Title: Colonising the Aged Body and the Organization of Later Life

Title: Colonising the aged body and the organization of later life

Authors:

Paula Hyde, Manchester Business School, University of Manchester

Diane Burns, University of Sheffield Business School, University of Sheffield

John Hassard, Manchester Business School, University of Manchester

Anne Killett, Allied Health Professions, University of East Anglia

Author Accepted Manuscript

Accepted 4November 2014 by Organization Studies.

To be cited as:

Hyde, P., Burns, D., Hassard, J., and Killett, A. (2014_Colonizing the Aged Body: The Social Organization of Later Life”, Organization Studies, 35(11):1699-1717

Full paper can be found at:

Colonizing the aged body and the organization of later life

Abstract

Residential care can seem inevitable for older people, especially where they are not fully independent.Based on fieldwork in eight care homes, arrangements for care are examined with reference, primarily, to Deetz’ (1992) theory of ‘corporate colonization’. Extending this theory, it is argued that grouping older people in care homes can result in a form of social segregation, one that reflects the management of the aged body in relation to normative constructions of dependence and decline.Focusing on the experiences of residents, the everyday effects ofdiscourses of deteriorationand decline on disciplining the lives of older people are described and analysed, with this analysis taking recourse to the work of Foucault (1979). The result is the identification of three related concepts at work in the colonizing process of the aged body: (i) appropriation of the body–the physical and social practices involved in placing older people in care homes; (ii) separation from previous identities–howa range of new subjectivities are produced in the process of becoming a ‘resident’; and (iii)contestingcolonized identities–the ways in which residents attempt to challenge normative concepts of managed physical and mental decline.Overall the disciplining of the aged bodyis theorized not only as an adjunct to the notion of ‘corporate colonization’ but also,more generally, as a prominent and powerful organizing principle of later life.

Keywords: Age and ageing;corporate colonization;disciplinary power; organization theory;residential care.

Introduction

‘One of the characteristics of colonization is that in order for the colonizers to oppress the people easily they convinced themselves that the colonized have a mere biological life and never an historic existence.’ (Freire, 1971:5)

To be old in modern society is to join acategory defined by pathology(Canguilhem, 1991),characterised byloss of meaningful activity, chronic illness and decline, growing dependency and the potential to be a burden to one’s family. These discourses about ageingseparateand segregate older people into an amorphous ‘mass of needs bound together by the stigma of age’ (Hazan, 1994: 21). As a result, the need for residential care is commonly accepted to be inevitable, if perhaps regrettable, for older people.

Age is thereforea significant organizing principle in contemporary society (Gullette, 2004). Social practices advantage youth and the ‘young body’ and cast the aged body as different and in some respects unnatural (Jones & Higgs, 2010). ‘Naturalageing’ is concomitant with the continuing ability to work and maintain a healthy body. Suchfactors contribute to notions of longevity and ‘ageing well’, where to remain fit is, at times, conceived of as a moral imperative. When one can neither produce nor consume, in an industrial sense, then narratives of managed decline encapsulate arrangements for providing institutional care (Estes, 2001; Hazan, 1994). When care home residency is thought of as a commodity for consumption, responsibility shifts to individuals (the older person, their family or the state) to make rational ‘choices’, according to economic theory. This transition into old age contrasts with a ‘social rights’ approach that treats older people as citizens with entitlement to health care irrespective of their ability to pay (Estes et al., 2001).

With these issues in mind, the experience of older people in residential care is examinedwith respect to embodiment–the bodily aspects of human subjectivity – and including actions on the older body (Dale, 2001). In so doing,amongst others, the work of Deetz (1992) is considered, who argued that a host of practices combine to create a situation of ‘corporately colonized’ identities in organizations, where corporate interests proliferate and alternatives are almost unthinkable. This process includes a series of discursive practices such as:discrediting arguments as being trivial, refocusing attention from the system to the individual, naturalising decisions that privilege the few over the many, and avoiding sensitive topics which may contradict the preferred corporate view. Deetz’ focus was on the colonization of employee identities whereas the concern here is with the colonization of older people’s identities.As suchthis line ofanalysis is developed totheorize the colonizationand disciplining of the aged body as an adjunct to processes of corporate colonization; that is, theorizing older people’s bodies asboth the product of and site forcolonization.

The articletherefore seeks to develop an analysis of age and the body through organizational theorizing (Dale, 2001; Hassard et al., 2000; Holliday & Hassard, 2001). It argues that the organization of care includes processes of corporate colonization wherebythe life worlds of people living in care homes can become increasingly overshadowed, or even displaced, by corporate (mass) cultures where signals, symbols, forms of activity and values are managed. Age, as an organizing principle for residential care provision, converges with corporate colonization of the life world and in the process becomes intensified and accelerated. Ultimately the articleexplainshow age and ageing become salient organizing principles and how corporate colonization of the aged body involves the interaction of three concepts;(i) appropriation of the body– the physical and social practices involved in placing older people in care homes; (ii) separation from previous identities – how new subjectivities are produced in the process of becoming a ‘resident’; and (iii)contesting colonized identities –the ways in which residents challenge normative concepts of managed physical and mental decline.

Part One: Theorizingageandcolonization

What it means to be old

Increasingly the young and the new are lionised (Rhodes & Pullen, 2010), whereas old age is perceivedas a problem (Hazan 1994) – one that is pathologically constrained, as opposed to a normal part of life (Canguilhem 1991).Consequently, meanings and norms of what it is to age focus on illness and decline, with concomitant material and ideological consequences for older people (Estes, 2001: Gullette, 2004; Powell & Biggs, 2003). Cultural and political manifestations become apparent as ageing is constructed as an individualized problem to be best managed through enterprising choices (du Gay, 1996), such as‘active ageing’, ‘anti-ageing’ and ‘ageing well’ (Moulaert & Biggs, 2013;Biggs et al., 2012; Jones & Higgs, 2010).

The ageing well discourse is prevalent in national policy. Where the ageing as decline and dependency narrative used to refer to being over 65 and of retirement age, it is now pushed much later into the ageing process with dependency and decline narratives being activated when one becomes unwell. Conceptions of an active and fit ageing arethought to be colonizinginternational policy-making with widespread effects. At the point where activity becomes inactivity and fitness becomes ill-health discourses of care needs take over from ageing-well (Moulaert & Biggs, 2013). One solution to the problem of ‘ageing badly’, in the words of Powell and Biggs (2003:6),is ‘hiding the unacceptable face of older age in care homes’.

Corporate colonization and the organization of ageing

The organization of long term care for people in later life (aged 65 and over) is growing in significance for governments in developed countries, not least because of family arrangements which mean that those in full-time work lack the resources to care for older relatives at home. Large organizations are increasingly important in the provision of residential care, the governance of care practices, and the everyday management of older people. Corporate provision of residential care is a rapidly growing commercial sector (Estes, 2001). As corporations expand into the care market they provide capacity to house, cater and assist the older, dependent and fragile person. These corporations form but one small part of the ‘medical industrial complex’ associated with old age (Estes et al., 2001:59). Such developments have profound implications for organizing age and the management of the aged body (Burns, Hyde & Killett, 2012a).

‘Colonization’ has traditionally been used to describe relations between dominant and dominated societies (Boussebaa et al., 2012; Freire, 1971) and recent attention has focused on the effects of colonization on the transfer of management ideas across national boundaries (Frenkel & Shenhav, 2003; Muzio & Faulconbridge 2013). Less attention has been afforded tothe colonization of dominated groups within societies (for exceptions see Burns et al., 2012b). However, drawing on Foucault’s notions of disciplinary power, Stanley Deetz (1992) has demonstrated how corporations have become extremely powerful in colonizing and then controlling the institutions and practices of society as well as individual lives and identities. Moreover, he argues that corporate power is inherently non-democratic, pervades our everyday experience, and is regarded as hegemonically ‘normal’. Colonization is sustained by the commercialization of language, vocationalization of education systems and the restructuring of family life around the demands of work. Organizational processes strategically reproduce corporate ideologies by creating spurious consensus and encouraging employees to actively support corporate interests.

Hancock and Tyler (2004) criticised the ongoingcolonization of managerialism; that is, managerialist discourse, techniques and imperatives extend into everyday life. Inside work places, colonizing managerialisms are argued tointervene in the process of subjectivity;how a sense of identity is constituted and reconstituted (Hancock & Tyler, 2001).Thus the body has been characterised as a site of strategic mediation in the process of corporate colonization–a situation in which ‘organizational forms and practices appropriate and diminish the body' as it is‘trained, manipulated, cajoled, organized and in general disciplined’ (Turner 1992:15 in Hancock & Tyler, 2001). Building on earlier studies that examine not only corporate colonizationin and through the body(Hancock & Tyler, 2001; 2004) but also the effects of discourses of ageing on identity(Gabriel et al., 2010),thesocial and organizational practices which embody both are examined.It is argued herethat the body represents a vehicle for and site of colonization, onethat intensifiesin old age. Older people become the concern of the state, which facilitates professional interest and obligation. Social and health care procedures and practices are construed as meeting the needs of frail, vulnerable older bodies, offering both protection and sustenance (Biggs et al, 2012). One outcome of such developments is that aged bodies can come to be seen as no longer fit for citizenship and subsequently as ‘borderless’ phenomena.

The ageing body and social practice

Bodies are organized through practices that ascribe meanings and expectations on the basis of perceived characteristics and identities, such as age and gender (Dale, 2001; Holliday & Hassard, 2001). The present research indicates how the body becomes the vehicle for and site ofcolonization. It is through the aged body that the older person becomes exposed to an accelerated process of colonization, in this case by being removed from their extant life world and disciplined into a new one–residential care.

Foucault asserted that the application of all power is on the body (Foucault 2006:14).The aged body forms a site for social practice and disciplinary power. In contrast to pastoral power which treats the body as a site for care,disciplinary power strives to make the body more obedient as it becomes more useful, and vice versa, so an increase in utility is closely linked to an increase in docility (Foucault, 1979). Disciplinary power involves regulating the organization of space through the ‘art of distributions’, so that individuals are separated into particular spaces and within those spaces each area is coded for a particular function in order to make it as useful as possible.

Controlis achieved by several basic techniques; hierarchical observation, normalizing judgement and examination. Hierarchical observation renders the individual visible, with the effect of structuring their behaviour. Hierarchies of good and bad subjects are produced where position in the hierarchy can be used as a form of punishment or reward. Normalizing judgement rests on the concept of a ‘norm’ and coercion towards exhibiting ‘normal’ behaviours. Records are kept of progress or lack of progress in dense and voluminous administrative documents (Foucault 1979).

According to such theorising, a biological body might be treatedas though it lacked agency or identity; representing instead a surface that is merely acted upon (Dale, 2001). Within residential homes, managers and staff organize care through practices that distribute, monitor and control older people’s bodies (Martin, 2002). Through systems of management, the physical bodies of older people are acted upon as passive objects; as staff and managers talk about them, touch them, assign them to rooms, allow (or forbid) them to go for walks, and give permission (or not)for them to control their own medications (Martin, 2002).

Thisresearch focuses on the management and disciplineof the aged body as a subject of organizing practice. It takes the position that the aged body within the care home becomes a contested political site and subject to practices whichlocate the body in space and time. These practices have implications for older people’s subjectivities, the aged body as a site of social practice, andthe corporate colonization of later life.

Part Two: Researching the social organization of care

Methodology

The research which forms the empirical basis of thisarticle is derived from case analysis of eight residential homes in England providing care for older people.‘Care home’ and ‘’residential care’ are umbrella terms used here to cover nursing and residential care provision. Care homes can be registered to provide residential care, nursing care or a mix of the two. They also are organized to provide rehabilitation, long-term care and/or palliative care.

Eight care homes were selected using purposive sampling to include variation in function (2 residential, 1 nursing, 1 residential and nursing, 3 residential and dementia or physical needs specialists), size (from 10-60bed facilities) and sector provider type (corporate chains, independent, public and third sector). Inspection reports from the national regulator suggested that three of the homes had a history of poor care quality while five had a history of good care.A comparative method was deployed to examine the organization of care in these homesby focusing on events, practices and processesthat contributed to experiences in each case. The intention was to build theory from the process of contrasting data from our various casesites(Eisenhardt Graebnor 2007).

The study involved a philosophy of participatory organizational research. Following the principles of this approach, the researchwas designed to providea ‘communicative space’ (Kemmis, 2001) for organizational analysis: In other words, a space where older people could voice their opinions, then question and reframe issues of care quality and mistreatment. In this space, critical discussion was facilitated through providing an opportunity to redefine the organizational context. This was methodologically important as new definitions afford the opportunity to challenge extant knowledge and practices (Mumby, 1988).Older people resident in care homes are considered to be vulnerable;therefore, specialist ethical approval was required (National Research Ethics Service 09/H0306/63 Cambridgeshire 3 Research Ethics Committee). This ethical approval allowed for residents to be engaged in three roles: expert advisor to the study, peer researcher, and participant (REF, AUTHORS 2012).

The findings reported here are based upon a selection of observations of everyday activities, experiences and practices in the homes, plus evidence from semi-structured interviews with managers, staff and residents[i]. Case studies focused on (i) identifying organizational factors and practices associated with institutional care/abuse and (ii) developing ethnographic accounts of residents’ experiences of care together with employees’ experiences of doing care work.

In total, 294hours of observations were completed, with thisresearch taking place during morning, evening and night shifts. Research was carried out on weekdays and at the weekends for a period of six weeks in each home.In addition, 124 semi-structured interviews were carried out:86 with managers and members of staff and 38 with residents. Of these, 99 were digitally recorded and professionally transcribed. In the process, all research subjects (residents, managers and staff) were given pseudonyms. The interviews typically lasted between 30-60 minutes. Those withmanagers and staff aimed to understand the care home’s approach to the provision of care, employees’ ability to carry out their work, and issues concerning the quality of care. Interviews with residents explored their experiences of living in a home and the quality of care they received. Formal data collection was complemented by information accruedthrough informal channels; for example, casual conversations with staff, residents and visitors to the home. In addition, a number of internal documents were consulted, such as the care home’s statement of purpose,complaints records, policies and procedures and other publications.For the purposes of thisarticle,however,the focus is primarily on the experiences of residents as derived from face to face interviews, informal conversations and fieldwork observations.

Finally, both observation and interview data were analysed using a process of ‘systematic recursive cycling’;that is, regular iterations of single case data analysis followed by comparative case analysis (Eisenhardt & Graebnor, 2007). The aim was to establish an understanding of the relationships between organizational practices and resident/staff experiences.The nature of these practices and their implications for the organization of later life are explored here. Initially, research materials were examined to identify how people came to be living in the home and the processes of decision making involved. The primary concern was to determine the types of practices and processes involved in managing older people’s entry into a care home; that is, from theperspectives of residentsand staff. Through such research the relationships between corporate practices and the life worlds of older people were illuminated and the political dynamics of the aged bodydiscerned.