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Background
In the United Kingdom (UK), approximately 416,000 older people reside in care homes, making up 4 per cent of the over-65 population and 16 per cent of those over 85 (LaingBuisson, 2013). Most care home residents live with multiple morbidities, including dementia, stroke and Parkinson's disease, which are further compounded by physical frailty and declining functional independence (Gordon et al., 2013). On average, the length of stay in a care home is 15 months, with just under 30 per cent of people living longer than three years after admission into care (Forder and Fernandez, 2011). Unlike other health-care institutions, care homes have a two-pronged responsibility that is encapsulated by the duality of the term ‘care home’ itself. Care homes must not only ensure that residents’ complex care needs are looked after but should also provide a homely and comfortable environment in which residents can continue to live full lives and experience optimal subjective wellbeing (Peace and Holland, 2001). Care homes are also places of work and emerging models of care provision have been developed to support staff in providing person-centred care that views care home residents as rounded human beings rather than a collection of ailments and pathologies (McCormack, 2004). Given this multi-layered complexity, research that explores care home living from a broad social perspective – rather than a medical perspective – is critical to understanding how older people experience care home living.
The extent to which care homes meet their dual responsibility is variable. Even when residents’ physical care needs are met, many experience poor social and emotional wellbeing. In the institutionalised care home environment, residents can feel disconnected from their life-long identities as self-determining individuals (Andersson et al., 2007). Anthropological studies of moving into a care home have described the ‘social death’ that can occur as residents become disconnected from the domestic and social environments that shape their sense of self (Hockey, 1990; Hazan, 1980). Identity is a social process, where the ‘self’ is created and sustained within the context of others (Jenkins, 2014); however, there is considerable evidence that care home residents have scarce opportunity for social connection. In a study by the Alzheimer's Society (Sharp, 2007), care home residents were observed receiving only two minutes of meaningful social...