Death, dying and disparity: an ethnography of differently priced residential care homes for older people

Recent scholarship has highlighted the experiences of, and various challenges faced by, dying persons and the workers tasked with end-of-life care. However, research has not sufficiently considered what symbolic resources – such as beliefs, rituals and vocabularies – are drawn upon by care workers when caring for dying and deceased residents in care homes, together with how this is informed by financial regimes. I address this deficit by drawing upon an extensive ethnographic study, undertaken in southern England (United Kingdom) between 2013 and 2014, at two residential care homes (one low-cost and one high-cost) for older people. Counter to analyses of death and dying that too frequently foreground the extraordinary, rather than the mundane and everyday, I examine the gaping disparities between two differently priced settings. In the low-cost home, residents experience a social and moral death. The dying and the dead are treated with disregard and indifference. In the high-cost home, caring for the living was extended beyond the biological termination of life. This was influenced not only by the marketing of ‘high-quality’ care, but also by workers and residents who, in their gestures and rituals of honouring, remembering and mourning the dead, made high-quality care possible. My analysis shows, then, how cavernous inequities unfold within the care sector and how, in turn, experiences of death and dying are deeply fragmented by the market. I conclude by arguing that researchers must both take the normative and symbolic culture of care work seriously and examine how the availability of this is directly impacted by the costing and funding of care. Doing so, I argue, allows us to work towards establishing a care sector that is equitable both for older people and care workers.