What to wear today? This apparently simple question is informed, as sociologists tell us (and almost any magazine or advert), by what we want to say about ourselves. Social workers have known this for a long time; that what they wear is symbolic and has a meaning to themselves, and their professional context.
This makes Buse and Twigg’s recent article particularly interesting. Their study is part of is now called ‘cultural gerontology’, which is mix of ethnographic and qualitative methods.
This particular article reports on the data the authors collected in three English care homes where they focused on the significance of clothes in the daily lives of residents with dementia by observing what happened around clothes, what people wore or carried, and what was particularly relevant to this activity of daily living in a care home.
The study draws on a larger study of dress and dementia. It focuses on the research undertaken in three care homes involving 27 residents with dementia, and on frontline care home workers’ and managers’ views and practice.
The authors discuss the data in terms of familiar sociological themes such as space and place; but also points to the ways in which older people who are mentally and physically frail have not generally been included in studies about ‘culture’ and indeed clothes and fashion.
Key themes identified may be relevant to practice and understanding of the tensions for many parties in a care home. For instance, one finding relates to the tension between a care home being someone’s home, and the need to share this communal space. So, for example, at home people might pootle around in pyjamas but in a care home during the day this might seem inappropriate and risk judgements that care is not being provided by the home.
Furthermore, the researchers’ observations about the use of ‘props’ extends our understanding of clothing to take account of items such as handbags and outdoor garments.
In referring to their observation of ‘props’, typically handbags, they found these were being used by residents with dementia as ways of indicating activity or marking out privacy within the home by suggesting the person is busy looking at its contents, or uses a handbag to claim their seat or similar.
So, they observed, residents can be seen as holding a handbag (suggesting being outside one’s home) and wearing slippers (an indication of being indoors). This they term the ‘ambiguity’ of the care home – a place that is both public and private.
Public space activities also include the notion of ‘dressing up’ in a private space rather than dressing up (putting on party or best clothes) to go out. However, when residents with dementia do go outside the home, the subject of what they wore can lead to moral judgements being taken or assumed. Staff expressed their worries that what residents wore could be a visible sign of ‘being cared for’ or not, and the sometimes this needed to be negotiated or persuasion went on. Being dressed in a different way to other people could contribute to the stigma of dementia.
The authors conclude that
…cultural approaches can fruitfully be extended to the context of the fourth age and to older people experiencing mental or physical frailty; and in doing so it expresses a commitment to the wider inclusions of such groups.
Visitors to care home, professionally and personally, may find it valuable to look beyond what people are wearing and how they use and feel about items of clothing. This may prompt thinking about meaning and emotion. Over simplistic judgements might be challenged.
With the focus on personal care tasks when caring for people with dementia it is important to see that ‘dressing’ is not the only time care home staff and residents manage clothing and accoutrements.
One theme in this article focuses on how people working in care homes work to manage the situation when a resident puts on ‘outdoor’ wear and wants to go outside for various reasons or perhaps sees the wearing of such clothes as somehow important. Such work may be called emotional labour, commonly reported as typical of care home work, as well as the hard graft of helping people dress and undress.
This is an article full of insight and empathy for the views and experiences of people living in and working in dementia care homes. But it also offers opportunities to reflect on how dignity, compassion, kindness and patience can be part of relationships that are built around tasks.
We all think about what to wear, some more than others, so such research is easily translated into everyday experiences.
Buse, C. & Twigg, J. (2014) Looking ‘out of place’: analysing the spatial and symbolic meanings of dementia care settings through dress International Journal of Ageing and Later Life 9 (1) pp.69-95 [Abstract]