Placing Person-Centred Care
Geographical Gerontology , Relational Place , Long-Term Care
While the recent adoption of a person-centred approach to long-term care in Canada has done much to address the shortcomings of its biomedical predecessors (particularly bringing to light the social-psychological aspects of living with dementia), it has not resulted in notable increases in quality of life for those who live in long-term care facilities. The aim of this dissertation is to contribute a relational and place-sensitive perspective of person-centred care that highlights where the approach could be better aligned with its experience and ultimately informs a higher quality of life for people living in long-term care environments. To do so, empirically expressed tensions in the lived experiences of long-term care facilities espousing person-centred care are considered through the lens of a relational landscapes of long-term care framework derived from the burgeoning field of geographical gerontology. A qualitative, community-based, multi-site case study methodological design guided the collection of interviews with residents, staff and family members in three long-term care facilities designed to elicit their lived experiences. Observation periods in each facility contributed to my own perspective of the care environments. Tensions expressed within each of the empirically emergent themes that shaped the lived experiences of participants (atmosphere, flexibility and relationship-building) were considered as they relate to the core concepts of home(place), care and personhood to expand person-centered care and contribute to (while simultaneously arising through) the landscapes of long-term care framework. Specifically, the expansion of conceptions of home as a functional, familiar potential beyond its locational aspects; of care to incorporate a broader range of relationships and the potential of the built environment to foster these relationships; and of personhood as a de-centred process rather than a uni-directional outcome were found to be the potential nucleus of an expansion of person-centred care that addresses its experiential and conceptual tensions. Conceptually, the contribution of this research is an advancement of relational understandings of place and care in the long-term care context.