Detachment inside the facility

When older people transfer into assisted living, they enter a new social surrounding that is given to them i.e. they cannot choose who the other people present are. These other people make up the residents’ primary social world. Inability to bond within the primary social world may result in social isolation which then may result in feeling lonely (Brownie and Horstmanshof 2011).

Other residents’ qualities both affirmed and impaired the residents’ affiliation.

Living together in a group home enabled people to choose their company inside the home although they could not influence who the other residents were. Sally explained how resident heterogeneity enabled affiliation in a group home.

Sally: Well I choose who is suitable for me.

Jari: Okay. So you can like choose who you want to hang around with.

Sally: Yes. That's it. And so to speak I prefer them to be men.

Jari: Oo-kay.

Sally: Most women are just, you know, full of themselves and clothes and stuff, but they don't like, care...men think more broadly about things, at least the ones I know. (Excerpt 20, female resident, 82, moving independently with walker) Living in a group home for both sexes suited Sally perfectly since she preferred the company of men. Violet and Martha become close friends in the home, and as we saw, Sarah had her ways to make her primary social world more suitable for her regarding discussions during meals. However, since our interviewees were those with the best cognitive capabilities, they often found the co-residents impossible to socialize with due to their dementia illnesses. Paul’s account was revealing when I asked if he could bond with other residents.

Paul: Some of them just stare out in space. Can't really connect with them.

Jari: You mean some guys have some kind of memory disorders?

Paul: Memory disorders.

Jari: Yeah, then it's kind of difficult to make contact.

Paul: No, it won't work. Even when we were in the sauna with a couple of these guys, you can't really have a decent conversation with them. (Excerpt 21, male resident, 82, moved independently with walker)

For the residents with the best cognitive capacities, peers to bond with were few and far between. Paul and some others kept their door locked to prevent people with dementia from entering their rooms. Ida, who previously said that she stayed alone in her room due to dizziness, considered the quality of peers another reason to stay put.

Jari: Okay. Well, do you feel that you belong to a certain group living here?

Ida: I'm terribly lonely. But I don't miss anything that much. They are all like me.

Jari: Right. So you mean that being alone works well for you.

Ida: It works out fine. It's okay, everybody's just as old and silly as me.

(Excerpt 22, female resident, 94, moved independently with walker)

In the interview, Ida explicitly stated that she was terribly lonely, yet she chose to be alone in her room since other residents were “just as old and silly as me”. Harry gave a straightforward account regarding other residents when I asked if he took part in the recreational activities available.

Harry: Well they do have activities. I could attend many of those but I don't feel like it.

Jari: Yeah okay.

Harry: Doing activities with damn bitches like that, bitches who are a hundred years old, there's nothing to talk about you know, and we have nothing in common, so I feel like a hairy troll, fuck it. (Excerpt 23, male resident, 73, could move only aided)

Harry could be seen as a socially double marginalized resident since he was a relatively young man surrounded by older women, which made it difficult for him to bond with the others. Actually Paul, Ida, and Harry each seemed to choose to be alone rather than interacting with other residents, an interesting aspect related to social isolation in assisted living. On the one hand, they could have chosen the company of co-residents, which then would have made them feel different and disconnected from them even while spending time with them. Instead, they chose being alone in their rooms.

Difficulties in bonding with co-residents highlights the role of the staff in affiliation with primary social world, yet that was also not a simple issue, as Harry expressed.

Jari: Do they (nurses) know what your individual needs are, what kind of things Harry wants?

Harry: I don't know what they ...no I don't think they know.

Jari: Do they have time to chit-chat with you?

Harry: Not really, we only talk about work related stuff.

Jari: Alright. So you talk about things that have to do with living here, like when it's dinner time or when you can have a smoke...

Harry: Yeah, that's it. We don't talk about other stuff.

Jari: No personal stuff.

Harry: Yeah, no nothing like that. (Excerpt 24, male resident, 73, could move only aided)

Older people residing in assisted living are as colorful a group of people as any group of individuals. In addition, residents’ illnesses and medications can bring on negative characteristics and conduct disorders. The staff may find some residents challenging, which easily leads to avoidance and keeping interactions with certain residents to a minimum. Harry seemed to be such a straightforward person that the staff avoided contact with him. When we conducted the interview, it was past lunch time and he was still waiting for a nurse to help him with his morning routines. He was a smoker and he said that sometimes he had to wait until 4 or 5 p.m. to get to a balcony for a smoke. The staff seemed to keep their interaction with Harry to a minimum. Joanna also said that there were staff members who showed no personal interest in her whatsoever.

The staff’s personal characteristics were only one side of the story, the other was, once again, the staffing ratio and the staff’s workload. Eight out of ten interviewees said there were too few helpers available. One commented that there was enough aid for her, but not for those who were in worse shape than she was, and only one interviewee said that the situation was good. The staff said that their resources covered only basic care, which my observations supported, as seen in the next excerpt.

There were three people in Ella's room; the daughter, nurse and Ella who was in bed. The nurse was explaining that there were only two nurses on duty, and that they were going to give Ella a shower today. They hadn't had time to do that before lunch even though they should have. The daughter had asked why her mother was still in bed after noon in her night-diaper and without her teeth. The

nurse was a little upset and explained that one shouldn't be mad at the nurses, but to direct any complaints to their superiors. (Excerpt 25, observational notes) The small number of staff reduced residents’ affiliation inside the facility, since many residents, like Ella here, could not independently get out of bed and the insufficient staffing ratio resulted in these people being helped out of bed only once a day, usually for lunch. It was self-evident that this staff procedure reduced social contacts since the residents usually had to stay alone in their room all evening. Also, many nurses said that they felt sorry about this policy, because they would have preferred to spend more time personally with residents, time that would have prevented social isolation. The rule of keeping the staffing ratio to a minimum came from the economics of staffing, yet Ella paid the price once again.

Affiliation inside the home seemed to be difficult, yet not impossible, to reach.

As mentioned previously, friends were made among peers, and most of the interviewees also had good relations with some staff members.