THE POLITICS OF CARE IN A NURSING HOME FOR THE AGED SICK""

Abstract

This Academic Exercise examines the politics of "care" in a nursing home for the "aged sick" in Singapore. My central aim is to examine how capitalist organizational models of medicine and health care bracket the individual resident as "dependent" and "helpless'' i.e. "aged sick" and subsume her or him under a rationalized and bureaucratic framework of operation which is closer to a form of incarceration, a "total institution", rather than any conventional notion of "care". I argue that it is precisely this organizational and meaningful model of health care that constitutes and reproduces these notions of "aged', "aged sick", "helpless", etc. This pervasive system of meanings extends to and influences the social actors within the home - staff and residents. In examining this process, a three-pronged research strategy combining in-depth interviews or informal guided conversations with residents, administrators and nursing staff; participant observation in the routines of the home; and analysis of archival data such as medical documents was adopted during the course of five months' intensive fieldwork in the nursing home. The spatial and temporal organization of life in the nursing home is documented. In particular, the imposition of a time-table of structured activities and the use of tranquilizing medicines as forms of social control in managing "deviance" and "normality" among the resident population was discussed, with a special focus on the biomedicalization of senile dementia. The overall result is a situation whereby inmates with disparate and unique physiological, organic and psychological care needs are construed as undifferentiated exemplars of "sick", "mentally ill", and "deviant” , thereby being constantly and uniformly treated with tranquilizing medications. This medicalization of deviance is also assessed for its effects on the quality of residents' lives. The disparate ways in which residents address this problem are examined in relation to a continuum ranging from fitting in or resignation/ "normal" to managing situational restraints with creativity or resistance/ "deviant".