Patient, resident, or person: Recognition and the continuity of self in long-term care for older people Jari Pirhonen ⁎, Ilkka Pietilä School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Finland article info abstract Article history: Received 24 April 2015 Received in revised form 20 May 2015 Accepted 23 May 2015 Available online xxxx Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of ‘total’ institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person- centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study. © 2015 Elsevier Inc. All rights reserved. Keywords: Long-term care Continuity of self Recognition Older people Roles Introduction Moving into long-term care (LTC) greatly changes the lives of older people (Caouette, 2005; Milligan, 2009). They have to leave behind their home, neighborhood, and often their previous social surroundings (Barredo & Dudley, 2008; Kivelä, Köngäs-Saviaro, Laippala, Pahkala, & Kesti, 1996). Gubrium (1997, pp. 84–90) described these changes as breaking up a home. He noticed how older people talked about losing their previous homes in terms of losing places, possessions, and relationships, although de facto ‘it was their selves that were clearly at stake’ (ibid., 85). They were afraid of losing all the place-related memories of people and events, ‘all the little things’ that had made their lives unique. If breaking up a home was about losing one's self, then we suggest that building up a home in LTC might be about retaining one's self in the new surroundings. Just as Gubrium revealed the fear of losing one's self behind mundane talk about losing things, this article addresses the possibilities of older people to retain their selves in the midst of mundane LTC practices and interactions. These mundane practices and interactions afford older people with new roles and role expectations, which may challenge the continuity of their selves. It makes a difference for older people whether the care institution and its staff see them as persons, residents, inmates, or patients. The theory of continuity is one of the prevailing theories of aging today (Atchley, 1989; Parker, 1995). It emphasizes the importance of a life-long lifestyle and the continuity of personal characteristics as key elements in successful aging. There is also a rich body of knowledge about the links between the continuity of self and well-being in old age (Andrews, 1999; Atchley, 1989; Bozinovski, 2000). However, aging itself may challenge the continuity of self as it changes the person's appearance and physical abilities (Öberg & Tornstam, 1999; Webster & Tiggemann, 2003) and may lead to cognitive disorders, such as dementia (Cohen-Mansfield, Golander, & Arnheim, 2000; Surr, 2006). Role expectations in LTC Journal of Aging Studies 35 (2015) 95–103 ⁎ Corresponding author. E-mail addresses: jari.pirhonen@uta.fi (J. Pirhonen), ilkka.pietila@uta.fi (I. Pietilä). http://dx.doi.org/10.1016/j.jaging.2015.05.004 0890-4065/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Aging Studies journal homepage: www.elsevier.com/locate/jaging