Keywords

1 Introduction

With the increase of age and the decrease of self-care capability, many elderly people have to leave their own home and move into care home spending their remaining years. They usually face confusion in this new environment: they are in care home, but they do not have a homey feeling. In order to help residents integrate into the care home environment, this paper proposes the idea of ‘home as experience’. The study endeavours to inquiry how design can play a role in transforming ‘care home’ into ‘home’, and to help residents to regain their sense of belonging.

Some researchers claim that care home and home are incompatible with each other. For example, Eva Lundgren highlights their differences: boring-comfortable; dangerous-safe; artificial-natural; authoritative-autonomous [1:112]. On the one hand, although some family members continue to be involved in their lives, including frequent visits, personal care, social and emotional support [2], the role of the family is beginning to blur [3]. On the other hand, the environmental transformation from longer-term living home to new care home requires residents to make extensive changes in their lifestyle. The relocation leads to Person-Environment inconsistencies between older adults’ physical, cognitive and emotional competence and new environmental demands [4:380]. Residents often confront with boredom, anxiety, loneliness, obedience, and adherence to rules [1]. These changes will diminish people’s wellbeing and life quality.

This study aims to explore how care homes can become home. Firstly, the complex meaning of home was discussed through interdisciplinary literature review and was restructured into the conceptual framework with four dimensions (cultural, physical, social and spiritual). Secondly, the critical issues were identified regarding why residents struggled in care home. Five care homes in the Putuo District of Shanghai were visited, and four problematic aspects were revealed based on the conceptual framework. Thirdly, according to Dewey’s experience theory, the method of transforming care home into home was put forward, including to identify cultural symbols; to use physical spaces; to build social relations; and to discover value believes.

2 The Meaning of Home

The meaning of home is diverse and complex. It infuses with multi-disciplinary explanations. Furthermore, the explanation is full of personalized significance, as different people have various understandings in different contexts and times. This study analyzed the meanings of home as a potential design reference.

2.1 Literature Review

Historical and Cultural Aspects.

One of the earliest references to home is Hestia in ancient Greek mythology, goddess of the hearth and chief goddess of domestic activity (Merriam-Webster’s Collegiate Dictionary). In modern English, home is used to mean ‘a place of origin returned to’ associated with womb and tomb [5:30]. Many very early explanations of home signify birthplace, one’s own place and country [6:21]. At the early seventeenth century, the meaning of home switched to the house [5:37]. An example of home referring to ancestral houses is that: “The stately homes of England! How beautiful they stand” (Felicia Dorothea Hemans, 1793–1835). Since the eighteenth century, home as a family life began to appear in romantic literature [6:23]. Domestic usage of home is exemplified by “There is nothing like staying at home for real comfort” (Jane Austen, 1775–1817). The quotation of home in the twentieth century show more symbolic and idealized meanings. For example, the meaning constructed by the concept of comfort [7].

In the context of Chinese culture, home is made up of two parts: the upper part ‘宀’ means ‘house’ and the lower part ‘豕’ means ‘pig’, together the character means raising pigs in a roofed house, indicating the settlement form of dwelling, the living style of raising animals and household economy. It also conveys other meanings: living space; family community composed of consanguinity and the relationship in-laws; a productive economic unit; family discipline and ethics.

Philosophical and Religious Aspects.

In the field of philosophy, the study of the home is represented by Heidegger’s interest in the dwelling. Dwelling is considered a locus of human living in the world, and it is described as a process of turning a place into a home [8]. Furthermore, Bachelard [9] considers home to be the foundation of the philosophy of space, a corner of our world. Under the influence of these philosophers, many human geographers and phenomenologists in the 1970s focused on the significance of place [10:209]. Phenomenology regards home as an experienceable object, which emphasizes the important role of time and recognizes that special events in people’s lives affecting people’s experience of home [11:48]. Relph [12] points out place as the center of human existence. Tuan [13] studies the concepts of place, space, and home from a perspective of experience.

For religious believers, the significance of home concentrates on the spiritual dimension surpassing the physical and emotional level. Home is regarded as the goal of pursuing truth, which is inseparable from self-realization. For instance, the Bible reveals: the God and man are each other’s dwelling place (Gen.28:10–19). Buddhism also teaches people: the home is the return to our self-nature. Home is symbolized as a destination of spiritual life such as Paradise or Pure Land.

Psychological and Sociological Aspects.

The upsurge of psychological exploration on the meaning of home began in the 1970s [10:209]. Early psychologists focused on the emotional connection between people and home. Relative theories include Person-Environment Theory, Place Attachment and Place Identity. Marcus [14, 15] claims that home is interpreted as a symbol of the self. Porteous [16] emphasizes home as one’s territory. Hayward [17] categorizes the meaning of home systematically by giving a clear list, including physical structure; territory; locus in space; self and self-identity, and a social and cultural unit. Appleyard [18] points out that home can meet people’s psychological, social and physiological needs. Sixsmith [19] identifies three dimensions of home: personal, social and physical. Canter [20] focuses on people’s personal experience in the social context. Tognoli [21] argues that home differentiates from a house, by presenting five characteristics: centrality; continuity; privacy; self-expression and personal identity; and social relationships. Després [22] focused on material and societal forces. Benjamin [23] puts forward ‘home is that spatially localized, temporally defined, significant and autonomous physical frame and conceptual system’.

In the sociology field, the research on home is mainly about the themes of stratum, gender, economic relationship, family structure and homelessness. For instance, Somerville argues that home refers to shelter; hearth; heart; privacy; roots; abode and Paradise [24:227]. Kenyon (1999) categories four components of home: physical, temporal, social and personal [25].

2.2 A Conceptual Framework

Through the interdisciplinary literature review, we found that there was a lack of agreement on the definition of home. However, there are similar meanings amongst different interpretations. Inspired by Richard Buchanan’s four orders of interior design [26], the meaning of home can be summarized into four dimensions: cultural place, physical space, social family and spiritual destination. Meanwhile, they show four types of relations respectively: the ‘things-things’ communication relationship, the ‘people-things’ function relationship, the ‘people-people’ interaction relationship, and ‘people-oneself’ recognition relationship (Fig. 1).

Fig. 1.
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The conceptual framework of the meaning of home.

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‘Cultural place’ refers to the communication relationship between things and things. As a recognizable place, home contrasting with its surroundings shows its own symbolic characteristics and unique meaning. It has a relatively fixed identity, which depends on the specific geographical coordinates (such as district, street and house number), spatial features, as well as the natural and artificial environment of its residential areas.

‘Physical space’ refers to the function relationship between people and things. Space is an architectural phenomenon, with the physical structure, roof, four walls, furniture items, decorations, domestic applications, and related services. The physical dimension of the home is functional. It can be reflected only when the space is used by people. The physical space not only provides a shelter for basic activities such as sleeping but also meets the needs of familiarity, security, belonging and ownership.

‘Social family’ refers to the interaction between people and people. Home is not only a cultural place, a physical house but also a social unit of people. Family is a societal relationship and network of family members. The basic nuclear family usually consists of parents, children, brothers, and sisters. An extended family would include more people relationships, such as grand parents, friends and other relatives.

‘Spiritual destination’ refers to the recognition relationship between people and themselves. Home is a process of people looking for meanings in their inter-self existence. It can be an idea, a belief or a set of value systems. This kind of awareness and consciousness enables people to integrate all parts of complex life and form unity around a common purpose or goal. People will define the boundary of the home according to their realization. For example, students may view their dormitory as home, and religious believers may regard heaven as their eternal home.

3 The Problematic Areas of the Home

An investigation was undertaken through observations and interviews. Five care homes in Putuo District of Shanghai were visited, and five managers and twenty-seven older people were interviewed. Using the conceptual framework of the meaning of home as a reference, we revealed four existing problems of care homes.

3.1 Sampling

According to the service nature and the charging rate, five care homes were selected (Table 1). Putuo District Social Welfare Institution was organized by the district level government. This type of care home tends to provide the best services and facilities, and the price of accommodation was low. Ai Wan Ting Nursing Home was the only one funded by Putuo Education Bureau. Most of its residents were retired teachers or their relatives. It had small rooms and low cost. New Chang Zheng Welfare Institution and Shi Quan Sha Tian Nursing Home were set up and supported by the local community. They met the basic living needs at reasonable prices. Zhong Huan Yi Xian Nursing Home is a privately funded facility, with good service and high price.

Table 1. Basic information of five care homes in Putuo District, Shanghai.
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The criteria for selecting interviewees are: 1) interested in this study, 2) having worked or lived in care homes for more than one month, 3) able to communicate without help. Five managers were interviewed, one of whom had worked for 16 years. Twenty-seven tenants were also interviewed, ranging from ages of 70 to 94, with residential periods in care homes from 10 months to 7 years.

3.2 Data Collection

Data were collected from observation and semi-structured interviews. First of all, the indoor and outdoor environments were investigated and recorded by camera and notes, including public spaces, private rooms, various facilities, as well as people’s activities and behaviours. Secondly, five managers and twenty-seven tenants were interviewed. The managers were asked questions about how to help the older residents to experience home. The tenants were asked about whether they had difficulties to adapt in care homes, what the ideal home they desired, and what made them feel the care home as ‘home’. The average interview time took around an hour each. The interviews were audio recorded and important information was summarized in notes.

3.3 Data Analysis

The data collected include observation pictures, notes and interview recordings. Firstly, the photos were accurately described in words, and the interview recordings were transcribed into texts. Secondly, the phenomenological analysis method, ‘Focus on meaning’, was used to process the data, with three steps: meaning coding, meaning condensation and meaning interpretation [27] (Kvale and Brinkmann 2015). ‘Meaning coding’ provided a basic structure for analysis. According to the conceptual framework of the meaning of home, the problematic issues in care homes raised by the respondents were classified into four categories. ‘Meaning condensation’ was to extract the text into concise contents. ‘Meaning interpretation’ was a direct structural interpretation of the text. The literal meaning and hidden meaning were both explored.

3.4 Findings

Based on the conceptual framework of the meaning of home, four problematic areas of care homes were revealed, i.e. cultural symbols, spatial functions, social relationships, and value beliefs. There is a centralized contradiction in every aspect, namely: non-institutionalization and institutionalization, autonomy and constraint, dependence and alienation, aggregation and separation (Fig. 2).

Fig. 2.
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Problematic areas of care homes.

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Cultural Symbols: Non-Institutionalization and Institutionalization.

The five care homes convey the institutional symbol, which conflicts with older people’s desire for a non-institutionalized living environment. Their names and management styles gave an impression of authorities.

Unit Name.

Names such as Nursing Home or Welfare Institution represent the nature of an institutional organization. A tenant said: ‘some people are afraid of nursing home. It sounds desolate, lonely and disgraceful’. Many people felt moving into care home is ‘a helpless choice, with no alternative means to take care of oneself.’

Management System.

Hardware facilities and internal services are manipulated through institutional management. One manager said: ‘The older people who live on the first and second floors can take care of themselves, and paralyzed people live on the third floor’. A tenant complained: ‘There is no balcony in any rooms, and there are dense railings outside the window’. Some also said: ‘Curtains and sheets are white, like those in a hospital. The bed, the door and the furniture are all the same style’.

Spatial Functions: Autonomy and Constraint.

There were obstacles between the expected autonomous lifestyle and the actual constrained mechanism. It is very difficult for a unitary functional standard to meet older people’s different and diverse needs.

Living Space.

Most of the residents were forced to abide the rules and they could not personalize their private space. One manager said: ‘the space is too small to put anything. Residents are not allowed to change the layout here, especially in bedrooms for two or four persons to share. The simpler, the better.’

Furniture Facilities.

Indoor facilities lacked safety and usability. A tenant mentioned that she had once slipped over the floor, and suggested that ‘the floor should be made by non-slippery material, it should be soft, so even if people fall down, it would not be very serious.’ Another tenant said: ‘the clock hanging on the wall of the corridor once fell down and almost injured the person sitting under it.’ A tenant said: ‘the cabinet should be accessible, not too high and too deep. Currently we can’t get two-thirds of the depth in the cabinet.’

Social Relationships: Dependence and Alienation.

There is a certain sense of alienation between the elderly and other residents, caregivers and managers, which is far from the ideal harmonious relationship of family members.

The Relationship Between the Elderly People and Other Residents.

If a tenant’s living habits differed from others, s/he tended to be alienated from others. A resident said, ‘There are other three people in my room, each has different habits. They often have conflicts.’ One tenant said, ‘I only have one good friend here. Other people don’t have common hobbies; they can’t talk, and can’t fully communicate.’

The Relationship Between Residents and Caregivers.

Staffs’ attitudes sometimes will lead to residents’ negative emotions. A tenant said: ‘the attitude of the staff is very important, especially the attitude of the caregivers. If the room is not clean, people get very upset.’ One manager said, ‘The elderly people are easily affected by caregivers and managers. They worry about whether we care about them or not.’

Value Beliefs: Aggregation and Separation.

Active ageing needs the support of value belief, while many older people do not have substantial spiritual life. It results in weak self-identity and vague life goals.

Identity Recognition.

The tenants’ self-recognition and their attitude to care home were not unified. If elderly people do not accept the care home environment, it is difficult to integrate into it. A manager said, ‘It’s hard for older people to adapt if they have a fixed and stubborn mind and think they have to maintain their past lifestyle.’

Life Goals.

If tenants do not consider the meaning of life and pursue life goals, their participation and perception will be very low in care homes. One manager said, ‘If there are few activities, people will feel inadequate.’ A tenant complained, ‘I feel like I have nothing to do every day.’

4 Experience: A Method of Being-at-Home

John Dewey, an American philosopher and educator, developed the experience theory. He argues that an experience has a structure with four characteristics: purpose, form, manner and material [28] (Buchanan, 2007:15). Each complete experience is guided by a specific purpose, supporting human action and reception [29] (Dewey, 1980:50). The manner of experience is the interaction between people and the environment, ‘every experience is the result of interaction between a live creature and some aspect of the world in which he lives’ [29] (Dewey, 1980:44). In the interaction, people not only have to adapt to the environment, but their initiatives will change the environment. People play the role of both doing and receiving, supporting each other and maintaining a balance. The whole experience has a dynamic and continuous form. It is a temporal process, which embodies three stages with ‘inception-development-fulfillment’ [29] (Dewey, 1980:55). Materials of experience include aesthetic, intellectual (thinking) and practical (overt doings) dimensions [29] (Dewey, 1980:55). Emotion has a cohesive effect in integrating the scattered parts of the experience as a whole [29] (Dewey, 1980:42).

Residents have experienced in the care home, but do not have an experience. Creating a homey experience by design can make use of four characteristics of the experience theory: purpose, form, manner and material. The purpose is to transform care home into home. The manner is residents’ interaction within the care home environment. Older people participate in the creation of the environment, which provides the sources to promote the occurrence of experience, and at the same time affects and changes residents’ physical and psychological perception. The concrete methods of interaction are embodied in four action behaviors: to identify cultural symbols, to use physical spaces, to build social relations, and to discover value believes (Fig. 3).

Fig. 3.
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Design suggestions on experiencing home.

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Suggestion 1: Identifying cultural symbols. To enhance the affinity of care homes, cultural symbols can be designed to construct a visual or emotional impression. There are many symbols, including names, location, architectural design, aesthetic decoration, private items (e.g. souvenirs), etc. It is the expression of individual personality or social imagination, through communicational signs to create a place called home.

Suggestion 2: Utilising physical spaces. In order to meet the diverse needs, physical space design should be guided by the concept of inclusive design, taking into account older people’s various impaired abilities (such as reduced mobility, vision and hearing loss, cognitive impairment). There is a need to consider how to provide a safer, more comfortable and flexible design in terms of space function layout, furniture design, and material selection. Besides, facilities must be installed securely and repaired in time.

Suggestion 3: Building social relations. Maintaining harmonious people-people relationships in care homes can be achieved by design. This relies on the social interaction of the elderly with other residents, staff, family, friends and people living nearby (neighbors and community). These relationships represent trust and support. Opportunities for interaction can be realized through a series of collective activities. These activities can go beyond the boundaries of the house and are organized outdoors. For example, providing a special space for the elderly to communicate with relatives and friends; increasing learning or entertainment events to encourage people to participate actively and enhance mutual understanding with their peers; improving caregivers’ responsible attitude to increase residents’ satisfaction.

Suggestion 4: Discovering value believes. Designers can attempt to understand residents’ spiritual needs and improve their value beliefs, so as to stimulate older people to find the meaning of life. People have a way of knowing themselves and perceiving care home environment. They can be promoted to achieve self-realization by a designerly way, thereby expanding the understanding boundaries of the home and integrate it into the extended home environment actively. It is an opening to one’s own recognition, and returning to one’s inner-self home.

The form of experience consists of three stages: inception, development and fulfillment. This is a continuous process of being-at-home. At the inception stage, we could improve the cultural symbols of care home to help older people to have a sense of identity. In the development stage, we may construct tenants’ social relationships and make space function inclusive. In the fulfillment stage, with the accumulation of daily life, we can help older people gradually find the meaning of life and spiritual support, so that they and the environment integrate into a harmonious unity. The integration requires people to devote aesthetic, intellectual and practical efforts. Additionally, experiencing home is a circulative course. A satisfying experience will further conduce older people to identify the cultural symbols of care home, and then a new round form of experience will be evolved over time (Fig. 3).

The key to creating a homey experience is to deepen the understanding of the meaning of home. The deeper the research on the connotation of home, the easier it is to find the right direction of care home design. If we pay attention to the culture and physical dimensions, then people tend to design a material place and space. If we view home from the social dimension, care home design will pay more attention to the social relationship. If we understand the meaning of home at the spiritual level, then care home design will pursue value beliefs.

Once residents pursue the self-realization and expand the boundary of home, they will find their real home, an inner-self. They will break away from the shackles of defining their identity with external materials. Home could be everywhere and become portable. The transformation from home into care home can be understood as a ‘leaving home - seeking home - returning home’ process. The older people leave their own home, and then try to establish a new home in the care facility environment, and finally can return to his/her real home: ‘inner-self’ (Fig. 4).

Fig. 4.
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A journey of residents’ relationship with home.

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5 Conclusion

In order to resolve the confusion of living in care homes, this study proposes the idea of ‘home as experience’, to explore how design can help older people to regain the sense of home in a new environment. The complex meaning of home was discussed through interdisciplinary literature review, and a conceptual framework of home was built, with four dimensions: cultural, physical, social and spiritual. Through visiting five care homes in the Putuo District of Shanghai, we identified four problematic aspects based on the conceptual framework. According to Dewey’s experience theory, we proposed the method of transforming a care home into home through identifying cultural symbols, utilizing physical spaces, building social relations, and discovering value believes. On the theoretical side, this study produces a conceptual framework to help designers understand the meaning of home. On the practical side, the existing problematic areas in care homes were identified and suggestions for designers’ future practice provided. Different stakeholders: designers, managers, caregivers, residents, family members and social groups, need to cooperate in order to realize ‘home as experience’.