Deteriorating care home residents as ‘matter out of place’ in both care homes and hospitals: An ethnographic study

Older people living in care homes are susceptible to deteriorations in their health. At times of deterioration, care home staff play a crucial role in considering the potential benefits and burdens associated with either caring for the resident in the home or transferring them to hospital. Using data collected through interviews with 30 care home staff and 113 h of ethnographic fieldwork in care homes in England, we consider the ways that care home staff can perceive deteriorating care home residents to be, often simultaneously, vulnerable (or ‘at risk’) and dangerous (or ‘a risk’) in both the hospital and the care home. Drawing on the work of Mary Douglas, we suggest deteriorating care home residents can be considered to be ‘matter out of place’ and can therefore be considered as ‘placeless’ in whichever setting they receive care. Instead of asking whether deteriorating residents are in the ‘right place’ to receive care, we might instead ask whether healthcare services are the ‘right shape’ to support to deteriorating care home residents and their complex needs.