Demand for conformity

A recurring feature of individual attributes at the level of resident was that there was no room for difference. Residents like Chan King did not accept any deviation from her personal care habits, not even a suggestion from her daughter or the staff, for example, regarding her diet or how her laundry was to be done, for she construed any changes to be at odds with her will and as intrusions on her privacy. She rejected their ways of doing things for her.

I have to fit into my role exactly how mum would like me to. I should agree with all her thoughts and I should be more like her. She always affirms, “I am mum, not you”. (Susan, King‟s daughter)

It is sometimes difficult because you know residents don‟t live exactly the same way as they usually did before moving into the facility…. Whenever we, especially those nursing aides, do something which is different from what she expected or that is against her will, she goes directly her own way – no point for discussion; that‟s when we get into strife. It‟s still true – she thinks that we are not grateful at all. (Helen, the nurse)

Consequently, the residents who expected conformity to their needs and desires were reluctant to talk about their likes and dislikes. In order to avoid direct confrontation, these residents tried to stay away from the others and mask the difference. For example, rather than being considered uncooperative, King usually gives those “intruders” a wide berth and stays aloof from them.

She always stays in her own room. She doesn‟t come to the public places such as the television room or the lounge much. She doesn‟t like our garden. “It‟s not a proper garden.” You see, we usually get a broom and sweep all the leaves up and shovel all the leaves back there on top. When King comes to the garden, she moves all those leaves back – she likes it to look natural (a native garden)…. The professional gardener said that summer is never the best time to move or transplant garden plants. The sun is too intense. But King did the opposite; she liked to water the plants and then dig them in at night when others were sleeping. She left all the soil on the ground so as to let them have some sunshine in the morning. (Bing, the cleaner)

Kam Chi does not like the way the lounge area is painted – the stains on the window frames. She told our professional painters, “you shouldn‟t have that colour on the window frames. It is too shiny.” Some of the nursing aides find them demanding. They hate it when they make any criticisms. You know King would look to see if there was any dust. She wrote her name on the dust – that‟s what creates the tension. (Helen, the nurse)

The same thing happened with conversation. Residents who expected conformity did not like to open up or get connected. King always presented as cool and unfriendly in demeanour. Staff and families were reluctant to discuss their care with the residents as it was considered “too risky”. Sometimes they were made to feel negative and disheartened by criticism and unwanted advice from the residents which, if rejected, made things more difficult.

In King‟s eyes, everything we ever did was not good. We don‟t talk about anything with her because she always criticises. It‟s always, “I wouldn‟t do it in this way if I were you”. (Bing, the cleaner)

I don‟t even bother to join them. I don‟t open myself up. I have my own kingdom here. (King)

Some families used one of the three strategies for coping with residents going their own way. Some families and staff adopted a “no question approach”; they showed complete obedience to the residents and acted in accordance with their wishes and demands. Susan mentioned she was willing to do whatever King told her. These families were clearly dedicated to giving them the best possible care.

Some family and staff managed the “deviance” of residents by trying to get them to realise that they simply had to follow rules, to change and to do the right thing. They did this through criticism.

When King left all the soil on the ground overnight, I told her that she is not living at home now. It is our duty to keep the floor clean, both for safety and for sanitary reasons. Whenever there is water, mud, not to mention the occasional spills and scuffs on the floor, it is dangerous. One resident was recently knocked

out when he slipped on the dirty floor plates. When the floors are dirty, the room feels and looks dirty. I told King that her action was not acceptable and was hazardous to other residents, I have to let her know that she was wrong.

(Lillian, the Director)

A third approach was to minimise the residents‟ awareness of differences between their desires and preferences and what was possible at Parkview to minimise any frustration they might experience. Both family and staff limited their conversations to what they saw as trivialities, changed the subject or diverted the resident‟s attention.

When there was tension or uneasiness, King shifted the attention and changed the topic of discussion. She did not want to talk about herself. She talked about the weather, her grandchildren, etc. Helen left King alone whenever there was “something” straining the relationship.

Demands for conformity often tainted the triadic relationship for residents, who were often held responsible for driving the relationship. The residents expected both family and staff to agree with their opinions and conform to their ways of doing things; deviation from residents‟ established ways led to them becoming uncooperative and isolated.