise from the various ethnographic encounters. Thisiterative process enabled a deep understanding of the social dynamics and cultural nuances254within the care home, rooted in the lived experiences of those involved. Employing ahermeneutical approach, the theories emerged from the data, and as I analysed, I engaged in areflective dialogue between theory and the data. This interpretive process allowed me to delvedeeper into the meanings and implications underlying the phenomena I encountered within thecare home setting. As I navigated the complexities of care work, I found that theoreticalframeworks served as useful tools to make sense of and organise data, while also beingcontinually reinterpreted in light of the empirical evidence. For example, Kristeva's concept ofabjection provided a framework through which to understand the marginalisation andstigmatisation experienced by George. Through this lens, I was able to discern moments ofsubtle exclusion or devaluation experienced by George as instances of abjection. Similarly,Connell's theory of cathexis offered insights into how dominant forms of masculinity shapeinteractions and power dynamics within the care home, such as when William gives his youngcarer the nickname “pocket rocket”. By applying this theoretical lens, I could unpack thegendered dynamics at play and identify instances where traditional notions of masculinity orfemininity influenced caregiving practices. Ahmed's concept of affective economies provided aframework for describing how emotional exchanges occur within the care home environment.This theoretical lens allowed me to make sense of the emotional labour involved in caregivingand recognise the significance of affective relations in shaping the experiences of both careworkers and residents. And finally, Goffman's concepts of front-stage and backstage behavioursfurther enriched my understanding of the performative aspects of caregiving roles. By makingsense of the interactions I observed within the care home with this theoretical framework, I255could discern how care workers managed their presentation of self in different contexts,balancing the demands of professionalism with the need for emotional authenticity.However, it is crucial to recognise that theory alone can not fully capture the complexity of thecare home environment. Rather, theory serves as a tool for interpretation and reflection,guiding my understanding and sense-making of the empirical data. This hermeneuticalapproach allows for a dialogue between theory and practice, enriching both my analysis and myunderstanding of the lived realities within the care home. Considering this, I have included asection on the ethnographic contributions and considerations yielded by this study, focusing onthe similarities between care work and ethnography.Finally, I will conclude this discussion chapter by offering a comprehensive overview of thestrengths and limitations of this study, while also discussing potential implications for furtherresearch, practice, and policy development. By situating this project within broader debates andarguments surrounding residential care work, this discussion will underscore the significance ofthis study's contributions to the ongoing discourse on old age care.256“Caring Care”Understanding the intricacies of identity and gender norms within the context of care work is acomplex endeavour. While strict adherence to norms might limit the dynamic sense of identity,norms can serve as valuable tools for meaning-making and communication, particularly in thecare home environment where alternative forms of identity expression may be limited by socialisolation. In this context, residents are tasked with forging new relationships within a livingspace that might not entirely encompass the complexity of their lives. Within the framework ofhumanised care, it becomes imperative to explore how care workers approach gender norms toprovide individualised care. Earlier in this dissertation, the literature review illustrated that anincreasing number of scholars argue that old age has for too long belonged to the ‘etcetera’ inintersecting positions (Freixas et al., 2012). Instead, old age should be brought to the fore bydeveloping more critical perspectives in gerontology (Calasanti, 2010; Ferrer et al., 2017; Torres,2015). Paying attention to the situatedness and everyday performances of older adultscontributes to the development of “caring care” which sees the individual and meets them as ahuman being (Galvin & Todres, 2013). In essence, "caring care" within the Humanisation of CareTheory can be understood as care that is imbued with qualities of empathy, compassion, andrespect, and that prioritises the well-being and dignity of the individual receiving care. "Caringcare" further reinforces the focus on individual experiences and the situatedness of older adultsin the world of care research. In other words, matters of identity are matters of care.My experience provided abundant instances of caring care. The way Linda transparentlydetailed her expert strategies to transform meals into soft food diets for residents with the257enthusiasm of a chef, or how Julia, holding my hand tight, invited me to come with her toScotland next summer, weaving her cherished memories with our newly found rapport, or whenSusy communicates every move she makes as she provides care to immobile and non-verbalKrys, while watching Krys’ left eye for the blink that signifies discomfort; when Edna comforted acrying Julia, telling me, “I don’t know her, but I think she could be my friend”. This is referred toas “caring care”, and it occurred between care workers and residents, between workers,residents and myself, and between residents. And for every example I have of “caring care”, Ihave another for the opposite.“Caring care” permeates the task-based efficiency of institutional care, amidst the meticulousdocumentation of daily activities like calorie intake, bowel movements, and appointments.However, not everything that gets documented and filed into one’s care package embodies theessence of “caring care.” Often, it's the quiet, subtle acts that hum in the background oftask-based care that truly encapsulate compassionate caregiving. The constructs that societyimposes, labelling individuals as “sassy old ladies” or “fussy old men,” prove to be shallow andlimiting in moments of genuine interpersonal connection, where individual nuances are notonly acknowledged but genuinely cared for.In these moments of human-to-human interaction, the identities that typically facilitate ease innavigating the world may lose their significance. The currency of these identities fades asindividuals engage in the interchange of “caring care,” where authenticity and empathy takeprecedence over societal norms and expectations.258It is tempting to dwell in a realm of “shoulds,” discussing the ideal methods of administeringcare. However, a central finding of this study is that care work is inherently messy. It oftendemands immediate action, which prompts individuals to navigate their own norms and values,resulting in the subjective treatment of others. Concepts such as abjection and cathexis, orfront-stage and backstage care, provide a framework to explore these messy relationaldynamics, offering a vocabulary to articulate the slippery nature of interpersonal relations.In the next section, I will reintroduce the theoretical frameworks selected to make sense of thestudy's findings. I will provide an overview of the diverse ways in which I observed andparticipated in acts of care among residents and care workers. By revisiting these theories, I aimto shed light on the complex interplay of power structures, gender norms, and emotionaldynamics within the care home environment.259Integration of Theories with FindingsThe integration of theoretical frameworks plays a pivotal role in illuminating the complexitiesthat underlie gender norms, power structures, and emotional landscapes within the care homesetting. These theoretical foundations were carefully selected based on their relevance tounderstanding the nuances of caregiving dynamics and were identified during the datacollection and analysis stages, as the data reflected the need to construct a multi-facetedtheoretical system to explain various elements which make up or deny “caring care”.In this section, I intertwine the theoretical foundations of Kristeva's abjection, Connell'scathexis, Ahmed’s Affective Economies, and Goffman's front-stage and backstage concepts withthe empirical findings derived from extensive research within the care home setting. By weavingtogether these theoretical perspectives with real-life experiences, I aim to provide acomprehensive analysis that captures the intricate interplay of factors shaping the caregivingenvironment.260Here I present a very brief review of the theories I employed to think through the findings:AbjectionJulia KristevaKristeva's notion of abjection serves as a lens through which to understandthe affective and psychological dimensions of gender dynamics. By exploringthe ways individuals react to societal norms, I uncover layers of emotionalresponses that shape interactions within the care home.Power & GenderRaewynn ConnellConnell's exploration of power and gender dynamics directs attention to theintricate interplay within societal structures, transcending explicit actionsand institutional roles. Through the lens of power and gender, the nuancedrelationships and influences in various social contexts come to the forefront,shaping the dynamics within homes, workplaces, and broader societalframeworks.Affective EconomiesSarah AhmedAffective economies, as conceptualised by Sara Ahmed, delve into the waysin which emotions circulate within social spaces. It goes beyond individualexperiences of emotions to explore how feelings are not only personal butalso have broader social implications. Within the care home setting, thisframework allows us to unravel the emotional bonds, resistances, andresponses to societal norms that are embedded in caregiving interactions.Front-Stage &BackstageErving GoffmanGoffman's concepts of front-stage and backstage behaviour guide theanalysis of caregiving as an intricate interpersonal navigation. Byunderstanding the alternation between public performance and the privatepreservation of dignity, I unveil the performative aspects of gender withinthe social life of the care home.Figure 10 - A brief overview of theoretical frameworksDrawing from a wealth of qualitative data and participant observations, the integration of thesetheoretical frameworks with the empirical findings brings to light an understanding of caredynamics within the care home. The application of Kristeva's abjection reveals unexpectedlayers in daily interactions. For instance, during mealtime observations, seemingly routinepractices carry emotional weight, reflecting the residents' negotiations with societal normsregarding ageing and food-related behaviours. Connell's concept of cathexis emerges vividly inthe narratives of care workers who, beyond their prescribed roles, display a deep emotionalcommitment to the well-being of the residents. These emotional investments shape the qualityof care provided, emphasising the human side of caregiving.261Goffman's front-stage and backstage concepts come to life as care workers navigate the delicatebalance between public expectations and private interactions. These observations underscorethe performative nature of caregiving, where the reinforcement or challenging of gender normsbecomes a subtle, daily occurrence. The synthesis of theoretical frameworks with empiricalfindings not only enriches the analysis but also offers profound insights into the intricateinterplay of power, gender, and emotion within the care home. This integration forms thefoundation for a more comprehensive understanding that extends beyond the theoreticalrealm, contributing to the ongoing dialogue on the complexities of care dynamics.By integrating theories like Connell's power and gender, Kristeva's abjection, Ahmed’s affectiveeconomies, and Goffman's front stage and backstage, I have aimed for a comprehensive analysiswhile embracing the ‘messiness’ of the lived experience. This approach encourages anexploration of how emotions shape both care workers and care recipients, unveiling theinherent emotional labour in caregiving and the crucial role of emotional connections in shapingrelationships. Simultaneously, affective economies shed light on the circulation of emotionswithin social and cultural contexts. In this care home environment, they reveal emotional bondsand resistances, providing insights into how residents and staff navigate or challenge theinfluence of norms on care. Through this lens, we uncover a spectrum of responses to theinterplay of gender and old age, exposing emotional attachments that both reinforceestablished norms and challenge prevailing narratives.262Let us explore this with some examples. First, I would like to consider William's experiencesbeing redirected. The adherence to William’s masculinity was evident in Lucy's directengagement with William's intentions. Unlike other care workers who ignored or dismissed hisadvances towards Susan, Lucy openly acknowledged his intentions and advised him to ceasesuch behaviour. She also provided suggestions for possible and appropriate forms of physicaltouch. While some may see this as patronising (I certainly did at first), this instancedemonstrated one of the few occasions where William's masculine identity was acknowledgedand preserved. In contrast, we encounter Theresa, who received chastisement for enteringMatthew's room. She intended to assist him, yet she was reprimanded for being in the presenceof a male resident who was perceived as posing a threat. This act, justified by care workerJoshua as a means of "protecting" her from potential advances, ultimately resulted in shamingand erasing her individuality and caring nature, casting her solely as a victim of male advances.This is an example of how, as Ahmed argues, the affective economy works to maintain order.Within the care home, emotions circulate to contribute to the construction and maintenance ofthe social order (Ahmed 2014). The intersection of old age, gender, and sexuality leads to“shortcuts” in interpreting intention. These are not merely isolated events, but they arereinforcing a script by which care workers and residents order themselves. William knew to besneaky, that perhaps Lucy would see his behaviour as something that could be avoided orignored. Linda pierced through that veil:[Linda] squats to be eye level with William and continues, “You can hold hands, I think that'slovely! But you can not be pulling her like that. What are you up to, anyway?”263In a sense, William may have been counting on the abjection of his sexuality, to be ignored andpushed out of sight due to a general discomfort with old-age desire (Calasanti, 2001).However, Linda took the time to witness and observe William. She knew his tendencies and shefaced him as an individual, a man with autonomy over his actions. She was able tosimultaneously protect Susan while also treating William like a full person. Conversely, Theresawas shut down in her attempt to help her housemate and was scolded like a child. Thishumiliation was a result of the care worker basing assumptions on the emotional reaction to aman and woman engaging in a form of intimacy. Rather than investigate and understand, heapplied a punitive approach to control. The contrast between Lucy's acknowledgement ofWilliam's intentions and the reprimand that Theresa faced for assisting Matthew highlights theintersectionality of old age, gender, and sexuality in shaping perceptions and reactions. Theexample of Linda's interaction with William further emphasises the significance of individualisedcare and understanding in navigating the complexities of residents' needs and desires.Moreover, this scenario highlights the challenges faced by carers who must make split-seconddecisions in such situations, often without the opportunity for reflection or discussionafterwards. The absence of spaces for reflection and dialogue among carers perpetuates missedopportunities for learning and growth in providing sensitive care.Theoretical frameworks provide a lens to uncover the spectrum of responses to societal norms.Whether reinforcing established gender norms or challenging prevailing narratives, residentsand care workers navigate a diverse terrain of emotional investments that shape the socialfabric of care homes. The application of affective economies brings attention to emotional264bonds and resistances within the care home. Insights gleaned from participant interactionshighlight how residents and staff navigate or challenge gender norms, offering a glimpse intothe emotional intricacies that characterise the caregiving environment.Affective economies reveal motivations and dynamics underlying diverse reactions to societalnorms associated with ageing. This framework moves beyond simplistic acceptance or rejectionbinaries, providing insight into the multifaceted responses to societal expectations, especiallyconcerning gender and old age. Exploring the emotional terrain surrounding gender normsuncovers the profound emotional investments that both perpetuate and contest prevailingnorms. This exploration reshapes our perception of care, emphasising the deeply humanendeavour intertwined with emotional bonds and commitments.By examining the interplay of identity and gender norms, a more comprehensive explorationunfolds. The experiences of residents and care workers are situated within the broader contextof the care home, revealing how individual identities intersect with and shape the genderdynamics that permeate everyday interactions. Connell's emphasis on cathexis directs attentionto the emotional labour inherent in caregiving. Beyond explicit actions and institutional roles,the love and dedication embedded in care emerge as pivotal components, influencing theintricate dance between care workers and residents.Belonging within “Comfort Days” entails the ability to express oneself through attire, grooming,and recognition in a manner that encompasses the acknowledgement of our gender identity265(Streeter et al., 2020). The attention and care given to Lisa, as seen in the assistance with herappearance before every visit, exemplifies the care workers' commitment to upholding herfemininity and ensuring she presents herself in a "presentable" manner. On the opposite end ofthe spectrum, we have George, who preferred wine during a pub night but was repeatedlyquestioned about his choice and offered beer instead, and thus "corrected" George into adifferent presentation at the pub night. Through these observations, it becomes apparent thatcertain care acts reinforce gender norms by validating and preserving individuals' genderidentities, while others involve attempts to mould or suppress their behaviour to conform tosocietal expectations. This dynamic demonstrates the complex interplay between the caregivingenvironment, gender norms, and the recognition or erasure of individuality.The integration of Kristeva's abjection, affective economies, and Goffman's front-stage andbackstage concepts provides a comprehensive understanding of the interplay between power,gender, cathexis, and abjection in the care home. This multi-theoretical approach revealsnuanced aspects of gender dynamics within the care home, emphasising the importance ofembracing diverse frameworks to fully comprehend complex social phenomena. Affectiveeconomies offer insight into the emotional terrain surrounding gender norms in care homes,moving beyond a simplistic acceptance or rejection binary–this can help explore how theassumptions and attitudes we have around gender norms circulate through the care home toform rituals and habits. The difference in reaction to William and Theresa described above is asalient example of this. The inclusion of affective economies in the broader social and cultural266contexts of care homes provides a more complex view of emotional bonds and resistances,uncovering complex responses to societal norms.Goffman's front stage and backstage concept enriches the analysis by shedding light on theperformative aspects of gender in the care home's social life. Care workers navigate gendernorms along a spectrum, from adhering to traditional ideas to actively challenging them. Thisspectrum illuminates various caregiving styles and emphasises the human side of caregiving. Itis essential to avoid oversimplification and instead offer this spectrum as an exploration of themultifaceted nature of caregiving, where actions may simultaneously conform to and challengenorms, delving into the complexities of providing care. Think again of George, who wasrepeatedly offered a pint of beer despite his requests for wine. To the care worker, this was theimage of good care: an old man sitting in the care home pub with his pint. To George, this was adenial of his individuality.In contrast, thinking through Orla’s experience with these frameworks, we can see examples of“caring care” in action. For example, Orla's interactions with the carers in the context ofsmoking breaks in the rabbit hutch reveal emotional dimensions. The act of smoking, oftenconsidered a social activity, takes on a specific meaning within this caregiving context. Itbecomes a shared experience, a moment of connection between Orla and the carers, sheddinglight on the affective and psychological dimensions of their relationship. By synchronising theirsmoking breaks with Orla's, the carers challenge societal norms that might stigmatise or isolateindividuals engaged in smoking. This shared activity becomes a way to subvert potential feelings267of abjection that Orla might experience due to societal attitudes towards smoking orage-related activities, not to mention the complexity of a care act being something unhealthyfor the body.The carers' actions, particularly the consideration of Orla's preferences and the inclusion of herin decision-making, align with Connell's concept of cathexis (Connell, 1987). There is a sense oflove and dedication inherent in the way they time their breaks with Orla's, ensuring she hasagency in her choices. This goes beyond explicit caregiving actions and institutional roles,emphasising a deeper emotional connection. The carers' approach, involving Orla in thedecision process and respecting her preferences, reflects an acknowledgement of her agency.This moves beyond a one-size-fits-all approach to caregiving.The synchronised smoking breaks and the shared activity of sitting in the rabbit hutchcontribute to the affective economies within the care home. Emotional investments are at play,shaping the social fabric of Orla's care environment. The act of smoking becomes a texturedelement of Orla's care plan, adding layers of meaning to the caregiving interactions. Theemotional bonds formed during these smoking breaks circulate within the social context of thecare home. It creates a unique emotional landscape that sets Orla apart from other residents,emphasising the importance of understanding diverse reactions to societal norms. Furthermore,the smoking breaks in the rabbit hutch can be seen as a backstage activity, a private momentbetween Orla and the carers. From the widow's perspective, it may look sweet, but it is a268performative aspect of caregiving that occurs away from the public eye. This aligns withGoffman's concept of front-stage and backstage behaviour.The private setting of the rabbit hutch allows for the preservation of Orla's dignity. The carersengage with her in a more intimate space, avoiding talking over her and respecting herpresence. This reflects an understanding of the performative nature of caregiving, alternatingbetween public and private interactions. In summary, Orla’s case exemplifies how caregivinginteractions, particularly around shared activities like smoking breaks, are imbued withemotional significance. The frameworks of abjection, cathexis, affective economies, andfront-stage/backstage behaviour provide lenses to understand the nuanced dynamics and howOrla's care plan is uniquely shaped by emotional investments and performative aspects ofcaregiving.The everyday ritual of Orla’s smoking breaks can be contrasted with William's evening with hisdaughter, which was a rare moment of emotional significance for William, marked by hisglowing demeanour and the special box of cigars sitting on his zimmer frame, an artefact of hisselfhood. However, the subsequent interaction between William and Greg introduced a shift inemotions, particularly as William faced pressure to conform to institutional norms, evident inthe insistence on having dinner and the unwanted offering of cake. The pressure to conform tocare norms is evident in Greg's insistence on William having dinner despite his refusal. The actof bringing a large slice of cake, despite William's declining appetite, reflected a societalexpectation of caregiving that did not align with William's preferences or needs at the moment,269thus illustrating the conflict between task-oriented care and “caring care”. Of course,task-oriented care is important, but when care workers are encouraged to mark off theircaregiving duties on an iPad, lots can be missed.William's glowing demeanour after the visit with his daughter exemplified the love anddedication inherent in familial relationships, which he was so often missing in the care home.However, the shift in his posture and expression after the interaction with Greg suggests a shiftfrom a moment of emotional connection to a more challenging and potentially rejectingsituation. Despite Greg's insistence, William asserts his agency by refusing dinner. This refusal,coupled with his withdrawal from the social space without saying goodnight, indicates anattempt to exercise autonomy in the face of institutional pressures. The contrast between thejoyful visit and the pressured interactions contributes to the affective economies within the carehome. Emotional investments are at play, shaping the dynamics between residents and careworkers. The act of offering food and the subsequent withdrawal of William highlight theemotional landscape within the care environment. Greg appeared stressed at William’s refusal,and interpersonal tension built between them.Furthermore, the visit with his daughter and the subsequent interactions with care workers canbe seen as both front-stage and backstage moments. The joyful visit is a private, intimateexperience (backstage), while the interactions with care workers, particularly Greg's insistenceon dinner, become performative aspects in the shared living space (front-stage). William'srefusal of dinner and the subsequent withdrawal indicate a preservation of dignity. Despite270external pressures, he attempts to maintain control over his choices and interactions. Thecontrast between the untouched cake and the cheerful cigar box symbolises the tensionbetween individual preferences and institutional expectations.The interaction involving Jean's desire for sugar in her soup provides a rich context for analysis,particularly through the lens of Kristeva's theory of abjection. Jean's request challenges thecultural norms and expectations held by the staff, leading to a negotiation of preferences andtastes within the communal setting. When Jean expressed a clear preference for sugar in hersoup, it was met with scepticism and discomfort by the staff. The emotional reactions, such assurprise and contradiction, underscored the cultural value attached to ordered meal systems.Kristeva's theory of abjection came into play as sugar in soup was considered taboo orunacceptable by societal standards. The staff's attempt to deny Jean's request and normalise itby insisting she wanted salt could be seen as a way to separate Jean's desire from what wasconsidered culturally acceptable (Connell, 1987). The power dynamics in the interaction wereevident in Keith's dismissive and condescending tone towards Jean. His attempt to take thesugar away reinforced the staff's authority and their role in enforcing societal norms. Jean'spersistence, however, represented individual agency challenging the established culturalexpectations20. The staff's refusal to give Jean sugar in her soup could be interpreted as anattempt to enforce societal norms and avoid the abject. Conversely, Jean's insistence on herpreference highlighted the potential for subversion, challenging established norms and forcing aconfrontation with the abject. This is important when thinking about care as a negotiation.20 It is worth noting that Jean was very new to the care home when this instance occurred. It would beinteresting to see if she would continue to reject these moments of control, or if she would eventually adoptthe “go with it” mentality that we can see in George271Jean’s subversion, though seemingly subtle, was an effort to uphold her sense of dignity in theresidential care environment.The unfortunate manifestation of Kristeva's concept of abjection finds a poignant illustration inGeorge's experiences, where his attempts to assert identity or significance is met with rejection.I argue that this rejection was furthered by his “abject masculinity”, his adherence to the‘normal’ forms of masculinity that care workers found easier to engage (memories of the Army,drinking pints, engaging in subtle flirty small talk with care workers). Consider, for instance, theHalloween party where George, seeking recognition, donned a paper cat mask but was largelyoverlooked by the busy care workers. This act of expressing himself through the cat maskunveiled a deep-seated desire for connection and acknowledgement.George's plea for my return underscored this yearning for emotional connection, yet it becamea point of friction with my own time constraints, inducing a sense of guilt regarding hisperceived lack of care. This interplay of emotions is a crucial aspect of Ahmed's AffectiveEconomies—where emotions circulate and impact individuals within the social setting—in thiscase within care home. This emotional dynamic is not isolated but echoes in the broadercontext, as illustrated by Kate's burnout (mentioned in the dissertation introduction) concerningGeorge's need for emotional connection. Unmet needs, when brought to the forefront, havethe potential to affect care workers, triggering feelings of guilt, inadequacy, or burnout. We cansee this when William rejects Greg’s prompts to eat as well. Greg becomes shorter with William,offended nearly, when he is unable to smoothly perform a care act. Ahmed’s framework272provides valuable insights into comprehending this phenomenon, and its implications will befurther explored in later sections of this chapter, contributing to a more nuanced understandingof and potential solutions for the current shortcomings in care.The Halloween party setting demonstrates affective economies in action, where attention,recognition, and emotional investments are exchanged. George's attempts to engage are metwith a lack of response, indicating a deficit in the emotional transactions within this socialcontext. The scarcity of emotional exchange may contribute to a sense of loss and longing,affecting the emotional economy of the caregiving environment. The busy atmosphere of theHalloween party represents a front-stage scenario where the focus is on the externalperformance and logistics of the event. George's emotional plea, however, provides a glimpseinto the backstage, revealing a more vulnerable and neglected aspect of his experience. Thejuxtaposition of the festive front stage and George's subdued backstage moment highlights thecomplexity of the caregiving environment. The lack of attention and understanding from careworkers suggests a missed opportunity for the emotional investment in acknowledging andaffirming the uniqueness of residents. Furthermore, it represented a missed opportunity forcare between George and myself: I was not able to miss my train, and had to interrupt thesituation. In reflecting, I wish I could have said something to pierce the “front stage” event andto go “backstage” to acknowledge George’s experience of loneliness (Goffman).Eva's discomfort and subtle rejection of my presence, as discussed in the ethics chapter of thisdissertation, provide valuable insights to further explore my role within the care matrix. When I273initiated a conversation about the weather, Eva's response indicated a form of social rejection,portraying my presence as an imposition that disrupted the expected interactions within thesetting. This interaction reflects the circulation of emotions within the social environment, asmy attempt at conversation and Eva's visible reaction created a discernible emotional tensionthat influenced the overall atmosphere in the room (Ahmed, 2014).Eva's care worker’s decision to use a thin nightgown in response to the heat introduces apractical consideration for comfort but simultaneously introduced a private element into thecommunal space. The act of being given a washcloth, typically a private and intimate practice,clashes with the public setting, emphasising the delicate balance between front-stagecommunal living and backstage personal activities (Goffman, 1959). This situation positionedEva to potentially feel dehumanised in the moment, prompting my decision to respect herboundaries and withdraw from the interaction, thus reasserting the idea that care is an ongoingnegotiation and process. In prioritising Eva's physical well-being to manage the heat, careworkers inadvertently placed less emphasis on her need for privacy in that particular moment,while shifting focus to her physical comfort during a heatwave. Recognising Eva’s right toprivacy, I made a conscious decision to remove myself from the situation, aiming to honourEva's sense of dignity while acknowledging the complex interplay between individual needs andthe broader context of care provision. In other words, I was trying to make a right decision inthe moment.274Employing a hermeneutical approach, I aim not only to apply theoretical frameworks to myobservations but also to engage in a reflective dialogue between theory and practice. Thisinterpretive process allows me to delve deeper into the meanings and implications underlyingthe phenomena I encounter within the care home setting.An Ethnographic Perspective on CareEthnography allows us to access the complex layerings which make up residential care settings,capturing the nuances of everyday practices and interactions. Through prolonged engagementand participant observation, it is possible to gain a fine-grained understanding of the social,cultural, and organisational dynamics that shape care provision in these settings. Ethnographyenables us to listen to the voices of those receiving care, empowering them as activeparticipants in the care process. By exploring power dynamics and uncovering hiddeninequalities, we can work towards promoting more equitable and person-centred carepractices. Ultimately, ethnographic research has the potential to inform and transform careprovision, enhancing the quality of care and the experiences of both care providers andrecipients.Making a decision in the moment is a recurring theme in my findings; my observations andreflections of my experiences in the care home illustrate how difficult it is to make thesedecisions. While it is the responsibility as an ethnographer to reflect on this process, careworkers do not have the same expectations for their work, nor do they have the same tools orresources (namely, the time to do so). In this section I would like to suggest that we recognise275and leverage the parallels between ethnographic research and care provision in residentialsettings. Ethnography, as a qualitative research approach, immerses the researcher in theeveryday lives of participants, capturing details and contextual subtleties that contribute to amore profound understanding of care. In the exploration of gender dynamics, ethnographicthinking uncovers layers that theoretical frameworks alone might miss. By immersing in thedaily interactions and daily rituals of the care home, findings reveal unspoken norms and subtlepower dynamics that shape the experiences of both care workers and residents. Ethnographicthinking extends beyond the immediate caregiving acts, contextualising practices within thebroader social and cultural milieu of the care home. The norms and values embedded in carepractices emerge as crucial elements in understanding the meaning and impact of caregivingbehaviours. Taking an ethnographic inquiry, which is still a rarity in studies on care homes,revealed how cultural backgrounds influence preferences in care practices.This project values the narratives of participants, recognising them as essential authors andinterpreters of the contextual realities of care. The stories shared by care workers and residentsprovide many different, sometimes contradicting, experiences, offering insights into themultifaceted nature of caregiving. Discussions brought out feelings of pride, overwhelm, andindifference among care workers, illustrating how personal experiences shape caregivingapproaches. These narratives elucidate the broader context in which care is provided.My presence in the field shaped the study, centering ethnographic reflexivity as a criticalcomponent of this work. Acknowledging my own biases and subjectivities, I engaged in constant276self-reflection to better understand how my perspectives influenced the research process. Myreflexivity notes revealed instances where my cultural background influenced interpretations ofcertain caregiving practices, such as when I identified more with Lucy’s instinct to avoidWilliam’s sexual advances. I witnessed the flaws in Lucy’s attempt to adequately addressWilliam’s behaviour, but I also recognised that I would react similarly, most likely due to mysocialisation as a young woman in a misogynistic society. This self-awareness prompted deeperexploration, fostering a more inclusive and culturally sensitive analysis of care work. Put simply:by reflecting on what I would have done, I understood again and again that care work is hard.Synthesising ethnographic insights with theoretical frameworks enriches our understanding ofcare dynamics. The interplay between lived experiences, cultural contexts, and theoreticalconcepts offers a holistic perspective, avoiding oversimplification and capturing the complexityinherent in caregiving. By intertwining ethnographic findings with the theory I chose to look atfindings, I have explored how emotional responses in caregiving situations are deeply entwinedwith cultural norms, contributing to a gendered pattern of dynamics within the care home.Embracing ethnographic thinking alongside theoretical frameworks elevates the discussion ofcare dynamics. It allows us to navigate beyond surface observations, providing a texturedunderstanding of gender, power, and identity within the care home. Ethnographic thinkingbecomes a crucial tool in avoiding oversimplification and uncovering the spectrum ofexperiences in the realm of caregiving. Importantly, this has allowed me to experience howdifficult it is to provide care, to make the best possible decisions in every situation. Myexperiences of sharing everyday life with the carers helped to expose their hard work and the277difficult decisions they must constantly navigate in their quest to provide care. As an outsider tothe care relationship, it is easy to point to instances of poor care provision as the sole fault ofthe care practitioner.Both care work and research involve building connections with others, listening to their stories,and responding with empathy and compassion. The fact that care, like qualitative research, isrelational underscores the potential for these two areas to benefit from one another. Theintersections between research and care work provide numerous opportunities for mutuallearning and growth. By recognising and building upon the shared relational nature of thesefields, researchers and care workers can support each other in their work, leading to betteroutcomes for all involved.Active involvement in daily care tasks allows for meaningful interactions with residents,addressing their immediate needs and fostering a sense of connection and trust. However,incorporating analytic reflection into daily practice enables care workers to deepen theirunderstanding of residents' experiences and identify underlying patterns or dynamics that mayimpact care provision. Reflective practice provides an opportunity to analyse interactions andidentify underlying factors influencing residents' behaviours and preferences. This deeperinsight allows for more personalised and effective care provision. Additionally, analyticreflection empowers care workers to critically evaluate their actions and decisions, consideringthe broader context of residents' lives and the impact of intersecting identities. This leads tomore informed and thoughtful decision-making in caregiving situations. Furthermore, engagingin reflective practice fosters continuous learning and professional development. Care workers278can identify areas for improvement, develop new skills, and refine their approach to caregiving,ultimately enhancing the quality of care provided. While incorporating analytic reflection mayrequire dedicated time and effort, the benefits far outweigh the challenges. By embracing thisduality of active involvement and reflective practice, care workers can enrich their caregivingpractice, leading to more holistic and compassionate care for residents.The lifeworld-led care perspective accounts for this complexity of care, arguing that trulycomprehensive care acts must include a careful integration of “a philosophy of the person, aview of well-being and not just illness, and a philosophy of care that is consistent with this”(Dahlberg et al., 2008). In this study, care workers have shown that they do reflect on theirattitudes, biases, and values and how this influences their work. Perhaps naming this and givingsome structure and conceptual framings to this process would help them understand how theways they interpret events and how they can better serve the needs of the residents in theircare, reflecting on their attitudes, sense of what is normal and not, and the values andperspectives they bring to their interactions. This helps understand how they interpret differentevents, impacting how they interact with others. Care homes have their own culture, and careworkers must understand this culture to help residents feel a part of it and notice when certainthings fall outside of the normal culture established as a group. The goal is to better gain adeeper insight into the care worker's role in the care relationship.When looking at care through the Gender & Power framework as provided by Connell, issues ofpower, labour, and cathexis are not cleanly separate categories: rather, they are interlocking,279and they contradict, shape, and exacerbate one another. Care as a negotiation between actors isinfluenced by gender relations. There is tension between the power dynamic of carers,residents, and men and women. The findings from this study can provide valuable insights intothe humanisation of care framework and its future application. The study highlights theimportance of recognising the emotional and physical labour required in care work and theneed to value and support the work of care workers.The humanisation of care framework focuses on promoting the dignity and autonomy of carerecipients and creating a more person-centred approach to care. The findings from this studyhelp inform the development and implementation of the framework by highlighting thechallenges and opportunities in care homes. For example, the study suggests that greaterattention needs to be paid to the emotional needs of care workers, who may experienceburnout and stress due to work demands. Furthermore, the study highlights the importance ofcreating a supportive environment for care workers, including training and developmentopportunities, support from colleagues and management, and adequate resources andequipment. By considering these factors, care homes can create a more positive workenvironment for care workers, which can improve the quality of care provided to residents.Overall, the findings from this study help inform the development and implementation of thehumanisation of care framework by providing insights into the challenges and opportunities incare homes and highlighting the importance of recognising and valuing the work of careworkers.280Effective caregiving transcends merely acknowledging needs, as care workers often strive to do;rather, it necessitates a willingness to perceive the needs of others as potentially distinct yetresonant with one's own. This requires the ability to transcend one's own worldview andempathetically engage with the experiences of others, akin to the approach of ethnography.Drawing upon Kleinman and Benson's concept of "anthropology in the clinic," care workers canderive benefit from interpreting these interactions through an ethnographic lens, therebygrasping the cultural contexts and relational complexities inherent in caregiving dynamics(Kleinman & Benson, 2006). Treating care interactions as mini-ethnographies diverges from thetendency to categorise each care recipient based on preconceived notions or stereotypes (e.g.,as "old" or "female"). Instead, it involves careful observation and exploration to discern whatconstitutes good care for each individual. Central to this inquiry is an examination of theresident's lived experience within the care home, encompassing considerations such as thenature of their transition into the care home and the significance of their unique circumstances.When considering the dynamics of abjection and affinity between care workers and residents, itbecomes pertinent to inquire who possesses the aptitude and rapport to effectively address theneeds of each resident. I observed numerous instances where a particular care worker struggledto connect with a resident, necessitating assistance from another individual who possessed abetter understanding of, or was more favourably received by, said resident. In many respects,numerous care workers already exhibit tendencies akin to those of ethnographers in theirprofessional endeavours. Emphasising the parallels between quality care provision and281ethnographic research serves to underscore the critical role such approaches play in deliveringquality care. Through the lens of gender, as explored within this thesis, we gain insight into thefundamental significance of identity and our relational dynamics in caregiving—an inherentlyinterpersonal endeavour. The analysis presented in the empirical chapters prompts us toconfront the transformative potential inherent in our understanding of gender norms withincaregiving contexts. By acknowledging the influence of gender norms, we are presented with anopportunity to reconceptualise and redefine the landscape of care. Nurturing affectiveeconomies that prioritise human connection goes beyond transactional interactions, fosteringdeep and meaningful relationships within care settings. Recognising the value of emotionallabour and its impact on the lives of both residents and staff is crucial.Context matters greatly in understanding the provision and reception of care. Historicalsocio-economic disparities, coupled with regional cultural norms, exert significant influence inthis regard. Gender roles, deeply ingrained within societal structures, shape expectations andbehaviours within caregiving relationships. Moreover, the intersection of gender with otherfactors such as class, ethnicity, or religion further complicates the dynamics of the carerelationship. For example, consider George's situation—a white cis-male married to a whitecis-woman, both actively involved in the Church of England community. Initially, they may seemfully integrated and understood within the care home setting. However, upon closerobservation, I discovered that seemingly minor distinctions in George's preferences andbackground held considerable sway over his treatment. Subtle nuances such as a distinct accent(which, unbeknownst to my American ears, carried weight among locals), differing priorities,and even the preference for wine over the expected pint subtly marginalised George. Yet, within282the context of the care home environment, where daily interactions shape one's entire world,these seemingly insignificant factors posed significant challenges for George and his careworkers.The intersection of age with gender and class introduces additional complexities. Olderindividuals may face unique challenges and vulnerabilities within the care system, particularlywhen compounded by factors such as gender identity and socio-economic status.Acknowledging and interrogating these intersecting dynamics is crucial for a comprehensiveunderstanding of care work for older adults. By examining how gender, class, and age intersectand manifest within the caregiving context, we can better appreciate the experiences andchallenges faced by individuals within this region. This contextual lens enriches our analysis andunderscores the importance of addressing systemic inequalities in care provision. However, it isessential to avoid reducing residents to mere categories that define their status. Each individualpossesses a unique identity and set of experiences that cannot be fully encapsulated by societallabels. Recognising the complexity and individuality of each resident is paramount in deliveringdignified and person-centred care.Strengths and LimitationsEmploying an ethnographic approach, this study led me deep into the lived experiences andperspectives of both care workers and recipients within this care home. This immersiveexploration yielded a nuanced and comprehensive narrative, unveiling many, oftencontradicting, challenges in care work. Each interaction, observation, and conversation added283layers to the rich and granular data, contributing valuable insights to the current discourse oncaregiving dynamics. I employed feminist methodology and process consent to address biases,create a safe research environment, and value diverse perspectives. These approaches werecrucial for conducting ethical and inclusive research with older people in a care home setting,establishing rapport, gaining trust, and producing meaningful findings.It is important to acknowledge that ethnographic studies, by their very nature, are inherentlyfocused on specific settings, groups, or phenomena. While the insights gained from this studyoffer profound revelations for the particular care home setting under investigation, they maynot directly translate to diverse care homes in different regions or countries, or to various typesof care services such as home care or hospital care. Navigating the limitations of ethnographyrequires a delicate balance. On one hand, acknowledging the contextual specificity of thefindings is crucial for maintaining integrity and relevance. On the other hand, I recognise theunparalleled ability of ethnography to answer complex research questions and unveil thehidden dimensions of caregiving relationships.Central to this endeavour was the introspection into my own positionality and reflexivity. As theresearcher, I recognised the profound impact of my biases, assumptions, and perspectives onthe interpretation and analysis of data. Transparently acknowledging these influences becameimperative for ensuring the validity and reliability of the findings. Engaging in reflective practicesallowed me to navigate the complexities of subjectivity, constantly interrogating my own role inshaping the research process.284Moreover, the practical challenges inherent in ethnographic research demanded resilience andadaptability. Balancing the demands of establishing rapport with participants, collecting andanalysing data, and maintaining ethical conduct required careful planning and resourcemanagement. Yet, despite the logistical hurdles, the immersive nature of ethnography offeredunparalleled access to the intricacies of care work and relationships.In the end, embracing these challenges and being mindful of the distinctive contributions ofethnography allowed me to generate insights that transcend mere data points. It enabled me tocapture the essence of caring care, not just as a theoretical concept, but as a lived realityintertwined with the complexities of human interaction and empathy. As researchers continueto explore the nuances of care work, embracing the immersive and reflective nature ofethnography will remain essential for unravelling the intricate threads of caregiving dynamics inspecific contexts.Using multiple theories in this study presents both strengths and challenges, and is a decisionworth defending. By integrating insights from Connell's power and gender theories, Kristeva'sabjection, Ahmed’s affective economies, and Goffman's front stage and backstage concepts, weexplore the complexities of relationships, emotions, and gender norms in care homes. Thistheoretical meshwork does not just aim for complexity for complexity's sake. Rather, it offerspractical insights for improving care practices. Each theory brings a unique perspective,contributing to a comprehensive exploration of the caregiving environment. Importantly, notevery case neatly fits all theories equally, and that's where the flexibility of this "meshwork"285proves invaluable. It allows us to adapt our analytical lens to the unique aspects of each case,without sacrificing depth or breadth.While the theoretical meshwork offers practical insights for enhancing care practices, it'sessential not to overstate its reach. Rather, each theory brings a distinctive perspective,contributing to a comprehensive exploration of the caregiving environment. For instance,Connell's theory illuminates structural influences, while Kristeva's work delves into theemotional dimensions of care. This flexibility in approach ensures that our analysis remainsgrounded in the complexities of real-world care contexts, avoiding oversimplification whileconfidently advancing our understanding and potential for improvement.The use of various frameworks reveals tensions and contradictions within the data. It brings tolight the complexities of individual experiences, such as the simultaneous adherence to andsubversion of traditional gender roles in different contexts within the care home. From apractical standpoint, the insights gained from this approach can inform targeted policyrecommendations. Understanding power dynamics, emotional labour, and genderedexpectations enables the development of interventions that address specific challenges withincare home environments, promoting the well-being of both residents and staff. Ultimately, thismethod encourages reflexivity within the research process. It prompts the continuousquestioning of assumptions, recognising the diverse and fluid nature of social phenomena. Suchself-awareness contributes to a more transparent and robust study, acknowledging thesubjectivity inherent in ethnographic research and enhancing the validity of the findings. Thismethod isn't about narrowing our focus; it's about broadening our lens to encompass the286multifaceted nature of care. By weaving together insights from various theoretical frameworks,we can illuminate the diverse facets of care provision and resident experiences. This approachnot only aligns with established qualitative research methodology but also embodies acommitment to robust and comprehensive analysis. By incorporating insights from multipletheories, we not only enhance the depth of our exploration but also ensure that our findings arefirmly grounded in the complex realities of care home environments.Finally, it is important to revisit the limitations of conducting in-person research in a care home,with adults who do not possess the capacity to self-consent on forms, and during a pandemicwhich disproportionately impacts old adults. I would have loved to interview more participants,but they were unable to provide written consent for this. I grappled with feelings of guilt forbeing able to spend time with people who had not been able to spend time with relatives orfriends for months. During the study, pandemic-related restrictions were gradually easing,allowing a glimpse into the reopening of the care home environment. However, this newfoundopenness was fragile, constantly under the looming threat of re-closure upon the discovery of aCOVID-19 case on the premises. The study's progression mirrored a continuous effort to securepermission and access to a population that, even as pandemic restrictions lifted, remainedsomewhat secluded from broader society. It is important to clarify that describing the structureof the care home itself as a limitation may not be entirely accurate, as this is the inherent realityfor care home residents. Nevertheless, the boundaries and barriers associated with thispopulation significantly shaped the design and facilitation of the study, profoundly influencinghow I came to understand and engage with both residents and care staff.287Implications for Research, Practice, and PolicyBuilding upon the examination of findings, I have here aimed to explore the broaderimplications of the emotional intricacies within the care home, analysing the impact of genderdynamics on care practices and relationships to gain insights into the complexities that shapethe caregiving environment. Findings underscore the importance of acknowledging andrespecting individual identities, emotional investments, and the intersectionality of factors suchas gender and old age in caregiving interactions. By examining how gender norms influencecaregiving responses, we uncover subtle shifts in power dynamics. care workers, consciously orunconsciously, navigate societal expectations, influencing the nature of care provided andshaping the overall caregiving landscape.The acknowledgement of individual identities and emotional investments contributes to thedevelopment of more individualised care approaches. This recognition fosters a deeperunderstanding of residents' needs and preferences, moving beyond generic caregiving practicesto a more personalised and humanised approach. The case studies emphasise the role ofemotional bonds in caregiving. By navigating gender norms with sensitivity, care workers havethe opportunity to build trust and connection with residents. This, in turn, enhances the qualityof care and promotes a supportive and empathetic care environment. The challenges faced bycare workers, such as those seen in Theresa's case, highlight the difficulties in adhering tosocietal norms while providing genuine and individualised care. These challenges offeropportunities for reflection on how normative expectations can impact the caregivingexperience.288Exploring the affective economies at play opens avenues for enhancing cultural sensitivity incare practices. Recognising the diverse responses to societal norms within the care home allowsfor the development of inclusive and culturally aware caregiving approaches. The collectiveinsights from the case studies call for a paradigm shift toward "caring care." This approachtranscends traditional norms and institutional roles, placing a greater emphasis onindividualised, emotionally aware caregiving that recognises and respects the diverse identitiesof both care workers and residents. In essence, the emotional intricacies within genderdynamics not only influence care practices and relationships but also have profoundimplications for humanising the care environment. This human-centric approach recognises themultifaceted nature of caregiving, emphasising the importance of emotional connections andindividualised care.It is crucial to reflect on the overarching themes that have surfaced throughout the study. Thissection engages in a thoughtful reflection on the findings and proposes recommendations forfuture research and practical applications within the care home setting. The case studies andanalyses underscore the complexity of gender dynamics within the care home. Beyond a binaryperspective, we observe a spectrum of responses that residents and care workers navigate,shaping emotional landscapes and power structures within the caregiving environment.Connell's concept of cathexis becomes particularly relevant in understanding the emotionallabour inherent in caregiving. The intersectionality of factors such as gender and old age reveals289how emotional investments contribute to the construction and maintenance of social orderwithin the care home.ResearchThis study lays a sturdy foundation for subsequent research endeavours to delve into otherdimensions of care work, offering a springboard for exploration into diverse aspects thatwarrant further investigation. leveraging the insights gleaned from this study, future researchcould probe into various facets, including the influence of cultural diversity on care provisionand the intricate relationship between care work and mental health. Cultural diversity presentsa rich terrain for exploration within the realm of care work. While this study focused on gender,future studies could investigate how cultural backgrounds shape caregiving practices,perceptions of ageing, and expectations surrounding care provision. By examining theintersections of culture, ethnicity, and caregiving within the care home environment,researchers can deepen our understanding of how cultural diversity influences the dynamics ofcare and the experiences of both care workers and residents.Additionally, the relationship between care work and mental health represents anotherpromising avenue for inquiry. Research could explore the psychological impact of caregiving onindividuals, examining factors such as burnout, compassion fatigue, and resilience among careworkers. By shedding light on the emotional dimensions of care work, future studies can informstrategies for supporting the mental well-being of care workers and enhancing the quality ofcare provided to older adults. The ethnographic lens, with its immersive and holistic approach,emerges as a powerful tool for unravelling the intricacies of care work. Future research projects290can build upon this foundation by employing ethnographic methods to explore new dimensionsof caregiving experiences. By immersing themselves in the daily lives of care workers andresidents, researchers can capture the complexities and lived realities of care work in ways thatquantitative approaches alone cannot achieve.This study also contributes to ongoing debates and discussions about care research and theethics of consent. In the ethics chapter, an exploration of the barriers and issues related toaccess to the field of care work unveiled significant challenges that I faced in gaining entry tothis care home. Paternalistic attitudes towards older adults, as well as towards care recipients,can act as formidable barriers, impeding researchers' ability to conduct thorough investigationsand limiting our understanding of these critical environments. It is crucial to examine thecontours and origin of these preconceptions.Paternalistic attitudes, rooted in ageism and societal perceptions of dependency, can manifestwithin care settings, where older adults may be marginalised or dismissed, their voices andperspectives overlooked or undervalued. This paternalistic lens not only undermines the dignityand rights of older adults but also distorts our understanding of their lived experiences withincare environments. Similarly, paternalistic attitudes towards care recipients, particularly thosewith complex care needs or cognitive impairments, can perpetuate a power imbalance thatcompromises the ethical conduct of research. Care recipients may be perceived as passivesubjects, rather than active participants in the research process, leading to their exclusion ormarginalisation. This condescending stance not only violates the principles of respect for291persons and autonomy but also hinders researchers' ability to capture the full spectrum ofexperiences and perspectives within care settings.Addressing these barriers requires a concerted effort to challenge and dismantle paternalisticattitudes towards older adults and care recipients. Researchers must advocate for the rights andagency of older adults, recognising them as active participants in the research process withvaluable insights to contribute. Moreover, fostering a culture of respect, dignity, and inclusivitywithin care environments is essential for creating ethical research conditions that prioritise thewell-being and autonomy of all individuals involved. By confronting paternalistic attitudes andadvocating for ethical research practices, researchers can pave the way for a more nuanced andcomprehensive understanding of care environments. This ethical imperative not only enhancesthe validity and integrity of research findings but also promotes social justice and equity forolder adults and care recipients within society.Practical Applications for Care PracticesThe lifeworld-led care perspective emphasises the importance of integrating theoreticalconcepts into the development of competence at work. As I reflect on the findings of this study,it becomes clear that care workers are not just providers of care; they are experts in their field,navigating the complexities of caregiving with empathy and sensitivity. Through my interactionswith care workers, I have witnessed their willingness to reflect on their attitudes, biases, andvalues, recognising the profound influence these factors have on their practice.292Formalising this reflective process and providing structured conceptual frameworks can furtherempower care workers to navigate their interpretations of events and better meet the needs ofresidents in their care. For instance, training sessions or workshops introducing theoreticalconcepts relevant to 'thinking like an ethnographer', such as 'culture' and 'norms', can guidecare workers in critically reflecting on their attitudes and perceptions. Fostering anorganisational culture that values ongoing learning and reflection is essential in supporting careworkers to integrate theoretical knowledge into their daily practice.The relational nature of care and qualitative research suggests a symbiotic relationship thatholds the potential for mutual enrichment. Both care work and research entail the cultivation ofconnections with individuals, active listening to their narratives, and responding with empathyand compassion. By acknowledging and embracing the relational aspects intrinsic to both fields,practitioners can refine their skills and contribute to improved outcomes for those under theircare.Understanding care through an ethnographic lens provides care workers with a valuableopportunity for self-reflection on their attitudes, biases, and values. This introspective exerciseis pivotal in recognising how diverse interpretations of events can influence their interactionswith residents. Adopting an ethnographer's mindset prompts care workers to critically examinetheir perceptions of what is considered normal and how their values shape their interactions.Given the unique culture within care homes, this reflective process becomes essential for careworkers to comprehend and integrate into the established cultural norms. Such awareness is293fundamental in identifying deviations from the norm, ensuring a cohesive and inclusiveenvironment for residents.Aligning with the lifeworld-led care perspective urges care workers to navigate the complexitiesinherent in caregiving. This approach emphasises the integration of a philosophy of the person,a holistic perspective on well-being beyond mere illness, and a congruent philosophy of care.The goal is to foster a comprehensive understanding of the care worker's role within the carerelationship, emphasising the importance of holistic care that goes beyond addressingimmediate physical needs. By intertwining the principles of ethnography and the lifeworld-ledcare perspective, care workers can navigate the intricate landscape of caregiving, promoting notonly physical well-being but also a profound understanding of the individual's lifeworld. Thiscomprehensive approach, rooted in self-awareness and cultural sensitivity, enables care workersto provide person-centred care, ultimately enriching the lives of those entrusted to their care.The findings from this study highlight the strengths and limitations of current care practices andaims to inform the development of more effective and equitable care services responsive to thediverse needs and experiences of care workers and care recipients. It emphasises theimportance of gender-sensitive care services and highlights the need for training care workersto recognise and respond to care recipients' diverse needs and preferences, particularly thoserelated to gender, relationships, and culture.PolicyWhile the primary focus of this project is not on policy impacts, the findings from this studyoffer valuable insights that contribute to broader discussions on policy reform in the care sector,294both within the UK context and beyond. Specifically, they underscore the pressing need forcomprehensive reforms that prioritise the well-being and recognition of care workers andcentre the experiences of older persons in discussions on the future of care provision for thisdemographic.Through rich and descriptive data, such as the introductory vignette detailing Kate, a careworker experiencing burnout, this study sheds light on the challenges faced by care workers intheir everyday roles. Witnessing care workers taking on extra shifts and over-extendingthemselves to support their colleagues emphasises the urgency for substantial improvements inremuneration and overall support for care workers. Adequate compensation not only addresseseconomic justice but also acknowledges the essential nature of their work, which is integral tothe functioning of society.Moreover, investing in training and efforts to support care workers define and develop an ethosof care is crucial. Care work demands a dynamic skill set that evolves with the ever-changingneeds of care recipients. Comprehensive training programs empower care workers with theknowledge and skills necessary to navigate the complexities of the care sector, ultimatelyenhancing the quality of care provided. Additionally, there is an urgent need to shift societalperceptions regarding the value of care work. Policymakers must champion initiatives that notonly address immediate challenges within the care sector but also contribute to reshapingsocietal attitudes toward the profound importance of care work. By advocating for betterremuneration, continuous training, enhanced support systems, and a societal ethos that values295care work, policymakers can lay the groundwork for a transformed and dignified caregivinglandscape.In addressing the policy needs for older adults in care, it is imperative to centre policies aroundthe lived experiences of this demographic, recognising and respecting the unique lifeexperiences, preferences, and needs of each individual. This study advocates for new paradigmsto make sense of care priorities, such as attention to the ‘smaller’ aspects of cultural normals asa vital element of life in residential care. This study supports that highlighting the voices andexperiences of older adults themselves is an essential, and often left out, component ofimproving the outlook of care services.296Final ThoughtsDuring my last visit to the care home, I sat in the sun with Julia and her godson. On thatparticular day, a funeral procession unfolded in the back parking lot, with a hearse parking for awhile as friends and housemates bid their goodbyes. When Julia's godson asked if she wouldlike to participate, she dismissively remarked, "I don't know her." It struck me that Julia mighthave been disturbed by the presence of a funeral procession on another day and in a differentmood. A nearby care worker explained that these processions visit the deceased’s "lastneighbourhood"—which, for residents, is the care home grounds. I could not help but reflectcritically on the idea that the care home is the final community setting for many of its residents.One might have lived in a traditional neighbourhood for decades, possibly woven into agenerations-long history. However, this care home is a place where most residents have typicallybeen for only a few years, many having moved from other towns. “But this is not home, is it”,Joan remarked in an interview a few months earlier.Even within the relatively short span of this ethnography, the care home had undergonesignificant changes since my first day of fieldwork. Despite participants passing away or beingmoved to higher levels of care, and members of staff leaving, the rhythm of the care homepersisted. On this particular day, a funeral took place, yet more people seemed to comment onthe rarity of sunny weather, an event less frequent in this rainy region than the inevitable cycleof illness and death. Embracing the inevitability of illness and death is an integral aspect of thereality within the realm of old-age care.297However, it is crucial to recognise that both residents and staff do not necessarily confront thisreality openly in their daily lives. A notable illustration of this is observed in the intentionalchoice made by a care worker not to showcase a portrait of George in Julia's living spacefollowing his passing. Rather than consistently revisiting the explanation of George's death, thedecision was made to spare Julia unnecessary stress, allowing her to remain rooted in thepresent and often omitting reference to her late husband.Contrary to being merely a site for medical or clinical interventions, the care home serves as thebackdrop where individuals experience and live out their lives. Residential care, in essence,promises to provide much more than just medical attention; it pledges to be a holisticenvironment where life unfolds. However, despite possessing awards and high ratings for thelevel of care, the care home did not always manage to provide comprehensive care to allresidents. George’s experience at the care home was an unfortunately salient example. Termeda "bottomless pit" by a stressed care worker, George's attempts to secure care for himself andhis wife seemed more like survival tactics. His frequent utterances of "Just go with it" reflectedhis resignation to the lack of control within this environment. Due to a feminised connotation,read: undervalued set of skills, much of the emotionally nurturing aspects of care work gounrecognised, and, “amplify the ambivalence of emotional nurturance in practice” (Hanlon,2023; 1).The overarching aim of qualitative care research is to discern how services can be improved,ensuring that individuals like George are less likely to experience shortcomings in existing care298services. As we navigate complexities within care homes, the Humanisation of Care Frameworkserves as a compass pointing toward a more compassionate and holistic approach to careprovision, supporting the cultivation of environments that honour individuals' uniqueness,fostering not only physical well-being but also a deeper sense of connection (Todres et al.,2009). The exploration of societal norms within caregiving is a strategic endeavour to identifyareas for improvement and innovation in care provision.Examining gender norms, power dynamics, and instances of abjection help us navigate towardtransformative care. By questioning established norms, we discover opportunities to redefinecaregiving parameters, opening avenues for humanisation where care workers authenticallyengage with the unique needs and experiences of care recipients. Moments of abjection, asKristeva articulates, are not only disruptive but also hold potential for transformation. Instanceswhere societal norms clash with individual identities present opportunities to challenge andreshape the existing framework, fostering more personalised care practices. Moreover, anawareness of gendered power dynamics underscores the need to shift toward more equitablecaregiving practices. Recognising power imbalances becomes an opportunity to cultivate asupportive work environment that values and empowers care workers, establishing a reciprocaland respectful relationship between care workers and care recipients. The call for "caring care"underscores the need to move beyond traditional norms and institutional roles, advocating for amore individualised, emotionally aware, and compassionate approach to care provision.299This study has offered a context-specific analysis of a particular care home, augmented bydetailed case studies and the application of carefully selected theoretical frameworks. Together,these elements yield a transformative understanding of gender dynamics in caregiving withinthe care home setting, shedding light on all-too-often overlooked complexities. Moreover, thisstudy highlights the potential of ethnographic research in care research, emphasising thesymbiotic relationship between "caring care" and ethnographic methodology. Through itsinnovative approach, this study not only contributes valuable insights to academia but alsooffers practical implications for enhancing the quality of care provided to older adults in carehomes. leveraging these insights allows us to actively shape caregiving practices that are moreattuned to the diverse needs of individuals, ultimately paving the way for a more humanisedand empathetic approach to the well-being of care recipients such as George.300ReferencesAge UK . (2018). Later life in the United Kingdom. Age UK.Allen, R. E. S., & Wiles, J. L. (2013). 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PMID: 37704280.https://pubmed.ncbi.nlm.nih.gov/37704280/323APPENDIX 3 Exhibition photos and invitationInvitation to the exhibition When We Get Old in Kolding, Denmark 2023324Discussing my contribution to the exhibition “When We Get Old”. Kolding, DK 2023325Appendix 4 Participant Information TableParticipating ResidentsHome # 1Pseudonym, gender, age Capacity/ParticipationGeorge, man, 89 Yes -Interview and Participant Observation (PO)Julia, woman, 92 No - POMax, man, 67 Yes - Interview and POLisa, woman, 83 No - POSusan, woman, 85 No - POKelsey, woman, 88 No - POWilliam, man, 87 No - POSarah, woman, 81 No - POLucas, man 76 NO-POHome # 2Pseudonym Capacity/ParticipationTheresa, woman, late 60’s No - POSilvia, woman, 102-years-old No - POMatthew, man, 87 No - POMargaret, woman 78 No - PODiana, woman, 79 No -POEileen, woman 82 No - PO326Ruby, woman, 92 No - POCarol, woman, 93 No - POHome # 3Pseudonym Capacity/consentOrla, woman, 81 Y - interviews & POEmma, woman 98 N - POKrys, woman, 65 N - POLynne, woman, 84 N - POHarry, man, 96 Y - PO & InterviewSuzie, woman, 82 No - POMary, woman, 89 No - POHome # 4Pseudonym Capacity/ConsentLuna, woman, 85 N - POJoan, woman, 93 Y - Interview & POMonica, woman, 98 Did not consent to interviews, but yes to POHenry, man, 93 N - POBrian, man, 88 YLucinda, woman 91 NParticipating StaffPseudonym327Karen, woman, late 40’sLucy, woman, early 20sLinda, woman, mid-50’sLarry, man, mid 20sKate, woman, early 40’sIrene, woman, mid 50’sEmma, woman, late 30’sJudy, woman, mid 50’sHannah, woman, mid 20’sEmma, woman, late 30’sKenny, man, mid 30’sMarcus, man, mid 40’sKatrin, woman, late 20’sFrances, woman, early 30’sVivian, woman, early 50’sMary, woman, early 40’sBecca, woman, early 40’sRachel, woman, early 40’s328

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