Times Higher Education - February 08, 2018

8 February 2018Times Higher Education 51

BOOKS

Living before Dying:

Imagining and

Remembering Home

By Janette Davies

Berghahn, 172pp, £85.00

ISBN 9781785336140

Published 15 August 2017

I

f there is one condition that

represents the “burden of care”,

it is Alzheimer’s disease.

Empathy is primarily directed

towards the caregiver, not the

patient; and it is especially the

family caregiver who receives

empathy. But how do professional

caregivers experience caring for

people with dementia? InLiving

Before Dying, trained nurse and

anthropologist Janette Davies

draws on fieldwork in a care

home for old people in Greater

Oxford to reveal the intimate

interconnection between the

professional caregiver’s and the

resident patient’s quality of life.

The study abounds with

disturbing details of a routinised

and time-pressured culture of

care: a patient served a banana

cut on a place mat; a patient

seated on a toilet soiled by

slopping from bedpans emptied

previously. Readers have long

learned such harrowing details

from news reports and the inter-

ventions of charities. But Davies

breaks new ground with her

attention to “the total inter-

dependence between employees

and residents”. Even more, she

shows how strongly management

decisions influence the caregiver’s

• and by extension the patient’s


• daily routines and experiences.
  Time pressures condition the
  infantilisation of patients, because
  “mutedness facilitates task-
  centred completion of the job”.
  Davies’ reference to the height
  of the BSE (bovine spongiform
  encephalopathy or “mad cow
  disease”) crisis suggests that the
  study took place during the early
  to mid-1990s. This was the time
  when Tom Kitwood and the
  Bradford Dementia Group began
  advocating for the rights of
  patients and consideration of
  biopsychosocial approaches to
  dementia, and here Davies could
  have framed her findings more
  critically. Similarly, some reflective
  afterthoughts on how her study
  speaks to the situation of care
  and care homes in 2017 would
  have enriched this book.
  Take, for example, the fact
  that the management’s ideal of
  a “home from home” was
  unachievable because of economic
  constraints. This powerfully
  demonstrates how care planning
  has failed older people for
  decades: although care homes
  have shifted towards more person-
  centred accommodation since the
  mid-1990s, places that really feel
  like a “home” for their residents
  continue to be rare and unafford-
  able for many.
  Or take Davies’ reflections on
  the “remnants” of what Erving
  Goffman termed the “total insti-
  tution”. Together with her find-
  ings on caregivers’ perceived

powerlessness, they provide much

ammunition to support key

points made in the 2014 Rown-

tree round-up on “pay, conditions

and care quality in residential,

nursing and domiciliary services”:

“Working conditions and organi-

sational culture are essential...to

ensuring low-paid staff feel

valued and satisfied, recruitment

and retention of talented staff is

maximized...staff continuity is

needed to ensure relationship-

building between care worker

and service user that is of vital

importance to care quality”.

Davies’ work illuminates how

essential empathy for professional

carers is and shows how this

supports the patient. Paying care-

givers the living wage is one step

towards improving care; the same

is true of ensuring opportunities

for development and adequate

training that value the caring

vocation.

Living Before Dyingis an

important and timely contribution

to a rising body of social scientific

and bioethical work about demen-

tia, including the anthropology of

senility. It should be read by all

those who want care to improve

for older people, with and with-

out dementia.

Martina Zimmermann is a

neuropharmacologist and health

humanities researcher, and the

author ofThe Poetics and Politics

of Alzheimer’s Disease Life-

Writing(2017), available open

access thanks to Wellcome Trust

funding.

Fragmentationcare planning has failed older people for decades: places that feel like a ‘home’ are unaffordable for many

HARVARD UNIVERSITY PRESS

http://www.hup.harvard.edu

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William Poole

“[A] smart and original book...

It offers a complex literary

history by way of an extended

biographical reading of a

single poem; it demonstrates

with astonishing exactitude

how Milton’s life and – most

impressively of all – his reading

enabled this epic... [An]

excellent book.”

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“[I]nformative, ethnographically

rich and highly readable and,

to those unfamiliar with the

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