Contributor: Susan Banks PhD

Type the words “aged care” into an internet image search engine and you will be presented with two sorts of photograph. One shows a young person (usually a woman) and an older person together, both smiling. It is an image of loving warmth. Check their positions and postures, though, and it becomes clear that the younger is beneficently giving and the older gratefully receiving. The other sort of image is the “young hands–old hands” photograph. Here, a gnarled, wrinkled and weak hand is held by a perfectly manicured, soft and line-free hand. In both these categories, aged care staff are portrayed as patrons, and clients as supplicants: older people are being positioned as weak, of lower status, and cheerfully passive.

Searching news archives gives a very different result; here the stories returned are almost universally of abuse or neglect; they depict aged care as something to be scared of, with workers cruel demons and older people impotent.

These portrayals encapsulate the public story of aged care, and they bother me.

I wanted to understand more about what was going on in aged care interactions.[1] Is care an expression of love and altruism, an extension of ourselves to give ease to another, or is it a straightjacket, applied to control unruly bodies, emotions and minds? How do hands-on, or direct care workers (personal care assistants and community care workers) and the older people they work with experience the work of aged care? What meaning does it have for them? What is going on when ease or support is given not to a loved intimate but to someone we visit as part of a job? And why does care sometimes go wrong—why are some of the stories of aged care about cruelty, narrow control, institutionalisation and abuse?

I used observations, interviews and visual methods to explore these questions in my PhD research. In our interactions, workers and clients told me about motivation, about successes and failures, about how they viewed care, and about their relationships with one another and with management. I observed subtleties of interaction—engagement, power-plays, and small and large signs of trust—that also told how meaning was created or sustained.

The most important finding was that this was a relationship or an encounter that relied on mutuality. Evident in their moment-to-moment performances in service interactions was a desire for their competent self—a self that was congruent with the participants’ own sense of themselves—to be both presented and acknowledged. Workers wanted to be able to show their compassion and skills, to do a job that the client welcomed and valued. And clients wanted to be understood and valued in return: to be treated with respect and attention. I used the work of a German philosopher, Axel Honneth, to help understand this mutuality, and, those instances where it was missing. Honneth has described a three-level model of ‘recognition’—love, rights and solidarity. Love is that form of recognition in which two people recognise and seek to meet the unique needs of one another. Rights is recognition of another’s moral accountability or judgement. And solidarity describes the recognition that each of us can contribute to a larger common project.

The numerous successful—and meaningful—service encounters that I heard about or witnessed in my study shared a number of features. Each person paid attention to the other’s unique needs and desires, demonstrated faith in their judgements, and enabled one another to contribute. Workers and clients worked together in the events and tasks that enable each other to be the person they feel comfortable being; a task that both requires and fosters recognition.

The experience of recognition is encapsulated in the words of a worker in my study. He was talking about how hard he had been trying to strike up a relationship with one of the residents he worked with, and how he had realised that he could ask the man about a favourite pastime:

“And so I had, like, an opening. And you know, as soon as you make a connection, there… any walls that they’ve put up to you as a health care provider, come tumbling down. And, you know, even the thing that they will, they hate doing—whatever it is—you can somehow get them around, because you… you’ve opened it up a little bit. You’ve taken a barrier down; you’ve become people to each other.”

Susan Banks
School of Social Sciences
University of Tasmania

A note on the image:

I recruited workers and clients to the study independently, and invited each client to nominate their favourite worker (whether in a facility or in the community), who they then invited into the research. All client:worker dyads were offered the opportunity to take photos about their relationship. Only a few chose to, and Olivia (community aged care client) and Joanna (CCW) were one dyad who really got into it. Once they’d taken lots of images, I printed them out, laminated them, and we talked about them in interviews. All participants were interviewed multiple times over the course of about a year, in most instances. Here is the ‘story’ Olivia told me about the slipper image:

“Yeah—Joanna (pseudonym) and I bought them, together. They cost sixty dollars. I don’t usually spend sixty dollars on slippers. But we were both rapt with them. … They’re beautiful, aren’t they. Yeah—and they’re a delight to wear. And that’s, we bought them together. … So those are our slippers.” (Olivia)

Note: I have explored the importance of recognition (and what happens in its absence) in three publications:

Banks, S. (2016). Knowing me, knowing you: Disability support worker as emotional mediator? Sexualities 19(5–6), 659–676.

Banks, S. (2018). The social dynamics of devaluation in an aged care context. Journal of Sociology 54(2): 167–177.

Banks, S., & Denny, L. (2018). Planning for the future of aged care: Changing attitudes towards older Australian and aged care workers. Institute Insights: Insight Four, Hobart, TAS: Institute for the Study of Social Change, University of Tasmania.

You can read more about recognition theory in:

Honneth, A. (1995). The Struggle for Recognition: The moral grammar of social conflicts. Cambridge Polity Press.

Honneth, A. (1997). Recognition and moral obligation. Social Research, 64(1), 16-35.

[1] My research explored both aged care and disability support interactions.