Moral Care: The Spatial Organisation of Work in Residential Homes for Older People

This paper examines the impact which the spatial organisation of work in residential care homes for older people has upon the quality of care-giving. It has been proposed that the privatisation of residential care in the United Kingdom has resulted in a dualistic market. Here, residential homes at the lower end of the market drive down costs in order to attract local authority purchasers of care. Residential homes at the higher end of the market, on the other hand, compete on quality, tailoring their services to meet the needs and demands of older people who purchase their own care. This paper examines one way in which this divergence in the costing of care has altered the manner in which care work is carried out: namely, how space is used. The paper draws upon an ethnographic study of two residential care homes for older people, which are located in the South of England. It found that, in the higher cost home, care workers enforced strict boundaries concerning the management of personal care activities and their resulting waste products. Here, care workers’ use of space took a symbolic form. In the low-cost residential home, on the other hand, little was done to establish boundaries between ‘clean’ and ‘dirty’ matter. This paper considers the ethical implications surrounding the presence or absence of this symbolic boundary maintenance. In short, this paper captures how the spatial organisation of care work in residential homes becomes imbued (or not) with symbolic meaning.  What is more, it establishes how pricing and funding differentials have a bearing on whether such meanings are established and/or upheld. The consequence of this is a deeply inequitable care sector where low-cost care comes at an ultimate moral price.