Transition into an age of supported independence: A rite of passage?

The passage into in-home care in old age is a major life transition for an increasing number of older people. Structural and numerical population ageing and the widespread adoption of policies of ageing in place mean many older people are reliant on formal care services within their own home in later life (Doyle and Timonen 2007). Laslett's (1996) characterisation of old age distinguished between the third age of fit and active living and the fourth age of 'decrepitude'. Our research (Hale, Barrett and Gauld 2010) has focussed on those older people who are neither active and fit nor 'decrepit'. We distinguish this as a group of older people who live in a state of 'supported independence', and see those who receive care in their own home as exemplars of this state. The process of becoming frail and/or disabled such that formal care services are required to continue to live in one's own home, and the social and institutional exchanges that accompany this process, represent a transitionary phase. We employ the rites of passage analytical framework to tease apart this process and scrutinise closely the experience of the transition. Van Gennep's original concept of three stages, separation, liminality and reconnection, was developed to understand the changes in social status and roles, and the different religious rituals associated with these, in the cultures he studied. As Hockey and James (2003) suggest, though, the model has a much wider applicability, and can be used to understand changes in social role and identity in modern secular contexts. They maintain that: According to the analytic model, passage through each of the three phases of the ritual meant that individuals had been detached from their previous social position, processed through an intermediary state which shared the features of neither the previous nor the successive social position, and then had been incorporated into a new set of rules, roles and obligations (p. 25). The rites of passage framework is recognised also in the social gerontological work of Moore and Myerhoff (1977), Hazan (1984), and Hallmann (1999) in family caregiving, Hockey and James (1993, 2003) in considering passages through the lifecourse, Twigg (2000) in the area of personal care, Frank (2002) in her study of assisted living, and Parks (2003) with her focus on care at home. We employ the model to illuminate the experience of older people who make the transition into supported independence in their own home. The concept's value lies in its holistic focus on transition and its subdivision into three clear stages. The provision of formal in-home care services to support ageing in place, for example, is assumed to lead to continuity and stability. The rites of passage framework, however, allows us to uncover the discontinuities that are a part of that experience. We examine these in terms of the spatial discontinuities, temporal discontinuities and the implications of social relationships for those who make this transition. The framework allows attention to be given to the stage of liminality, an 'in-between' stage characterised by an unsettled social status and identity. The third involves reincorporation and reconnection with the wider society, with a new set of rules, roles and responsibilities. By following this period of late life from the onset of frailty, through assessment to acceptance of care in the home and thence to a question of 'reconnections', we have a closer view of some of the key issues with achieving 'reconnection' with the wider society. We conclude by emphasizing the significance to older people, researchers, policy makers and practitioners of recognising what has hitherto been an unexamined part of the ageing process.