Constituting senses of independence

One reason that I noticed the problem with the notion of independence is because of anthropological scholarship. Anthropologists writing in the Western contexts show us how people’s sense of independence is tightly tied to ideas of property ownership. American anthropologist Elana Buch’s research among Chicago in-home caregivers is especially insightful here. She shows how, there, independence is understood to be something one owns, a state one can “afford.” And this independence is by no means understood to be not relying on other people and things. people living alone rely on in-home caregivers all the time, but they speak proudly about their independence. What allows this sense of independence is that they own the home and they can afford the service. They are not being “helped” by charity or family, but they get what they purchase.

But how are the senses of independence configured among older Chinese people? This is an especially tricky question for our clients, as they are spending their later life in nursing homes instead of staying with and being taken care of by the children per the cultural tradition.

To answer the questions, we conducted a study on independence: what it looks like and why they want it. We found different residents had different definitions and, importantly, that the experience of independence is shaped by how one joins and interacts with the nursing home community.

Talking to the residents

To chart the different kinds of independence, over the course of five days, I conducted 20 in-depth interviews with G’s nursing home residents across 4 facilities. The length of these interviews ranged from half an hour to two hours, sometimes sitting on the chairs in the resident’s own room, sometimes over lunch, and sometimes over poker games. I have learned the importance of allowing the interviewees to be as comfortable as they can when we want to learn what they really think.

Sample room of aging-friendly chairs (that allow people to sit comfortably in different ways)

People come to live in nursing homes for very different reasons—and as I found from my research, there are patterns. Drawing personas allows us to understand the residents as different yet similar people. This is especially important in researching eldercare, where generalizations are often made in terms of age. Just because people are older doesn’t mean they are the same.

I presented these different definitions of independence and their relation to the community in three personas: Grandma Lin, Dr. Zhang, and Mr. Wu. They represent three different groups of residents, the users of care service.

Drawing personas

Grandma Lin moved in three months ago together with her husband, Grandpa Li, who had been diagnosed with Alzheimer’s Disease for a few years. Prior to institutionalization, Grandma Lin was the main caretaker of Grandpa Li but also of the home space. She cooked for him, did laundry, monitored his health, and calmed him down when the disease went onset. If he wasn’t asleep, she wouldn’t sleep either. It was draining her. But they never thought about institutionalization because, well, she thought she could handle it. He went missing a few times when going out for a walk. The last straw was this one time last November. He went missing for over a week. He wandered off and went across a major bridge full of busy traffic to the other side of the city where he used to live as a child. That can’t happen again. They moved into the current facility shortly after. Grandma Lin enjoys her stay so much. She printed out a little road sign of the street where Grandpa Li used to live. She hangs it on the door so that he knows where home is. No more household chores for Grandma Lin. Food has variety, service is heart-warming, and no more wandering off for her husband. “They even clean the room better than I do!”

So what are the senses of independence?

Dr. Zhang used to be a provost at a university. He retired some fifteen years ago but still keeps close contact with his scholarly friends. He has been living here with his wife for over two years now. It is an action of open-mindedness. He begins the day with news—international news, actually—and cereal (something decisively foreign in China, especially among older folks). Then he reads, writes, practices calligraphy, and visits his like-minded friend, Dr. Deng, who lives next door and who studies I Ching (Book of Changes). The activities at the nursing home are a bit of a lowbrow for him. Making silly paper handicrafts? Untrained watercolor painting? Bingo? Come on. He’d like to see some symphony every now and then. Why not get some university student orchestras? He appreciates the basic service provided, but something is always just a bit off. He doesn’t like having his laundry washed together with others, so he bought a washer for himself (and his wife). Or, the food is fine, but more prawn over pork belly would’ve been nicer. He rates the service here 10/10 “not because it’s perfect but because they’ve tried their best.”

Mr. Wu’s wife passed away a few years ago. He had been living alone. His children live in another city and cannot visit very often. The children are worried that his high blood pressure got to a stage that needs closer monitoring. Mr. Wu, of course, didn’t think it was a big deal. He was eventually half-heartedly convinced after a hospital visit that involved an ambulance ride. Now, living in the nursing home for six months, he finds it hard to adjust to these various aspects of collective life, especially the sleeping schedule, eating schedule, and the limitation of mobility. For him, loneliness is the biggest problem. He likes to read, follow the news, and make handicrafts, but he has few people to share. His desk is full of little rocket models and milk carton-turned lamps and sculptures. He finds having house chores covered great, but he also finds the institutionalized life lonely and isolated. Food started to feel repetitive after a while, but it’s not much to complain about. He misses his evening walks by the lake nearby his home. He worries that living in the facility for too long will reduce his capacity to live independently, so he’s considering moving back home every now and then.

In the following meetings, I presented these three personas and my initial analysis to my team. I showed that while the company’s promotion of independent living revolves around performing individual daily tasks, the residents understood independence in diverse ways.

Linking independence with the community

From there, I proposed the prototype of different emphases in the facility community life for these different senses of independence.

Our team them brainstormed practical ways of improvements.

We then sorted the recommendations into three areas and started to layout the internal and external stakeholders. Our team members also conducted competitor analysis and drew out some services provided in other institutions for reference.

Some moments during the interviews stood out to me as they completely contradicted my expectations and assumptions. One was when I realized how clearly clients remember the date they moved into the institution. When I just started the interview, I had assumed that people wouldn’t remember such a date, and I specifically blurred the question and only ask, how long have you been living here? (Because, I thought, people would just have a rough sense of it and say something like “half a year” or “about two years”.) To my surprise, they always replied to me with the exact date: “We moved in on March 13th”—this is even the case when they stumble when recalling the age of their partner— “87…no, 86 years old”!

I highlighted this discovery and suggested that we need to start to put more thoughts into celebrating the resident’s move-in dates. More than an administrative marker on the paperwork hidden in a folder, the date is an opportunity to acknowledge the resident’s belonging to the community.

Inter-departmental collaborations

While we were working on operative recommendations, we reached out to other departments to collaborate. Some of our suggestions were turned down before we could test them out, especially the monthly all-you-can-eat lunch. Dietitians think it would add too much additional work for caregivers to monitor the food intake of people with dietary restrictions, and the quality control team thought it would cause too much food waste. But they agreed to try out the different regional food samplers on Saturdays. Eventually, the chefs decided to make three samplers of “cheat” dishes in addition to the usual lunch every Saturday. We put a lot of emphasis on food because everybody talks about food and has opinions on food—everybody thinks about food. We figured food might be the key to building a sense of community and expectation (and there is no lack of anthropological discussion on the centrality of food in social life).

A few weeks later, I went back to the facility and re-interviewed a few residents. In retrospect, I probably shouldn’t be surprised, but while many like them, quite a few people specifically told me that they didn’t think it was a good idea. They said it was not because the flavors were not good but because they felt it was too much food and was a waste. This was a valuable lesson for me. I thought we were b as I learned that changes. I brought back the feedback to my team, the dietitians, and the operation team to discuss how to make changes. We decided to keep the specialty food idea but reduce the frequency. The dietitian team took over and planned a monthly regional dish and incorporated some knowledge boards on food culture.

Other suggestions went through similar discussions and trial and error. After many meetings, polaroid photo shooting was eventually changed to purchasing a Polaroid printer, which is budget-friendly and allows us to print out edited photos in a centralized location. This will make it easier to make photo albums as gifts (such as for move-in anniversaries). Although inviting student orchestras seemed to be quite difficult because of the space and logistics limitations, the facilities and operation teams were willing to seek out opportunities and bring interested residents to more public events. We discussed ideas such as participating in talks at the municipal library. Marketing also took over the idea of differentiated independence and began to explore new strategies.

Reflection

Change may not always be an improvement, but it’s always an opportunity.

It is impossible to please everyone with any changes, we knew that; but what I learned here is also that a change, even an unsatisfactory one, is an opportunity for conversation and for active listening.

Collaboration makes anthropological insights exciting.

This is the first time I have conducted a UX project in an industrial setting. I was especially excited to discover that my anthropological training and skills are so useful, and they helped me to listen and make unique observations. However, it is by collaborating with my team members from all kinds of backgrounds that I learned how these observations can be made operable.