Dissertation
Attunements of care: the role of environmental services staff in the Care and surveillance of continuing care retirement communities
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2025
DOI: 10.25820/etd.007812
Abstract
Most older adults will require long-term care service or support at some point in their lives. Continuing Care Retirement Communities (CCRCs) are a residential option designed to accommodate older adults’ movement through different levels of care along a continuum, from independent living to assisted, and then on to skilled nursing care. This dissertation is based on thirteen months of ethnographic research conducted with housekeeping and laundry staff at two CCRCs in the Midwest. Housekeeping and Laundry staff, also known as Environmental Services Staff (EVS), had explicit duties that included cleaning, sanitizing, and maintaining the facilities, including public spaces, staff-only areas, and residents' private rooms. However, EVS staff often performed work that extended past these official duties.
Housekeeping and laundry staff paid detailed attention to resident apartments, material belongings, and social patterns. Each week, housekeeping and laundry staff observed the habits of individual residents, noting residents’ preferences and habits for themselves and their spaces. In their work, housekeeping and laundry staff learned from other EVS staff and administration how to develop nuanced attention to the spaces and patterns of residents. In addition, EVS staff learned how to familiarize themselves with residents’ habits and how they were reflected in residents’ material belongings over time. EVS staff used these resident preferences and patterns to attempt to respond in a way that (ideally) met both their own and residents’ expectations for good care.
In this dissertation, I argue that EVS staff develop their attunement to changes in residents’ habits and belongings over time, and that this attunement enables them to interpret these changes as indications of changes in residents’ health and wellbeing. Building on Cristina Grasseni’s (2007) concept of skilled vision, I analyze EVS staff’s process of developing this attunement by gaining knowledge and familiarity with specific residents’ preferences, needs, and habits. Part of developing EVS’s particular form of skilled vision is a socialized emphasis on providing good care to residents. For EVS staff, good care meant adapting to resident preferences for their spaces, sustaining residents’ homes as socially private spaces, and providing compensatory labor to help residents maintain independence and sustain personhood. Over time, EVS staff noticed changes in a resident’s habits and living environment that signaled possible changes in their health and well-being. EVS staff then had to decide if the changes warranted reporting to CCRC administration or if EVS staff (or others) could/should compensate for the resident’s decline with their own labor.
Vitally, the CCRC administration also relied on reports from EVS staff about residents' conditions and their living spaces. These reports provided CCRC administration with information about the health and well-being of residents, particularly independent living residents who were not regularly seen by CCRC primary care staff. CCRC administration needed to be able to manage resident populations across care levels, and the reports from EVS staff informed possible transition timelines for residents whose health was beginning to decline. I describe CCRC administration’s reliance on EVS staff’s observation of residents as a form of capillary surveillance, building on Foucault’s understandings of capillary power systems (1976). The administration needed capillary surveillance to provide information about the changes of residents to provide control over transitions within the care levels. The administration emphasized to EVS Staff the importance of reporting resident changes, even in situations of possible decline, and perhaps especially so in these instances. The stakes of this surveillance, which depended upon EVS staff’s knowledge and understanding of resident habits and preferences, put EVS staff in a position of moral, financial, and physical risk. EVS staff maintained a delicate balancing act to navigate contradictions between attempting to continue providing good care for residents and meeting the reporting pressures of CCRC administration.
This dissertation expands the scope of previous studies of how non-medical personnel in nursing homes, hospitals, and other residential care facilities, such as EVS staff provide care. EVS staff performed care through surveillance and adaptations to their labor, pursuing what they believed was the best option for good care. These staff are often stereotyped as having narrower roles than they actually perform and having minimal interaction with or effect on care recipients. Instead, this dissertation highlights the critical roles of EVS staff in covering gaps within CCRC facilities through surveillance and care.
Details
- Title: Subtitle
- Attunements of care: the role of environmental services staff in the Care and surveillance of continuing care retirement communities
- Creators
- Brittany Anderson
- Contributors
- Elana Buch (Advisor)Theodore Powers (Advisor)Erica Prussing (Committee Member)Mercedes Bern-Klug (Committee Member)Aaron Seaman (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Anthropology
- Date degree season
- Spring 2025
- DOI
- 10.25820/etd.007812
- Publisher
- University of Iowa
- Number of pages
- x, 176 pages
- Copyright
- Copyright 2025 Brittany Anderson
- Language
- English
- Date submitted
- 04/28/2025
- Description bibliographic
- Includes bibliographical references (pages 166-173).
- Public Abstract (ETD)
- Continuing Care Retirement Communities (CCRCs) are designed to offer care across a continuum, from independent living to skilled nursing care. In a thirteen-month ethnographic study at two Midwest CCRCs, I focused on the role of housekeeping and laundry staff, also known as Environmental Services (EVS) staff. While their primary duties included cleaning and maintaining facilities and resident spaces, EVS staff played a more nuanced, unacknowledged role by observing residents' specific habits, preferences, and personal belongings, and learning how these aspects reflected residents' health over time. This process involved EVS staff adapting their labor to meet residents' needs while preserving their privacy and independence in the pursuit of providing good care. Over time, EVS staff observed changes in residents’ habits and homes that indicated potential shifts in their health. EVS staff then had to decide whether to report the changes to CCRC administration or compensate for the decline with their labor. CCRC administration relied on reports about resident health. These observations helped inform decisions about when residents might need to transition to higher levels of care. The administration’s reliance on EVS staff for surveillance created a complex relationship between care and oversight, with staff balancing the desire to provide good care with the pressures to report changes. This dissertation highlights the often-overlooked role of EVS staff in residential care facilities, showing how they contribute to care through surveillance, adaptation, and informed responses to residents’ evolving needs, despite working under significant moral, financial, and physical risks.
- Academic Unit
- Anthropology
- Record Identifier
- 9984830921302771
Metrics
14 Record Views