In search of 'personal care': challenges to identity support in residential care for elders with cognitive illness.

Institutions and institutional care for older people continue to evoke ambivalent reactions from older people themselves and their carers. So there is world-wide interest in 'assisted living' schemes which appear to combine the benefits of a staffed nursing home with the freedom from restriction associated with care in the community. For this American study, the first author took a part-time job as a caregiver in an eight-bed home which had been converted from an existing detached house in an affluent suburb. The report on this fieldwork provides an illuminating account of the tensions involved in working in a 'quasi-institution'. For example, the tension between relating to the residents as persons in social situations, and then shifting to a more instrumental mode to perform personal care tasks.