The Language used in Aged Care
By Dr Christine Clark
These comments arise from the doctoral research undertaken with health care assistants in Auckland New Zealand prior to Covid hitting the world. The comments are still valid.
Language used in aged care is interesting and very contradictory. In the majority of situations, the words and gestures used were perceived by the care giver reflecting caring yet it was often denigrating or demeaning to the resident. Words such as ‘wearing a nappy’, instead of using incontinence products; ‘feeding them’, instead of assisting with nutritional needs; calling them ‘mum’ and ‘pops’, instead of by their name were normal practice. This language was created, reinforced, and habituative in the workplace because it was easily understood and, while it was not intended to be disrespectful, could be perceived as being expedient (Nussbaum, Pitts, Huber, Krieger, & Ohs, 2005). Unfortunately, whilst the care givers were using a commonly practiced language, it also implied a dependency and reduction in status of the resident. Similarly, a study examining ageism and language, including that occurring in aged care, found residents perceived an increased feeling of incompetence and lowering of self-esteem predominantly due to the modification of language used by the HCA to address decreased cognitive and, at times, physical ability (Nussbaum et al., 2005).
In trying to establish an improved level of communication, the carers believed that using speech associated with earlier years would be easier for the resident to understand. An example provided was ‘putting on the nappy’ is easier than using the term incontinence product, with this explanation being supported in research (Nussbaum et al., 2005). Carers also spoke in a way that belied their meaning, appearing to objectify the residents by ‘doing them’ which was in directly opposite to the emotion relayed by the participant. Ann commented; “Hold each other and cry and remember them and then go onto the next one.” Her message is of caring and grieving; yet the resident is reduced to the ‘next one’ which appears derogatory and in contradiction to the context. However, I believe the use of such language was expressing the carer’s reality; the notion was easily shared and understood by colleagues and indeed anyone in the environment. This view was also supported by Berger and Luckmann (1991).
A similar situation existed with the use of familial terms such as referring to the resident as mum or dad or a grandparent: “It’s like our dad or mum we are treating them like this other person. The resident I saw die just wanted to be held and comforted” (Inna). Researchers suggest use of such ageist language reflects a patronising and condescending relationship, demonstrated especially in the language used to the older person (Kane, 2002; Nussbaum et al., 2005). Although using these terms may be explained as examples of ageism, findings from my research suggests that some participants expressed it is a demonstration of respect common to their culture, as explained by a carer from the Philippines: “maybe because we are family orientated we are brought up to be really close to family”. Using the term mum or dad was an endearment, it meant respect and was perceived by the carer to be an integral aspect of the job, as stated by Penny: “my job is to look after the residents because when you come here this is like family. This is your family, this is how I see my family.” Interestingly, Fischer and Wallhagen (2008) used the term ‘fictive kin’ to describe how the HCA replaces his/her family with the family of the residents, providing them with the respect and love. Fischer and Wallhagen reported the use of honorifics in addressing the resident as common, and I certainly found that.
Language indicating a denigration of respect would be that associated with caring for a child, referring to the resident as a baby, using nappies, or explaining that the resident behaved as a child which is frequently reported with residents suffering dementia. This language was commonly used alongside actions associated with providing task focussed care and, in some instances, care that demonstrated a lack of understanding of the disease. “She’s a dementia patient, there’s no point in talking with her. I fit her in and do her care, put the nappy on and put her in the lounge. I don’t spend as much time or detail on them as they don’t understand” (Kate). Using baby talk/elderspeak, was reported as promoting the resident’s withdrawal in communication and adversely affected relationships surrounding the resident, with others perceiving this form of communication as being the most appropriate and affecting the culture of the organisation (Johnston & Womack, 2015). Using elderspeak was also reported as affecting resident behaviour with Williams et al. (2012) reporting how when condescending language is used the resident was twice as likely to resist care.
Communication with the residents is important and examples of inappropriate language such as ‘love the oldies’ and ‘they don’t understand’ have been provided. This language is described as ageist; language and behaviour reflecting discrimination against older persons and reinforcing stereotypical attitudes such as all elderly are; senile, frail, and deaf (Nussbaum et al., 2005). Ageism affects the attitudes of staff in aged care with this being evident in the excerpt above where Kate spoke of a resident with dementia being left alone and another carer spoke of ‘doing them’. ‘Doing them’ is a derogatory statement, implying control, a common feature amongst the participants’ language.
Not all language is derogatory. In fact, many of the carers believed the language they were using was appropriate and respectful; for example, in many of the participants’ narratives, residents accepted and enjoyed being a substitute family for the HCA. A common finding of this research involved the migrant participants, all of whom had left their family ‘back home’ transferring their affection onto the resident, effectively substituting the resident for family, as reflected in their actions and language; “I feel like I am helping my mum” (Nell). Fisher and Wallhagen (2008) described transferring emotion from the family onto the resident, supporting this finding. The Theory of Transference was originally provided by Freud to explain transferring of emotion from one person to another and is described as being of value in providing caring in the health environment (Gattuso & Bevan, 2000).
“I get quite emotional about seeing them here and caring for them, no one else is here for them so we are here, on behalf of the families. I have left my family back home and they are now like my mum and my dad.” (Liz)
Transference is therefore, not necessarily a negative process and can frequently enhance the caring experience for both the carer and the resident. For the migrant carers it helped lessen the feeling of loss associated with home, demonstrated affection and caring, and enriched everyone’s experience. The carers of this research shared the grief they felt at leaving family back home and now substituted the resident for family, even to the extent of taking them out, bringing in supplies and kissing them good night. They had transferred their affection from one family to another and received a feeling of being valued and loved in return. This is an important aspect of the carers work, both from the resident’s view as reported by Bowers et al. (2001) and from that of the carer (Carpenter, 2008; Frey et al., 2015; Rakovski & Price, 2010).
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