Residence and Care
It is typical for studies in this field to simultaneously capture elements of older peoples' residential (living) arrangements, and their health and social care. This is because in older age, many older people require both assistance with their everyday living activities and various health and social services. Consequently many places – including nursing homes, residential homes, assisted living arrangements, retirement communities, and even private dwellings – contain different elements and combinations of each.
Concerned with longer term movements between places of residence, the concept of 'aging in place' has emerged in the past decade in social and healthcare practice, policy, and research. As the term suggests, it articulates a priority to allow older people to live and be cared for in the place of their choice and to avoid their unnecessary relocation. Because of the concept's obvious geographical dimensions, geographers have naturally engaged with it and have offered more critical and the oretically informed explanations of the dynamics between aging, health, and place. Indeed, research by geographers shows the many ways in which places of residence provide attachments, meaning, and current and historical identity.
Geographers have engaged with the provision and experience of health and social care in a variety of ways. With an emphasis on the political economy of care, certain studies have indicated how policy changes, and the restructuring of health services, shift both the location of, and access to services, and older peoples' experiences of services. Indeed, with regard to the latter, studies highlight the potential tensions between the management of health services and older peoples' experiences of receiving them. In this way, commentators have been able to contribute to broader debates in the social and health sciences about what are, and what are not, the most appropriate places for older people to live and be cared for in. For example, the 'residential care versus community care debate' is implicitly geographical and has involved contributions from geographers.
On one side, the critique of residential homes has been twofold. One strand of criticism has focused on the inability of communal residential living environments to provide independence for residents and to protect their civil liberties, and the inability of regulating bodies to maintain adequate standards of environment and care. Meanwhile, a second strand of criticism views residential settings as places of stigma and social marginalization. Indeed, it is posited that regardless of whether quality standards can be improved, residential facilities will always carry negative associations that further marginalize older people through their association with them. In short, society will always dislike and think negatively of these settings as places of decay and decline.
On the other side, studies that support residential settings highlight that much of the aforementioned antiresidential literature is underpinned by an incorrect assumption that residential care is irrevocably institutional while people's homes are the only places to maintain personal control and freedom in older age. Moreover, commentators note that researchers who criticize residential settings often ignore the quality of older people's lives prior to them moving into such places. They argue that institutionalization occurs due to need regardless of the care setting, and residential settings cannot be blamed for generating dependency in older age. Others challenge the negative stereotyping of residential care and suggest that the residents of these settings are not institutionalized victims separated from society. Rather, residential settings are held up by their advocates as positive options for older persons that can be experienced by their residents as friendly, reliable, and safe communities.
Most recently, geographers have attempted to articulate the importance of place, to professional healthcare practices. Indeed, with respect to gerontological nursing, studies have attempted to identify the spatialities in everyday practice that have the potential to effect the experiences of older people. Drawing on Goffman's ideas on the creation of 'total institutions', a number of publications articulate the roles of nurses and their actions in the making of institutional places and place experiences. Meanwhile, other research attempts to connect geographical concepts and ideas to some fundamental concepts that drive professional clinical practice (such as client centeredness, autonomy, quality of care, and environment). Here, a geographical approach has helped rethink practices associated with physical and chemical restraint of people with dementia who often display challenging behavior. Various commentaries have articulated the spatial aspects and consequences of restraint and advocate the minimization of restraint and psychosocial interventions as practice solutions. Collectively, this emerging research not only connects the discipline of geography with health professional research disciplines, but also constitutes an attempt at providing a direct contribution to the evidence base for professional clinical gerontolgical practice.