PRACTICE DEVELOPMENT – CARE HOMES Older people actively reconstruct their life in a care home Glenda Anne Cook BSc, MA, PhD, RGN, RNT Reader, Centre for Collaborative Gerontology, School of Health, Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK Submitted for publication: 1 August 2008 Accepted for publication: 21 August 2008 Correspondence: Dr Glenda Anne Cook Reader Centre for Collaborative Gerontology School of Health Community and Education Studies Northumbria University Room H009 Coach Lane Campus Newcastle upon Tyne NE7 7XA UK Telephone: +44 0191 215 6117 E-mail: glenda.cook@unn.ac.uk COOK G.A. COOK G.A. (2008) (2008) International Journal of Older People Nursing 3, 270–273 Older people actively reconstruct their life in a care home The research reported here aimed to present the stories of care home residents through an interpretative study that was informed by a biographical approach and narrative method. Eight older people who lived in four different care homes in England participated in a sequence of up to eight narrative interviews over a six month period. The findings revealed how the older people tried to live as active biographical agents who were instrumental in shaping their own life in a care home. They were able to do this to a greater or lesser extent through the implementation of a range of resident-led strategies. The understanding of care home life that was developed through this study offers an alternative biography for living in care homes that is not only possible but achiev- able. This is a biography of frail older people who are active in reconstructing their life following the move to a care home, and living lives that are meaningful, pur- poseful and enjoyable. This sits in contrast to the standard biography that dom- inates current understanding of care home life that of older people merely ‘existing’ for the most part of their days. This image provides a vision for long-term care for older people, which is grounded in the views and aspirations of older people. Key words: active biographical agent, care home, older people, quality of life Background The move to a care home is a significant change in lifestyle for an older person. The transition itself commences prior to the move and the evidence indicates that adjustment continues after relocation has occurred (Kahn, 1990; Nay, 1995; Reed & Payton, 1996; Wilson, 1997). With the exception of Kahn (1999) and Iwasiw et al. (2003), studies have predominantly focused attention on adjustments to care home living during the early stages of residential life and up to 6 months whereas little attention has been given to later periods of care home life. Iwasiw et al.’s (2003) narrative study suggests that later adjustment focuses on maintaining previous relationships and establish- ing new ones, appraising their life in the home and seeking ways to maintain their identity in long-term care. Kahn (1999) reached the conclusion that adjustment was more than a feature of early residential life. He argued that residents continue to attempt to make the best of their situation by ‘a concerted and continual effort to reframe and reconstruct the social environment’ (p. 130). Yet this evidence that older people engage in an active process of adjustment contrasts with the stereotypical image of residents as passive recipients of care. An image described as ‘acting beings who are transformed into acted upon beings’ (Diamond, 1992, p. 127). For older people living in this way, the routines of care can strip away their personhood. They experience loss of control when they are unable to carry out the decisions that they make, and assault to their autonomy. These are themes that Davies (2001), Lee (2002) and NCHR and D Forum (2006) identified through their separate, reviews of the care home literature prior to 2000 and between 1970, 2000, 2006 respectively. More recently, Paternity’s (2003) ethnographic study challenged the notion that older people are always inactive or passive recipients of care. Her findings highlighted the way 270 Ó 2008 The Author. Journal compilation Ó 2008 Blackwell Publishing Ltd