Being

Since the latter part of Nussbaum’s (2011) question incorporates residents’

possibilities to be, it deals with their possibilities to maintain a social basis of self-respect. Therefore we need to consider their recognition as persons and chances for affiliation in assisted living surroundings.

3.2.1 Recognition

According to the philosopher Axel Honneth (2005), the whole social world may be seen as a struggle for recognition. The struggle occurs in three separate fields since

there are three fundamental elements in our positive identity: confidence, self-esteem, and self-respect. Honneth (ibid.) holds that we need to feel loved by our significant others (self-confidence), appreciated by our community (self-esteem), and respected by society (self-respect) to build and maintain a positive identity throughout our lives. Needs for love, appreciation, and respect do not vanish in old age. On the contrary, they might become more urgent when older people lose their functional abilities due to ageing and become more dependent on other people to be recognized as persons. This is particularly true for those older people residing in assisted living facilities, since in addition to diminishing functional abilities, they have left behind their familiar surroundings when transferring into the facility. They have also entered a new, perhaps frightening, social world and with new rules.

Culturally, moving to a facility may bring feelings of otherness, since our culture emphasizes successful ageing, where success is defined as activity, autonomy, and anti-ageing (Bowling & Dieppe 2005; Katz 2000). Also, moving to a facility has been described as a major event in older people’s lives (Gubrium 1997; Powers 1995).

According to Grenade and Boldy (2008, p. 472), becoming an assisted living resident means leaving behind a private home, family and friends (and pets), local communities and previous lifestyles. The routinized life in the facility may also endanger older people’s control over their lives and their ability to express their identity (article 3). Thus, older people’s recognition as persons, their chances to feel loved, appreciated, and respected, need to be thoroughly considered in assisted living surroundings. The transfer from a private home to a care facility may also be a relief to an older person and it may impact positively on their quality of life. However, encountering residents as persons affirms their continuity of self in any case.

Philosopher Arto Laitinen (2002; 2009) has elaborated on two features of recognition that are particularly fruitful when applied to assisted living: 1) recognition possessing the two powers of creating and maintaining objects and 2) the practicality of recognition. The two powers of recognition become apparent when we consider an older person transferring from a private home to an assisted living facility. The first power of recognition is to create; through the attitude of the staff and the nature of everyday practices, the facility may create an identity of an inmate or even a patient for the person moving in. According to previous literature, this is a regrettably common procedure, although probably not intentional (Collopy 1988; Lidz, Fischer

& Arnold 1992). As I pointed out previously, care facilities today have been noted still to have some features of Goffman’s (1968, p. 17) total institutions, where frail older people are at risk of losing their identity. However, the second power of recognition is to maintain; through staff attitudes and the nature of everyday

practices, the facility may support older persons’ life-long identities even after they have transferred into assisted living.

Laitinen (2002) also holds that due recognition is practical, which means that recognition is not just a cognitive procedure but it is action as well. Recognizing is acknowledging features and treating accordingly, i.e. recognizing a person requires one to treat her as a person. To return to Honneth’s (2005) idea of tripartite recognition, everyday life in an assisted living facility should be organized so that residents’ needs to be loved, appreciated, and respected are both acknowledged and actualized. Recognition from others is particularly important for frail older people and their continuity of self. The maxim of person-centeredness shows that care providers are already on the right track.

3.2.2 Affiliation

As Honneth (2005) points out, the recognition of a person actualizes in relation to other people and society (institutions). The transfer from a private home is therefore a significant transition in older peoples’ lives with regard to recognition. Gubrium (1997, pp. 84–90) describes the transfer from a private home to a care facility as a process of “breaking up a home,” when older people reluctantly give up their former lifestyle. Older people are still attached to people, places, belongings, and memorable events from the past although they understand that life cannot continue as it did before the move. According to Bethel Ann Powers (1995, p. 180), residents perceive a care facility as “the end of the line” where they become separated from the familiarities of home and life outside the walls. Jorun Drageset (2004) emphasizes the loss of social ties, especially relatives and close friends, which may result in loneliness in assisted living. People can indeed feel lonely although they are surrounded by others around the clock (Jylhä & Saarenheimo 2010; Uotila 2011).

When residents long for their previous life circumstances very much, their sense of belonging is directed to somewhere else, which may result in ruptures regarding their affiliation.

Nussbaum (2011, pp. 39–40) finds that affiliation is one of the most important human capabilities together with practical reasoning. For her, affiliation is a twofold capability. Firstly, affiliation denotes “being able to live with and toward others, to recognize and show concern for other human beings, to engage in various form of social interaction, and to be able to imagine the situation of another (Nussbaum 2011, p. 34).” Secondly, affiliation is about “having the social bases of self-respect and

non-humiliation and being able to be treated as a dignified being whose worth is equal to that of others (Nussbaum, ibid.).” Based on these definitions, affiliation encompasses the social bases of self-respect, and has a close connection with Honneth’s (2005) concept of recognition as elaborated previously. Residents should be able to live among, and connected to, others, and be treated as dignified beings whose worth is equal to that of others. We also could say that residents should be able to bond with people inside the facility and maintain their previous connections with people outside.

Previous research has largely compared these social worlds, providing conflicting results of their importance to residents (Burge & Street 2010; Fessman & Lester 2000), yet Nussbaum’s perception of affiliation as a twofold capability emphasizes the importance of both social worlds. This study approaches affiliation in assisted living through ruptures in it, i.e. residents’ experiences of social isolation. Due affiliation may not be reached when residents feel that they cannot reach people on site or that their bonds with people outside are weakening, which results in social isolation, which in turn may result in loneliness (Weiss 1973; Victor, Scambler &

Bond 2009). Social isolation is usually seen as an objective and quantifiable reflection of one’s lack of social interaction and the reduced size of one’s social network (e.g.

Nicholson 2012; Steptoe et al. 2013), yet it can also be understood and addressed as a subjective experience. Victor, Scambler and Bond (2009) define social isolation as lack of communion between individuals and detachment from the socio-spatial context of daily life, highlighting the spatial elements of social isolation (see also Sinclair, Swan & Pearson 2007).

Social isolation might have specific features in the assisted living context where one is physically close to others, yet at risk of feeling separated from the everyday social environment along with prior social relationships. We need to know how the experiences of social isolation are embedded in the social context and structure of the assisted living environment, and examine the opportunities of conceptualizing and addressing social isolation as ruptures in affiliation. Thus, to understand what older persons are able to be in assisted living, we need to study whether they are recognized as persons and whether they are able to reach affiliation.

The theoretical background of this research was framed in this chapter on human flourishing. The Aristotelian perception of Eudaimonia (flourishing) was converted into Nussbaum’s capabilities, which were then conceptualized as residents’

possibilities to do and be i.e. their autonomy, agency, recognition, and affiliation. In the next chapter (4), I will present the detailed research questions. Chapter 5 presents how and where my empirical research was conducted.