Residents’ Independence
In the interviews with residents, ‘independence’ or ‘independent living’ was an important theme, often referred to when residents were asked what they valued about where they lived. The word ‘independent’ was used with two different meanings. These had different connotations and implications.
First, independence meant autonomy – being able to live and do as they chose: “I can do what I want” (Resident 50). This was a particularly strong theme: the residents valued the freedom to come and go as they pleased; perceiving themselves to have the freedom to do as they liked; not being told what to do; and organising activities or not as they chose. From the academic literature, we know that autonomy is one of three fundamental motivations for people (the other two are: feeling competent and a sense of belonging with others). Autonomy is essential to well-being and thriving.
An important aspect of feeling independent/autonomous was the perception of having choices. This was frequently talked about with reference to choosing whether or not to join in activities taking place in or from the almshouse site, or choosing whether to have company or not. Many residents emphasised how they value feeling free to come to communal areas to talk to people if they feel like it but equally feeling free to close their own front door when they feel like having time to themselves. In one case, when faced with a requirement to move to other accommodation to allow the redevelopment of their current homes, residents valued being offered the choice of moving back in three to five years, even while acknowledging that their circumstances would be different. Some exercised their choice to move elsewhere rather than to the accommodation planned for them. There was evidence of widespread respect amongst residents and staff for choices to be an active member of the community or to be more private or to move between the two. See Additional Information below for more information on the importance of choices for older people.
Second, independence meant capability – having the physical or mental ability to deal with what life required of them. This links to the fundamental motivation for competence which has been established in the academic literature, and like autonomy is also critical for well-being and thriving. In the interviews, this particularly related to awareness of declining physical or sensory abilities with increasing age. With some, there was pride in maintaining abilities as long as possible:
“I still use my electric drill when I can and things like that”
(Resident 1).
One resident explicitly linked independent capability to self-esteem. There is potential for severe negative impact if a person’s sense of capability is undermined so that they feel incapable.
Alongside residents’ emphasis on the importance of independence in terms of their capability, they valued the security of support that was readily available to them if they needed it: “If anything happens…you only have to press a [alarm call] button” (Resident 11).
In fact, this was a particularly valuable aspect of almshouse living for them. In the theme on Person-centred Support, we discuss the importance of individualised and appropriate support. But there is a very delicate balance required between providing support and respecting autonomy and capability. For example, in a focus group, Resident 29 said “Everyone keeps an eye on each other” and Resident 30 immediately clarified: “From a sort of distance, nobody’s in your face”. An implication from the interviews was that, for some residents, more support could undermine a sense of independence, particularly with respect to capability. Residents could, at one and the same time, appreciate aspects of support while disliking them – an interesting example here was discussion of the daily check-in system which required each resident to push a button each morning to indicate to staff that they were well. One resident said “I hate it, I hate it” (Resident 25) but, during a focus group, there was acknowledgement that the system had worked successfully in a recent case. There was evidence of resistance to other elements of support such as a key box outside the door of each home so that a carer could gain access: this led to comments that it was “too institutionalised” [Resident 64] and also “We’re not that old yet” (Resident 62). This last comment echoed others in which residents associated some types of support with old age and resisted them on that basis. However, others accepted that some support was needed:
“I know there are some things that happen now where I think, ‘No, I can’t do that”
(Resident 32)
There was appreciation for staff who managed to strike that careful balance and are there only when needed.
There was recognition of how the balance will be different for different people and can change for individuals, either temporarily during a bout of ill-health for example, or gradually over time if capabilities reduced as people got older. One insight from the interviews related to how families can undermine independence: one resident spoke of how she had seen people go downhill when they moved to be near family. She said:
“I know it’s a funny thing to say, but I always say, I’m very grateful that my children don’t live near me…which means I have to make decisions for myself”
(Resident 24)
This shows the value of one aspect of support offered by staff in some of the partner charities where they would advocate on behalf of residents, and potential future residents, in discussions with their families.
In the interviews and focus groups, some residents’ attitudes showed a degree of institutionalisation. By this we mean a dependence on support beyond what seems necessary or assumptions about regulations being imposed. Speaking of other residents, one person noted “some of them won’t even try to do things” (Resident 2), giving the example of neighbours bringing the TV remote control to the staff office to get someone to change the batteries. On one hand, people brought previous experience with them to their lives in almshouse accommodation – a few expressed expectations of imposed rules. On the other hand, communication from the charity in some cases led to (unfounded) assumptions that the charity sees itself “as responsible for our happiness” (Resident 27). Careful wording of all communications, emphasising personal responsibility, and maintaining clear and consistent professional boundaries during interactions with residents can help to manage expectations.
