Doing (nothing) together : moments of contact within the daily life of nursing home residents with dementia

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Doing (nothing) together

moments of contact within the daily life of nursing home residents with dementia

Graduate School of Social Sciences

Master Thesis Cultural and Social Anthropology: Applied Anthropology (track)

Ilja Brugman

iljabrugman@gmail.com 10743405

Amsterdam, 4/7/2019

24 562 words Supervisors Kristine Krause Laura Vermeulen Second readers Vincent de Rooij Yo van Ede

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1 "Declaration: I have read and understood the University of Amsterdam plagiarism policy [http://student.uva.nl/mcsa/az/item/plagiarism-and-fraud.html?f=plagiarism]. I declare that this

assignment is entirely my own work, all sources have been properly acknowledged, and that I have not previously submitted this work, or any version of it, for assessment in any other paper."

4/7/2019 Ilja Brugman

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Abstract

The fourth age narrative depicts people with dementia as being inactive and lacking subjectivity. This research tries to counter these ideas by looking at the enacted appreciations of nursing home residents in Amsterdam and by questioning our assumptions about activity and inactivity. The nursing home residents with dementia are often excluded from research because they lack a (coherent) voice. By shifting my focus from verbal expressions to non-verbal enactments it becomes possible to account for their appreciations and non-appreciations. To see how appreciations of nursing home residents are acted upon in their daily life this research draws upon observations. Therefore looking at enacted appreciations and crafted conditions in this research is both a methodology and a theoretical standpoint. In following what was appreciated by the residents I look at making contact, something that was possible in both moments of activity and inactivity. The conditions crafted for making contact were not only influenced by the people within the nursing home but also by the environment of the nursing home itself, including pace and time. Altogether I hope to show that nursing home residents with dementia do not only live a life of inactivity and decay.

Keywords: Nursing homes, Dementia, Activity/Inactivity, Fourth age, Subjectivity, Performativity

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Acknowledgements

There are a few people I want to thank for helping me during the different stages of doing this research.

While doing fieldwork

First and foremost I want to thank the residents of the nursing home for giving me the opportunity to get to know them and all their different personalities and subjectivities. I feel privileged that I was able to do my research with such kind and friendly people. After sharing so many touching moments I eventually felt sad to say goodbye. This, of course, would not have been possible without the staff. I want to thank the managers for seeing the added value of my research and the nurses for letting me ‘do nothing’ and making me feel at home three months long. And thank you Irene and Eline for the special moments during your ‘belevingsconcerten’ and ‘ontmoetingsgroepen’ and for the conversations about my research topics.

During the process of writing

I want to thank my supervisors Kristine Krause and Laura Vermeulen for inspiring me and for making the best possible version of this thesis. Further I want to thank my friends, fellow students and family for reading and rereading my thesis and for their mental support. And a big thank you to the Ben Sajetcentrum for giving me the opportunity to share my story and keep in dialogue while writing.

And during the whole process

A warm thank you to my grandfather, who recently passed away, he showed me that while being diagnosed with dementia there are still many happy and meaningful moments to share. He never lost his sense of humour and also kept asking me how my study was going- like a real grandfather does.

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Introduction

Doing research in a nursing home

I would like to begin my thesis by describing the moment I said my final goodbye to the nursing home residents. When I started my fieldwork on a psychogeriatric ward I had never imagined that nearly every resident on the ward would eventually started to recognize me. Some saw me as the researcher whilst others thought I was a nurse, but I became a familiar face to them. Over the course of my fieldwork I would help the residents with small things, get them a cup of coffee or tea when there was not a nurse present in the room. Or I would talk or sit with the residents, hold their hand or just exchange a smile. At different occasions I was surprised with questions like ‘how is your study going?’ and whilst writing fieldnotes ‘that is for your research right?’. This mutual relationship was something that grew during my fieldwork and towards the end I even began to sense that most residents appreciated my presence. This feeling was mutual; I also liked being around them. When my fieldwork period came to an end I felt sad that I had to say goodbye to these sweet people. The first person I said goodbye to was Maria1_{and she responded that it was}

such a pity that I was going to leave. Mr. de Jong sat sleeping at the table but I decided to wake him up to say goodbye. I tell him it is my last day of fieldwork and I also say a more general goodbye to the other people. When I walk out of the living room and say a last goodbye and Mr. de Jong says ‘God bless you’ and Maria adds ‘Yes may God bless you’ I feel a bit emotional.

Before I had been to a nursing home myself I had a very different picture of what it was like to live there: I thought it would be a dreadful place to be in. And I was not alone with this idea. The idea I often came across with was that the people living there sit in a chair and stare into

nothingness all day long. This notion is very noticeable in the documentary In de Leeuwenhoek made by Dutch media personality Hugo Borst and artist Adelheid Roosen. In this documentary they spend a few days in a nursing home2_{. They talk about boredom and what they see when}

entering a ward: “there is a lot of doing nothing and napping [Er wordt veel genietst en gedut]”. This doing nothing is something I recognised myself. My grandfather moved into a nursing home

1_{In my thesis some residents are addressed by their first and some by their last names. This is how they themselves} wanted to be addressed by me. For privacy reasons their names are not their real names. For their pseudonyms I used a list of the most common surnames in Amsterdam and most common first names in the Netherlands. The names of the staff are also anonymised, except from Eline and Irene who wanted to be addressed by their real names.

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8 after he was diagnosed with dementia. When visiting I often did not have to search for him, he would be at the table in the living room dozing away. When working as a cleaner at a

psychogeriatric ward I also got little impressions of people their lives in a nursing home. The ward was often silent and I saw residents fall asleep quite often, sometimes halfway through their breakfast. These moments of silence, doing nothing and napping I conceived of as signs of boredom.

These imaginaries about nursing homes as places of boredom in which people are dozing away are also described in the academic literature on aging. Here a distinction is made between old age and ‘old’ old age in which the latter is seen as “an arena of inactive, unhealthy,

unproductive and ultimately unsuccessful ageing” (Higgs and Gilleard, 2015: vii). This idea of unsuccessful aging is further elaborated upon in the fourth age imaginary. A period of healthy and happy aging, the third age, is accompanied by the concept of ‘the fourth age imaginary’, extensively elaborated upon by Higgs and Gilleard (2015). The fourth age describes a narrative of decay and dependency. The decay shows itself through illness, not being able to express oneself properly and consequently losing one’s subjectivity and the opportunity to live a happy life (ibid.: 14). In line with this reasoning, people suffering from dementia will eventually enter the stage of the fourth age (Gjødsbøl 2017: 116). Due to these ideas about inactivity and losing subjectivity there is a fear of ending up in a nursing home during the last stages of one’s life and becoming like a ‘non-person’ (Higgs and Gilleard, 2015: 20) living life like a vegetable. Not only is the institution itself feared, the residents living in these homes are also considered to be cut off from the rest of society- enduring a social death (Stafford 2003: 17, cited in Gjødsbøl et al. 2017: 116). People talking about social death and living like a vegetable seem to be talking about moments of inactivity and add to ideas of nursing home residents living a monotonous life. These moments of inactivity are feared and, together with other ideas, create the negative connotations

surrounding nursing homes.

However, whilst I was working at my cleaning job or when I visited my grandfather I also saw nursing home residents that could not sit still, that walked around all day long eating their breakfast while standing. I saw residents laughing and enjoying each other’s company. These observations did not align with my previous ideas about nursing home residents as being inactive or socially dead. I had the impression that a lot of things happening on a ward went unnoticed. Furthermore, I wondered if residents were really appreciating some of the organized activities on their ward as they often had to be persuaded to participate in them. I asked myself if the nursing home residents could have other ways to look at or appreciate activities. Therefore my initial research question became: How are daily rhythms of activity and inactivity appreciated by nursing

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9 home residents with dementia?

As I was doing my research I noticed that residents would not always appreciate activity nor dislike inactivity. The fact that the residents seemed to be not as concerned with activity and inactivity as the people outside the homes, made me wonder what it was that the residents appreciated. Was it just their personal preference? Were some of these nursing home residents fine with a lack of activity on the ward? Or was it something else? Towards the end of my fieldwork I came to realise that it was not about activity or inactivity, but it was about making contact that was appreciated by the residents. The moment of saying goodbye to the residents shows that I built a connection with multiple residents, just by being there regularly, paying attention and listening to them when I could. Building this mutual relationship was also apparent in the smaller moments before this, in which I got to know the residents better. In these

moments residents started recognizing me and asking me about my study or just showed little signs of appreciation. During my fieldwork I was not really aware that spending time at the ward and sitting in the living room was special, it felt a bit like doing nothing. However, I realised that it was something special. It became clear that making contact with the residents was not

dependent on the amount of activity or inactivity. Contact can be made during care routines and in dancing together as well as in just sitting together drinking a cup of tea or holding a hand. Therefore, instead of examining the role of inactivity and activity, I decided to focus on

something else. I changed my research question to the following: what moments of contact are present in daily moments of activity and inactivity of nursing home residents and in which moments do they emerge?

The fourth age narrative steers ideas about dementia patients in a negative direction with direct consequences. “In presenting dementia as a single pathway towards loss and decline, alternative pathways that provide more hopeful imaginaries become obscured” (Higgs and Gilleard 2015: 72-77, cited in Driessen 2018: 24). By excluding all positive versions of life with dementia, like pleasure, the fourth age imaginary does not give a holistic view of life with

dementia (Driessen 2018: 24). Only focussing on the negative aspects takes away the nuances and the positive aspects that can improve life with dementia. Therefore we should not stop at

“regarding dependence, decline, dirt, decay and death as a ‘failure of the aging process’”, because then our understanding of everyday care practices of the old and terminally ill, and their

embodied and bodily experiences will be inadequate (Whitaker 2010: 103). With my research I want to contribute to countering this negative imaginary of the fourth age by paying attention to what is important to people with dementia themselves. Following Kafers (2013) ideas about disability we should move from thinking of disability as a problematic characteristic inherent in

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particular minds and bodies to seeing it as a situation resulting from built environments and social patters (ibid.: 5-7). This means that doing research about people with disabilities, like those with dementia, asks for looking at concrete interactions in their sociomaterial environment (Driessen 2018: 24-25).

In this thesis I will explore which moments of making contact emerge in specific

situations of daily life in the nursing home. The concepts of “enacted appreciations” by Jeannette Pols (2005) and “crafted conditions” by Annelieke Driessen (2018) will help me understand what is important to the residents. Pols (2005: 206) notes that the patient perspective in social research only accounts for people that are able to speak (coherently) and excludes people that are silent or not able to produce a coherent narrative, like people with dementia. The question how to go beyond language and accept other possibilities of hearing has been a concern long present in the anthropology of the senses (van Ede 2009: 65). It “asks for a methodology that is rooted in daily, bodily, sensory experience, not in abstract, ideational, mere theoretical reflections” (ibid.: 70). As a researcher I therefore had to go beyond language and mobilized my own senses and body. By looking at how subjectivities are enacted upon by nursing home residents Pols wants to give people with dementia a perspective in research about dementia, making it able to see them as knowing subjects in research (Pols 2005: 203-204). People with dementia might not be able to express themselves verbally, however, this does not mean they have no means to communicate at all. By looking at how appreciations can be enacted in particular situations the attention shifts from the mind to the body. This allows for the body to be studied “as subjectivity or ‘being in the world’ rather than as representation” (ibid.: 212, footnote 10).

Since I want to study the body as subjectivity my focus is on the different situations in which contact was made on the ward. Therefore I first want to have a brief look at the concept of rhythm in order to understand the role of time and pace in the nursing home environment. Throughout the day the residents are not continuously awake and active in the same intensity, together creating the rhythm of the nursing home. Looking at cultural rhythmics as a

methodology sheds light on different life rhythms of social groups (Iparraguirre 2016: 614). Therefore looking at everyday rhythms that shape the lives of individuals and people in group settings gives an opportunity to “explore how some conform to dominant routines and

timetables, while others reject such temporal structurings or become sidelined because they are thought to be out of time and step” (Edensor 2016: 14). Looking at rhythm can thus shed light on ideas about nursing homes as different from dominant routines and timetables. The different rhythm according to which most nursing home residents live can then be linked to ideas of nursing homes as terrible places.

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11 My research took place in a nursing home in Amsterdam. The location where I conducted my research is a residential, care and service centre with many different facilities. This nursing home is part of a larger healthcare institution named Cordaan, which is one of the major care providers for different client groups in the Amsterdam region3_{. On part of the wards they offer}

psychogeriatric care: nursing home care for people with different forms of dementia4_{. My main}

research method consisted of doing (participant) observations, which I carried out on one of these wards. I chose a specific ward because the team manager pointed out that there is less of a group dynamic there than there is in the other wards. She argued that there would be more room for improvement. About twelve people live on the ward and each resident has their own

bedroom, but they spend most of the time in one of the two the living rooms. Besides the nursing home residents I also engaged with nurses, a spiritual caretaker and a music therapist and other people who played a significant role in the daily life of the residents. And apart from the observations in the living rooms, I also attended an ‘belevingsconcert’ in a different nursing home and attended a workshop on how to organise a ‘belevingsconcert’. Next to that I did a few (small) interviews with nurses about their jobs and the everyday life of the residents in which I asked them to order cards with activities from most important/meaningful for residents to less important/meaningful. Lastly I took a double interview with a spiritual caretaker and a music therapist talking about their job and the activities they organise.

Ethics

Power relations between researcher and informant can be complicated while doing research on a psychogeriatric ward because people with dementia are often highly dependent on others to care for them. My initial access to the nursing home was gained through the management of the nursing home, family members were thereafter informed by means of a poster explaining my research. Then, in order to derive consent from the nursing home residents5_{I had to establish}

myself as a researcher. The huge age gap between me and the residents made it impossible for me

3_{https://www.cordaan.nl/over-cordaan}_24/11/2018

4_{The people at the focus of my research all are diagnosed with a form of dementia. The World Health Organization}

defines dementia as: “[A] syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement.

Consciousness is not affected. (…).” http://www.who.int/news-room/fact-sheets/detail/dementia 04/11/18. 5_{I used The Process Consent Method developed by Dewing (2007). This ongoing consent method is specially} developed for working with people that have dementia.

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to blend in with my informants. Therefore I think they were aware that I was not ‘one of them’. This also showed as I was often called nurse [zuster] and asked to ‘help’ or do care related tasks. This confusion was easily made because staff was mainly female and there also were some younger people working there. Consequently it was harder for me to be clear about being a researcher. In the beginning I corrected the residents and eventually most of them understood that I was there for research or ‘school’, but some kept calling me a nurse [zuster]. As none of the residents reacted negatively to me introducing myself as researcher I did not exclude anyone from my observations. Still I did not ask any ‘interview’ questions to those residents refereeing to me as a nurse. Something else that made it difficult to position myself as a researcher was the language barrier: communicating verbally was not always possible or effective. For those

residents I tried to not make them feel uncomfortable or watched by going out of their way when I felt it was needed.

Further I have to consider my relationship with activity organisers, caretakers and other people who played a significant role in the daily life of the residents. I spend a lot of time in the living rooms where they did their jobs or visited their family. In order to prevent them from feeling like I was judging them I stressed that the residents were the subject of my research. But I felt like most of the caretakers and family members were just curious and enthusiastic about my research. Another ethical concern comes from doing applied anthropology, this asks for being more aware of the potential harm6_{your activities as researcher can have on specific persons or}

the whole community (van Willigen 2002: 48). The aim of the researcher should therefore always be to protect the interests of the research population (ibid.: 54). While doing research with people diagnosed with dementia posed a few extra ethical dilemmas I still wanted to involve the nursing home residents in my research. I want my research to be ‘about’ and ‘with’ the residents not ‘on’ them. It is important to research how an illness is experienced and what can be done to support people, and in order to do so we need to include the people suffering from the illness in our research (Nind 2008: 5). I think it is important to value the things they have to tell me, even if this is not in words but in actions, and I believe this will make my research more grounded in their daily experience.

6_{Van Willigen (2002) argues that the applied anthropologist has a different status from the research anthropologist} concerning two points. Firstly, the applied anthropologist has a twofold goal of producing scientific understanding as well as contributing to change at the fieldwork site. This brings about ethical concerns regarding the impact of this change on the community. Second, the applied anthropologist works together with an agency. This agency has a certain (power) relation within the community the anthropologist is doing research in which causes complex ethical concerns (van Willigen 2002: 47). Doing research with the goal of producing change and working together with an agency can become difficult if the interests of the informants are different than those of the organisation. The organisation is powerful and giving them information about staff or residents can make them even more powerful.

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13 In the first chapter I will take a closer look at the concepts enacted appreciations and crafted conditions and how these affected my methodology. Here I will also explain how to account for subjectivities for people with dementia. My second chapter is about pace, looking at the pace of the nursing home residents and how those making contact with them used pace in doing so. The third chapter will be about silence and time and how these are part of the

environment of the nursing home affecting the ways in which contact can be made. The fourth chapter is about moments of activity and how contact is being made during those moments. The last chapter then is about moments of inactivity and about how much room they create for making contact. In my conclusion I will list the most important conditions I have seen for making contact with the nursing home residents and I will explain what I did for the applied part of my thesis. Altogether I hope to show that nursing home residents with dementia do not only live a life of inactivity and decay. I want to do this by exploring in which ways they are able to show us their appreciations and how we can become more sensitive to these appreciations.

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Chapter 1 – Looking for subjectivity

It is lunchtime, most residents are sitting at the big table while I am sitting at a smaller table near the wall. I have a plate with a sandwich next to me and I am writing in my notebook. Mrs. de Vries walks past me, points at my sandwich and says with a smile, ‘Your sandwich! You just keep writing, don’t forget your sandwich!’.

…

I walk through the corridor and pass Mr. de Jong his room, I look inside. Mr. de Jong is sitting on his bed trying to put on his shoes. He beckons me to come in when he sees me. I ask him if he needs any help with his shoes- he does. I help him tie his shoelaces, whilst I am doing this he asks me how my study is going and we have a small conversation.

…

I walk into the living room, Mrs. Bakker sees me coming in, she smiles and waves at me. I head over to the corner of the room where she is sitting in her wheelchair to say hello.

If I want to focus on what is important to the residents themselves I have to look at their

appreciations. My interactions with the residents during the fieldwork show that my presence was appreciated, I was able to make contact and this making contact was mutual. As illustrated in the example above, Mrs. de Vries looks after me when I am busy writing and do not make time to have lunch. Mr. de Jong asks me how I am whilst I help him tying his shoes.Mrs. Bakker recognise me and shows that she is happy that I am there. However, the residents did not only show appreciation towards me making contact. During the day I saw multiple residents show appreciation and dissatisfaction about all sorts of things that happened. Whilst writing this thesis I noticed that I tended to write about the appreciations that are residents expressed in words. Even though this would not be a good representation of what I have seen during my fieldwork. These verbal appreciations were only a few where the appreciations that were enacted were numerous. Like Mr. de Vries beckoning me to help him and Mrs. Bakker waving at me. I think I tend to write down these appreciations expressed in words just because they were special. They stood out, and they often confirmed what I already understood from the appreciations that were acted out. It also shows a tendency to value what is put into words more than what is

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only account for people that are able to speak (coherently) and exclude people that are silent or not able to produce a coherent narrative, like people with dementia.

As argued in the literature about the fourth age imaginary people with dementia will eventually be “stripped of the social and cultural capital of later life which allows for the articulation of choice, autonomy, self-expression and pleasure”(Higgs and Gilleard 2015: 14). Therefore they are seen as becoming a non-person or enduring a social death and thus are considered to be losing their subjectivity7_{. Kontos (2006) argues that “this presumed loss of}

selfhood is itself a product of the Western assumption that status as a full human being is

completely dependent upon cognition and memory”. Both memory and cognition are affected by advancing dementia. Therefore, dementia ‘represents the loss of all those qualities by which we have come to define our humanness’ (Robertson 1991: 143 cited in, Kontos 2006: 195-196), depicting those with dementia as non-persons due to a lack of subjectivity. Although Kontos uses the concept of selfhood, the tendency to focus on cognition is also present in thinking about subjectivity. This assumption is part of the “Western philosophy’s tendency to split mind from body and to position the former as superior to the latter” (ibid.: 195-196). Subjectivity is considered to be situated in the mind and therefore one of the first things affected when someone has dementia.

Perceptions of people with dementia as lacking subjectivity extend themselves in notions that dictate that people with dementia are incapable of showing reciprocity (Gove et al. 2017; Clare et al. 2010; Graham & Bassett 2006). For instance in interpersonal interactions people with dementia “are perceived as sometimes failing to demonstrate recognition of others, to

acknowledge or show interest in others or to respond to verbal or non-verbal invitations to social contact” (Gove et al. 2017: 950). Such perceptions of people with dementia lacking reciprocity “are reﬂected in references to people with dementia as vegetables, plants, an empty shell and as being ‘just a body’” (ibid.: 950-951). Being just a body means not only not being able to express your own feelings and ideas it also means not responding to others or being capable of making contact. However, as my observations show I experienced something else. I made contact with different residents and was able to build up relationships with them. Although most residents would indeed get confused if asked a direct question on their opinions or they would not be able

7_{The term subjectivity here indicates someone’s personal experiences. Some authors I quote use the terms selfhood} and personhood, although different I think in this case they have similar meanings. Still I want to use the term subjectivity because this term does not, like personhood, assume a stable entity. This makes it possible to conceive subjectivity beyond the verbal. Next to that subject positions can be temporal and thus be linked to specific situations (and appreciations). Therefore subjectivity brings together an experiencing self and a self that can be recognized by others, both bodily and verbal, giving the subject a position from which to speak and to be heard.

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16 to answer this question. Maybe asking a direct question was not the right way to go approach them because, regardless their inability to express themselves verbally, it was quite clear to me and the nurses what they liked and what they did not. That is why I want to argue that the subjectivity of the residents, their own experiences, are still there. We only need to learn how to see them.

As became clear studying people with dementia poses limits to cognitive and memory-centric approaches of subjectivity. In this thesis I want to take a different approach to

subjectivity. Whilst in many studies concerning subjectivity is seen as situated in the mind, I see body and mind as interwoven. I hereby take inspiration from Jeannette Pol’s work and want to look at how subjectivity can be enacted in certain moments and situations. People with dementia are still able to express themselves through “their embodied ways of valuing something”

(Driessen 2018: 25). “In their actions, people “demonstrate” what they like or dislike” (Pols 2005: 210), for example by walking away, laughing or being more talkative. This shift in focus to actions has implications for how we think about subjectivity. “Instead of the subject being an active, autonomous and authentic individual with a perspective on the world, the subject becomes a co-production, a result of interactions with others and a material world” (ibid.: 211).In following this perspective I perceive subjectivity as co-produced, as something that arises in certain situations. Therefore I deem subjectivity to be linked to moments in the daily life of the nursing home residents and not dependent on the individual characteristics relating to memory and cognition (ibid.: 215).

This approach to subjectivity asks for a different way of analysing. The focus should not be on narratives but on the enacted appreciations (Pols 2005: 210). Driessen (2018) has a similar approach to studying subjectivities of people with dementia. She focusses on practices and in doing so shows that in the right moment subjectivities can be acted and enacted in relation to others (Driessen 2018: 24-25). This again means making a shift in focus from cognitive capacities to enacted appreciations and crafted conditions, a concept used by Driessen (2018: 24). This concept points to the importance of the relational conditions: the residents are not fully autonomous beings but need invitations to become appreciating subjects (ibid.: 34). Residents can be invited to emerge as appreciating subjects through different conditions crafted by others. Driessen notes that care professionals have an important role in crafting these conditions during daily care tasks (ibid.: 26, 34). Still not only the residents, nurses and other people play a role in these interactions, the material environment also plays a role. “The subject, when conceptualised as a co-production, is the result of the interaction of the various participants in a material setting” (Pols 2005: 213). Both Driessen and Pols argue that we should understand people, and their

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17 subjectivities, not in isolation but in interaction with their socio-material environment. Studying appreciations then means being attentive to the non-verbal but also looking at how residents are engaged by others and their environments. This amongst other things could include adjusting pace, ways of speaking and gestures like holding a hand or making eye contact. Being attentive to these different ways of crafting conditions helps me to look at the moments the residents enjoy, moments of making contact, of listening to music together and enjoying each other’s company. And also at moments that are not appreciated, where residents seem unsatisfied or unhappy with the situation.

This focus on enacted appreciations and crafted conditions also influenced my

methodology. In order to understand the nursing home residents, my anthropological other, I could not rely on verbal expressions only. In order to get to know the resident’s subjectivities I had to listen to my own subjectivity: I had to partake, perceive and experience with all my senses (van Ede 2009: 65). Therefore the largest part of my research consisted of doing (participant) observations. Spending time, in the form of walking, sitting and eating with the residents helped me to understand their daily life better. The second week of my fieldwork I also slept for three nights in the nursing home, which helped me to experience how it is to ‘live’ in such home. During these observations I took part in sensuous anthropology, I was able to see, hear, smell, taste and feel everything around me (ibid.: 65). The spending a few days in the home also helped me decide what were the best times to do observations. I found the moments of eating breakfast, lunch and dinner most important and felt like they divided the day in different parts. After dinner most residents wanted to go to bed so it made sense to do my observations from breakfast to lunch and from lunch to dinner. How spending time in the nursing home affected my own bodily experiences also becomes clear in the next chapter which will be about pace.

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Chapter 2 – Aligning pace

Slowing down

During my first day at the nursing home I was sitting in one of the living rooms of the ward. There are only a few residents in there, one of them is a man sitting at a big table in the middle of the room. Mr. Jansen, he has short grey hair and a stubble beard. He is taking off his sweater, which happens very slowly. He moves little by little, the movement is not smooth but a bit doubtful. After he has taken his sweater off he tries to get up from the table. Instead of pushing away his chair he pushes away the whole table, almost hitting the woman on the other side. He gets up and tries to put his sweater on, again very slowly, but he does not really manage to do so. I have to hold myself back from helping him because I just want to see what happens instead. Eventually he walks in my direction. I ask: ‘can I help you?’ he answers but I do not understand what he is saying. He walks away towards the corridor, still struggling with his sweater. I leave this as it is and go on with taking notes, watching the other residents in the living room. (…) After a while I hear an irritated or even frustrated ‘never mind’ coming from the corridor. I look up and see the man standing there. He put on his sweater by himself but it is all tangled up and half inside out. I am surprised and feel a bit guilty, was he still waiting for me to come and help him? I go and help him untangle his sweater and put it on properly. This whole episode takes about ten minutes, which felt like a long time to me.

…

Two weeks before the end of my fieldwork I have an appointment with my supervisors. The first part of the day I spend in the nursing home and after that I take the tram to the UvA building for the appointment. I decide to write out some observations whilst I wait for the appointment. The moment I walk into the building I am a bit overwhelmed, it is really busy. Everybody is walking fast, it is noisy and big. Feeling surprised I quickly look for a more quiet place to sit down.

Pace is something we are mostly unaware of in our daily lives, unless you are confronted with a different pace or suddenly have to switch paces. If you are walking down the street you are often unaware of your pace until there is someone else walking slower in front of you, or the other way around, when someone passes you by. Pace is one of the conditions that craft the moments in which appreciations can be enacted. During my fieldwork I studied pace within the nursing

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19 home, and while doing so I became aware of my own pace. The first moment this happened is an experience from the beginning of my fieldwork. The moment where Mr. Jansen is taking off his sweater. Because of my faster pace, I miss a few points that would have told me what Mr. Jansen wanted from me. I do not follow him where he is going after I ask him if he needs any help and I do not understand his answer. I just go on with my own thing: doing observations in the living room. Trying to see everything at once I quickly shift between the different residents in the living room. In doing so my pace is quite fast. Therefore I am already a few steps ahead when Mr. Jansen calls out ‘never mind’, still struggling with his sweater. For me the question if I could be of any help was already answered when I did not understand him and he walked in a different direction, while he still seems to be waiting for me to help. This example is not only about the fact that I do not know Mr. Jansen very well because it is my first day at the ward. Because later during my fieldwork I still do not understand what he is saying most of the time. It is more about my pace of doing things, if I had waited somewhat longer on a clear answer or sign from Mr. Jansen I had probably noticed that he was still waiting for me. The second moment in which I became aware of my own pace happened towards the end of my fieldwork, therefore this time I was more used to the pace of the nursing home. When I walked into the UvA building I was surprised by the fact that I felt overwhelmed, because I cannot remember ever feeling

overwhelmed when walking into the UvA. Apparently this was a result of me spending a lot of time in the nursing home. It made me realise the differences in pace between the nursing home and the UvA. And although I was spending a lot of time in the nursing home I was unaware of how used I had become to the slower and more quiet pace there.

Something else that indicated pace within the nursing home was that I could hear the difference between a resident and someone of the staff or family walking down the corridor. This is something I was already able to hear as a cleaner in a different nursing home. There it is

important to know if there are residents around because I cannot leave my cart with cleaning supplies unattended for safety reasons. One thing immediately gives away it is not a resident you hear walking around, it is the sound of keys jingling. Next to that is was someone’s pace that made me able to differentiate: there is a certain hurry, determination or firmness in the nurse’s way of walking. Staff is almost always in a hurry because there is a lot to be done, they walk fast and they also do their job routinely; they have a goal when they walk around. While the pace of the residents is often slower, more irregular and uncertain. It does not sound like they are in a hurry when walking around. This is something that could also be experienced by the residents themselves. As Phinney and Chesla (2003: 288) note “People [with dementia] feel themselves slowing down. Words and thoughts seem slow to come and their bodies move with hesitation.” I

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20 was able to differentiate between residents and others as soon as I entered the ward and it also applied to people that I did not see before. The fact that I could hear the difference between residents and others walking through the ward shows that they have a different (walking) pace.

Together, these experiences show that the environment of the nursing home creates a certain pace which affects the daily life of the people living there. Everything there happens a bit slower than I am used to in my student life, but I think slower than what most people are used to. This slower pace does not apply to the nurses and other staff members working in the nursing home. “Within theWest, space and time have traditionally been understood as shaping our sense of how we are with others in two key ways: we are together with others insofar as we occupy the same space; but divided from ourselves and from others due to the movement of time” (Bastian 2011: 152). The residents and the staff both occupy the same space: the nursing home. But are divided by their different paces. Nursing homes themselves can even be seen as out of step and time with other parts of society, making them dreaded places. These differences in pace between the nursing home residents and others have consequences for making contact. As I mentioned before I already noticed this the first day on the ward when trying to help a resident taking off his sweater. If your pace is much faster than that of the residents you often go past them instead of doing something with them and making contact.

Aligning pace

Therefore, when making contact, slowing down was often required. Most of the time my pace was also faster than the residents’ pace. There were a few things that I started doing that helped improve my contact with residents. I later realised they often were different ways of aligning pace. I adjusted my pace of speaking, not speaking too fast helped. While asking a question or having a conversation I waited for an answer because it often comes, only a bit later. I also noticed that it often did not work to start a conversation or ask a question out of nowhere. It would help if I first made eye contact, put a hand on someone’s shoulder or would sit next to somebody and say hello. The same applies for helping someone, just pushing someone’s chair for them when walking by would surprise them but being more calm and giving a brief warning before would help. Just ‘shall I help you with your chair Mr./Mrs. …’ would be enough. In order to really make contact with a resident you have to adapt to their tempo, you have to align pace. Aligning pace is something I saw happening in different ways and during different moments of the day.

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21 residents and the effect it has on making contact becomes clear. The residents sit at the table and eat their lunch which they have been waiting for most of the morning. Staff is still cleaning up the rooms and also wants everybody to have their lunch quickly, there is also a food assistant to help.

The food assistant is making sandwiches for the residents on the kitchen counter, she has bread, different spreads, butter and plates within reach. She is making sandwich after sandwich and does not ask Pieter what he wants to eat, although he is very capable of telling her. She makes a sandwich with salmon spread. Turns around and puts it in front of Pieter saying ‘there you are Mr. de Jong’. She turns around again and goes on making sandwiches. Pieter says ‘you said the wrong name’, but the food assistant does not hear him and shows no reaction, she is still busy in the kitchen. Pieter waits for a while, and does not eat his sandwich, he then asks her ‘is this sandwich for me?’. ‘Yes’ answers the food assistant. Pieter eats half his sandwich and then puts the rest on the counter top, which I have never seen him do before.

This example shows how the different, faster, pace of the food assistant seems to confuse the resident. To begin with she does not take the time to ask Pieter what he likes to eat, while he is very capable of telling her. She makes the sandwiches fast and routinely and does not notice that she accidentally says the name of the man sitting next to Pieter. Pieter is a bit confused by this and waits for her to confirm that this sandwich is indeed his. Again she does not take the time to check more carefully. By not checking she does not align pace, moreover she is already busy with a different sandwich for another resident, not noticing Pieter’s confusion. Although Pieter starts eating his sandwich after he asked if it is indeed his, he does not finish it, which he normally does. And puts the sandwich away without saying anything. This indicates there must have been

something he did not like about it, it could be seen as a dis-appreciation.

Another example of a food assistant making lunch shows how aligning pace can improve contact with a resident.

The food assistant is making sandwiches for the residents. She turns to Mr. de Jong, puts a hand on his shoulder and asks him what he wants to eat. He does not answer immediately but his answer is clear, a sandwich with salami. The food assistant looks in the fridge but there is no salami, she goes to the other kitchen and comes back with salami. She makes him two sandwiches and gives them to him. After he finishes the two sandwiches he asks her for a third one.

Here, the food assistant slows down by taking the time to ask Mr. de Jong what he wants to eat and waits for his answer, instead of getting caught up in a fast pace of making sandwiches. This not only results in him eating two sandwiches, but also in him asking her for a third one. This time there is no confusion and it is clear to the food assistant what Mr. de Jong wants as well as it

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22 is clear to Mr De Jong that the sandwich is his. Slowing down here makes a better lunch.

As I mentioned the nurses often had a faster pace while doing their jobs than the residents living in the nursing home. But they are aware of this and they do their best to slow down. During an interview with one of the nurses, Anna, it becomes clear that aligning pace is something that happens during different care tasks.

I ask Anna to put a few cards with activities in order from most important/meaningful for residents to less important/meaningful. The first thing she does is link the cards ‘care/nursing’ and ‘having a conversation/chat’. She says that those two cards belong together because during the care routine you have conversations with the residents. People say things and you react, you have conversations about the past or about what comes to a resident’s mind at that moment. She notes that she thinks this is important because this moment of care is the basis for the rest of the day. If the care goes too fast it will result in a resident being restless, or you have a resident that refuses to eat or is depressed. She describes the moment of giving care as a moment of giving attention and making contact, the rest of the day you have to divide your attention amongst several residents she says.

Anna here describes the importance of giving attention and making contact, if you do not give this attention during the care this will affect the resident later that day. She sees restlessness as negative and contradicts this to positive moments when the ward is quiet and residents are relaxed. She also links this restlessness to pace, by describing that making contact is about adapting to the resident: ‘reacting what comes to a resident’s mind at the moment’ and about ‘care going too fast’. Both are ways of aligning pace with the residents. Making contact is also person to person in this example, she notes that the rest of the day you have to divide your attention amongst several residents. Dividing your attention has the consequence that you have more to do in less time and therefore it often increases your pace of doing things. As I noted earlier, during the day the nurses are often busy and this creates a greater difference in pace between them and the residents. How dividing your attention amongst several residents and the effect this has on making contact with them is something that also became clear in the different examples of lunchtime.

Aligning pace also happens during other activities. One of the few regular activities on the ward is organised by Irene and Eline. Once a week Irene Kruijssen, music therapist, and Eline Hoorweg, spiritual caretaker, organise their ‘ontmoetingsgroepen’ or ‘belevingsconcerten8_’.

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23 During the ‘ontmoetingsgroep’ [meeting group] they talk with the residents about a theme that is interesting to them and make music (sing and play guitar) in order to contribute to the wellbeing of people and improve group dynamics. Irene also brings her dog, a white Labrador called Storm, which she trained to be a therapy dog. During the ‘belevingsconcerten’ [experience concerts] they make use of singing and music (with carefully selected instruments) for people in the more advanced stage of dementia. It is about giving meaning to life [zingeving], making contact and personal attention. During these group activities Irene and Eline also align pace with residents in different ways.

In preparation of the ‘belevingsconcert’ that is going to take place I help Irene and Eline putting chairs in a circle, leaving gaps for the residents in wheelchairs. In the middle of the circle stands a small table where the music instruments are displayed on colourful fabrics. Storm, the therapy dog is walking through the room. The residents are brought in one by one by nurses and Irene and Eline themselves, they all get a place to sit in the circle. A few family members are also joining. When everybody is seated Eline and Irene take place in the middle of the circle on small stools that have wheels underneath so they can move through the circle at eye level with the residents. They begin to move around and start the opening song that marks the beginning of the

‘ontmoetingsgroep’. With this song they welcome everyone joining the ‘belevingsconcert personally by singing ‘welcome dear Mr./Mrs. … we enjoy you being here’. While singing they make eye contact, or hold someone’s hand. They are in front of the only man of the group, Mr. van Dijk, he does not really seem to react to the singing, staring in front of him but then he mumbles something. Eline asks him ‘can we sing for you?’. He answers very clearly ‘yes’ and smiles. Eline and Irene go on with singing, going around the circle until everybody is personally welcomed. For these concerts Eline and Irene make a program with different songs and poems to perform. Today they are amongst others singing the song ‘Tulpen uit Amsterdam [Tulips from

Amsterdam]’. Irene, while singing, takes the hands of a woman in hers and moves them gently to the rhythm of the song. She holds her hands very lightly allowing the woman to withdraw if she wants. The woman starts smiling and together they move to the beat of the song. After a while Irene gently puts the woman’s hands back on her lap and goes to the next resident, again they hold hands and move to the rhythm of the song while making eye contact. The woman smiles and sings along to some of the words, Irene sings at such a pace that the woman is able to sing along. As she notices that the woman really enjoys this song, she makes eye contact with Eline and they sing the same song again.

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24 Eline and Irene start the ‘belevingsconcert’ by welcoming everybody personally, they really take the time to give everybody a place within the circle and sing to every resident personally. Where they feel it is needed they use different ways of making contact, like a touch or by asking a question as they do with Mr. van Dijk. This way the ‘belevingsconcert’ starts more gradual and the residents are engaged slowly and in their own pace. At the time the opening song has ended most residents are more engaged with the activity. By doing all these small thing Eline and Irene craft conditions for making contact and for appreciations and pleasure to emerge. During the singing they both make eye contact and more physical contact by holding hands with the

residents. This is a way to make contact but also a way to check if the residents are able to follow what happens and keep up. If they have the feeling this is not the case they often try to slow down and align pace. By moving to the rhythm together, or by stopping the song and talking to someone before moving on. These same moments of checking and aligning pace happen throughout the rest of the ‘ontmoetingsgroep’ or ‘belevingsconcert’. During the

‘ontmoetingsgroepen’, aligning pace also plays a role in talking with residents. Eline tells me this during the interview:

“We are there for an hour and we very consciously decided to fully be there. And then it is not important what tempo someone has, when Mrs. X is talking we keep waiting till Mrs. X is finished.”

Irene and Eline do not hold on to their own pace but slow down to the pace of the residents by waiting for them to finish. As Irene and Eline do this together they are often attuned to one another and one moment of eye contact or a small sign with a hand can be enough to make each other clear they have to adjust to a resident. During these groups they are very aware of the different pace the residents live in and during a workshop they gave in which they trained

interested staff members of the organisation (Cordaan) to give ‘belevingsconcerten’ they also talk about this.

Eline and Irene tell the participants how important it is to lower the tempo of the music so it becomes slower. They say you should give the residents the opportunity to process the stimuli. To do so they slow the song down to the tempo in which the slowest can sing or hum along. Because you can always adapt from fast to slow but the other way around is not always possible. Eline and Irene have an agreement that if they notice that a song goes too fast for a resident during their ‘belevingsconcert’, for example if someone lags behind with singing along, they sign to each other and the guitarist that they should slow down the tempo.

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25 As they explain here Eline and Irene use pace to make contact with residents. By slowing down they do not go past the residents during their ‘belevingsconcert’ (and also during their

‘ontmoetingsgroep’) but create a moment in which making contact is possible and everybody can enjoy the music together.

In this chapter I wanted to show that the nursing home and the nursing home residents have their own specific pace. Concluding from the theory about time it can be said that nursing homes are not conform to dominant routines and timetables and therefore become side-lined from dominant routines. Slowing down in order to align pace with the residents could then be seen as a way to overcome this ‘gap’. In order to craft conditions for the residents to express themselves: to show appreciations and make contact you have to align pace. Aligning pace is done by different people in different ways. The nurses do this by not going too fast during care routines. The food assistant does it by taking the time to listen to the residents. Eline and Irene do this by slowing down the tempo of their songs, by taking the time to see if what they say is understood. Next to that they let people tell stories in their own tempo, and wait for answers. I myself also learned to slow down in order to improve my contact with the residents. As I have shown now, slowing down and aligning pace is often a requirement for making contact with the residents. In the next chapter I will talk about the role the environment of the living room has in relation to time.

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Chapter 3 – In the living room

The environment of the nursing home

As I already mentioned my observations did not align with my previous ideas about nursing home residents as being inactive or socially dead. I felt like a lot of ‘activity’ happened on the ward that went unnoticed because most people only see little bits and pieces of a whole day. In this chapter want to have a look at what happens in the daily life of the residents to better understand the role of time, activity and inactivity on the ward. To illustrate this I am going to describe a morning in the nursing home that could be considered a typical morning.

I enter one of the living rooms, the radio is on (skyradio) and the net curtains are closed because of the sunlight coming in. The living room is spacious with a big table placed in the middle of the room that can easily seat all six residents. At the moment only three residents are seated at the table. At one side of the room a small kitchen is situated along the wall and opposite to the kitchen is a tv corner with a couch and more relaxed chair, two other residents are sitting there. Along the rest of the walls there are several other seating options. The walls are painted a light taupe that matches the curtains and the chairs around the big table. The rest of the furniture is a hodgepodge of different styles, some of it belonged to previous residents some of it belongs to the nursing home. A lot of furniture is broken or stained and a few curtains are hanging half off their rails. It does not look really homey to me, the room is too big, but because of the different seating arrangements there is something to choose from. There are only a few ‘pretty’ things, and they are out of reach for most residents like the bouquet of flowers that is always on the big table and the decanter next to it.

As I enter the living room one of the residents, called Pieter, asks me if I can help the man sitting next to him, Mr. de Jong, to sit down at the table. I take a look to decide whether he needs help, but he mumbles ‘no’. The food assistant who is in the kitchen making sandwiches says ‘he can do it himself’. I greet the residents sitting in the living room by making eye contact and saying ‘good morning’. One of the women, Maria, sitting in the tv corner beckons me to come, I go over and ask her how she is doing. She tells me Mrs. Meijer, who recently passed away, will be cremated today. We talk about how old she was. The woman sitting to the opposite of us, Mrs. De Vries, joins

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27 our conversation: ‘I don’t know what you are talking about, are you talking about me?’. I walk

towards her and kneel down next to her, I summarise the conversation for her. After, I sit down on a chair along the wall to do my observations. I will remain there until lunch time at twelve o’clock.

10:07 Mrs. De Vries gets up from the couch to return her empty cup to the kitchen. After she rinses the cup and puts it next to the sink, she walks out of the living room. Pieter sees one of the other residents, Hendrik, who was sitting at the table get up to go to the balcony to smoke a cigarette. Pieter turns to Mr. de Jong and says ‘I never smoked’. Mr. de Jong nods and is silent for a while, just when I do not expect him to answer anymore he says ‘ for how long did you smoke?’ Pieter sees this response as an invitation and initiates a conversation, however Mr. de Jong this time remains silent.

10:15 Mrs. De Vries is back again. She sits down on the same couch and greets Maria sitting opposite her ‘how are you’ ‘good’ ‘I am also good’. Mr. de Jong and Pieter, still seated at the same spot at the big table, are having a small conversation again. I think they are talking about soccer. Mrs. Smit walks towards them and comes to an halt really close to Pieter. She does not seem to consider his personal space but also does not make any contact with him. He says ‘you can walk on, we are having a conversation’ and as nothing happens ‘go there [pointing Mrs. Visser on the other side of the table, asleep] and wake her up’. Mrs. Smit does not react to Pieter but eventually walks away to stand still in a different place. Mrs. De Vries still sitting on the couch says ‘coffee’ and stands up to make herself some coffee. When she returns to the couch with the coffee she says ‘without milk and sugar’ to Maria. Hendrik goes to the balcony for a cigarette again, he is back within a few minutes. At the table Mr. de Jong falls asleep sitting in his chair, his head is tilted backwards and his mouth is open. Silence fills the living room, but it is never absolute. You can hear noises from the corridor where the nurses are tiding up or interacting with the residents that are still in bed. And Mrs. Smit has a habit of screaming now and then. Pieter picks up a newspaper lying on the table in front of him. I hear him turning a page now and then, there is also an occasional snore from Mr. de Jong.

Two handymen enter the living room to work on the kitchen cabinets. I quite enjoy the sudden ‘action’ of the handymen but after a few glances everybody seems to lose interest, except from Mrs. De Vries. She seems to keep an eye on the two men. Maria goes to the balcony for a cigarette, it takes her a few tries to get up from her chair. When she is standing she quickly shuffles to the big

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28 table where she makes a stop to catch her breath before she goes on to the balcony. Mrs. De Vries

takes her empty coffee cup and walks towards the kitchen, when she passes me, she stops. I take the empty cup and tell her I will put it away for her. She walks out of the living room but comes back a few minutes later to sit down in a lazy chair against the wall. The handymen leave the living room.

11:27 Maria shuffles back from the balcony and sits down at the big table in the living room. Pieter, still reading his newspaper, tells Mrs. Smit walking around to ‘go away’ because she keeps screaming. There is a visitor for Mr. de Jong, I think it is his grandson. The grandson comes in and says hello, asks Mr. de Jong whether he has had breakfast yet, Mr De Jong answers ‘yes’. After that the grandson walks away towards the corridor. One of the nurses walks into the living room with jewellery from Mrs. Meijer. She asks Maria if she wants a necklace. Maria does and the nurse lets Maria pick one. The grandson walks back into the living room, the nurse greets him enthusiastically and asks him how he is doing and after a short conversation he says goodbye to his granddad and leaves. Maria has chosen multiple necklaces but can only wear one ‘otherwise you will look like a Christmas tree’ says the nurse.

11:50 Maria hears one of the nurses talking from the corridor, she calls her multiple times but the nurse does not react. Pieter turns around to have a look at the kitchen cabinets and continues reading his newspaper after that. There are other noises from the corridor, a few nurses are making themselves ready for the funeral of Mrs. Meijer. The funeral procession will go past the nursing home, where they will follow them to the cemetery. Maria asks me at which cemetery the Mrs. Meijer will be buried. I tell her to ask the nurse when she is back because I do not know. She heads over to her favourite chair in the TV corner.

12:08 It is time for lunch, the soup is brought from the kitchen downstairs. Except for Maria everybody is sitting at the big table where lunch is served. When the nurse comes in, Maria immediately asks her which cemetery the funeral is at. The nurse tells her. Mrs. De Vries is rolling and unrolling her paper placemat. The nurse starts handing out soup in bowls and plastic drinking cups for those who cannot eat with a spoon. Meanwhile Maria also takes place at the big table. She again struggles getting up from her chair. Hendrik enters the living room in his wheelchair and he asks the nurse for a cup of coffee. When all residents have their soup the nurse starts helping Mrs. Smit to eat her soup, she is the only one not sitting down at the table.

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29 12:25 Everyone has finished their soup. A few minutes later the food assistant comes into the

room to make everybody a sandwich. She works fast and routinely. Everything needed to make the sandwiches is on the kitchen counter. Plates, different spreads, butter, knifes, bread. Mrs. De Vries says ‘I do not have anything yet’, she gets bread with butter, cheese and a knife to make herself a sandwich.

At 12:45 the first residents are finished with their lunch. Maria goes back to her chair next to the tv and Pieter brings his empty plate and cup to the kitchen sink. Mrs. De Vries also cleans up, Pieter tells her ‘well done, you did a great job’. After she places her plate in the kitchen she goes to the couch next to the tv and sits opposite of Maria, smiling towards her.

There is loud talking from the corridor. Maria recognizes the voice of someone who used to work at the ward. After a while the former nurse comes in, Maria calls her name and she gets greeted first. After that she introduces herself to the other residents sitting in the living room, Mr. de Jong also recognizes her. She introduces herself to the residents, the small conversations make the residents smile and talk for a bit.

Maria, still sitting next to the tv, asks what time it is. I answer ‘one o’clock’ at the same time Mrs. De Vries says ‘exactly one o’clock’. ‘Oh then I am going to lay down’ Maria answers. She gets up from her chair and shuffles away towards her room. I ask Mrs. De Vries, now sitting alone in the tv corner, if she wants to watch something else than the current program. She says she ‘does not care’. I go and sit next to her and she tells me she is ‘not a tv person’. I ask her if she likes to read then, ‘no unfortunately not’. I ask her what she does like ‘needlework, but for now I do not have anything’. She gets up from the couch and makes herself a cup of coffee, I go back to my chair against the wall.

The food assistant comes in to clean the kitchen and the plates which are still standing on the table. Mrs. De Vries clears away her empty coffee cup and goes away to the other living room. Pieter is reading a newspaper again. The nurse comes in to have a chat. Mr. de Jong asks her if he can go to his room, she helps him go there. When she is back she asks Pieter if he wants to go upstairs to a different ward. He answers ‘I also like it here’, the nurse ‘Sure? Not too quiet?’, he says ‘no, but I can also see what is upstairs’. Just as the nurse wants to bring him there his wife comes in to visit him, they go to his room. There are only two residents left in the living room now, Hendrik staring in front of him and Mrs. Visser asleep.

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30 Whilst doing my observations and taking my notes I realised that I had to write down the time every now and then because otherwise I would have no clue what happened when while looking back at my notes. There were only a few moments during the day that clearly indicated time: the arrival of the morning shift, lunch, the arrival of the evening shift, dinner and going to bed or -for those still awake- the evening shift leaving. Next to that there would be a few visitors that would come the same day and time every week and there were organised activities that happened regularly every week. But next to these few indicative moments I did not have much feeling for how many time had passed, and I noticed this was the same for residents. Throughout the day I would often be asked by a resident ‘what is the time?’. This question seemed to be a moment of orientation within the day. Maria always goes to bed at 13 o’clock, as described above she asks what time it is after lunch. This time it is exactly time to take a nap but if for example lunch is early she could ask this half an hour earlier or sometimes later. I would often get this question in the moments in between the time shaping moments that happened throughout the day, or just before them. Nobody asked what time it was during lunch or dinner.

This living room environment with few time shaping moments plays a role in shaping experiences of daily life of the residents9_{, therefore it crafts conditions for making contact. This}

also becomes clear when we look at the same living room in a different situation. A different setting makes a different way of making contact:

The nurses have organised a party for their colleague to celebrate her 12,5 jubilee at Cordaan. For a few days the staff have been talking about this and have been busy organising the party. One of the living rooms is decorated with balloons and serpentines and there is a table with food. The residents are all sitting in the other living room, Mr. de Jong who always goes to bed after his lunch stays in the living room to my surprise. Mr. de Jong has grey hair that is cut very short and also has a short grey beard. He is wearing button ups and joggers. He is quite skinny and wrinkly but he has a twinkle in his eyes and he likes to laugh and make jokes. It is also the day Irene and Eline have their ‘ontmoetingsgroep’ which Mr. de Jong attends because he is still awake and in the living room. Half-way the ‘ontmoetingsgroep’ the party starts in the other living room, there is loud music and talking which we can hear. After a while, when the ‘ontmoetingsgroep’ is over, the doors that connect the two living rooms open and Mr. de Jong together with Maria are the first to go to the party in the other room, the other residents follow at their own pace. There is live music, food made by the staff, balloons and a lot of people that sit together and talk.

Doing (nothing) together : moments of contact within the daily life of nursing home residents with dementia