Introduction
Internationally, there has been a demographic shift towards an ageing population. This is due to an increase in longevity, and the ageing of the large cohort born between 1946 and the early 1960s, commonly called ‘baby boomers’. Population ageing has fuelled concerns regarding the sustainability of health and social care services. As large numbers of baby boomers age, there will be fewer younger people to support them (Stephenson and Scobie Reference Stephenson and Scobie2002). Older people have been described as a growing yet largely untapped civic resource for responding to changing community needs (Gonzales, Matz-Costa and Morrow-Howell Reference Gonzales, Matz-Costa and Morrow-Howell2015). Martinson and Halpern (Reference Martinson and Halpern2011) have noted the recent focus of active ageing policy discourse on volunteering. Encouraging active older people to support isolated and frail older people locates the solution to population ageing with older people (Martinson Reference Martinson2006–7; Peng and Fei Reference Peng and Fei2013).
Many older people do volunteer both formally and informally. The majority of older people who volunteer do so for welfare and community services (Gray, Khoo and Reimondos Reference Gray, Khoo and Reimondos2012) rather than intergenerational services (Australian Bureau of Statistics 2010). As these volunteers age, they will require increasing levels of support themselves. In addition, current patterns of volunteering among older people may not be sustained. Seaman (Reference Seaman2012) suggested that baby boomers may not be as generous with their post-retirement time as previous generations of older people. The majority of early baby boomer women take up formal volunteering for personal rather than altruistic reasons, on their own terms, through direct service and for causes they are committed to. Service co-ordinators should not assume volunteer participation will continue at the same rate or with the same commitment as previous generations.
Beneficial effect of volunteering in later life
Volunteering is an important part of later life with many advantages for older people, including health benefits (Anderson et al. Reference Anderson, Damianakis, Kröger, Wagner, Dawson, Binns, Bernstein, Caspi and Cook2014). Pilkington, Windsor and Crisp (Reference Pilkington, Windsor and Crisp2012) found that older people who volunteered up to seven hours a week reported higher life satisfaction and positive affect. Prospective cohort studies including the McArthur Study of Successful Ageing (Jung et al. Reference Jung, Gruenewald, Seeman and Sarkisian2010) reported the benefits of volunteering in maintaining functional independence in older people. Dulin et al. (Reference Dulin, Gavala, Stephens, Kostick and McDonald2012) found a positive relationship between volunteering and happiness in older New Zealanders. Dulin et al. (Reference Dulin, Gavala, Stephens, Kostick and McDonald2012) also found that volunteering and happiness is moderated by economic resources. Older people with lower socio-economic status have few opportunities to engage in activities such as volunteering, even though they might have more to gain (Gonzales, Matz-Costa and Morrow-Howell Reference Gonzales, Matz-Costa and Morrow-Howell2015; Stephens, Noone and Alpass Reference Stephens, Noone and Alpass2014; Warburton, Oppenheimer and Zappala Reference Warburton, Oppenheimer and Zappala2004). Inequalities in access to opportunities to volunteer may contribute to cumulative inequalities in health and wellbeing in older age (Stephens, Breheny and Mansvelt Reference Stephens, Breheny and Mansvelt2015).
Home visiting befriending services
Home visiting befriending services are a voluntary social service usually provided by charitable organisations. Understood as a ‘friendship-based service’ (Chal Reference Chal2004: 14), these services provide social support to isolated and lonely older people. Volunteer befriending schemes have been established in many countries to provide a structured service in which volunteers visit socially isolated older people living in the community (Pennington and Knight Reference Pennington and Knight2008). Volunteers provide regular and positive social interactions for isolated older people to expand their social networks beyond family members and paid carers. Home visiting services address the social isolation and loneliness many older community-dwelling people experience as their social networks reduce. Research on volunteer visiting services and befriending schemes has tended to centre on the positive effects a ‘befriender’ has on the service recipient (Chal Reference Chal2004; Lester et al. Reference Lester, Mead, Chew-Graham, Gask and Reilly2012; Mulvihill Reference Mulvihill2011a , Reference Mulvihill2011b ). Andrew et al. (Reference Andrew, Gavin, Begley and Brodie2003) examined the importance of home visiting befriending services to service recipients in the United Kingdom. Older people valued home visiting for conversation and companionship just as much as other home services. Service recipients described the importance of having companionship and relationships disconnected from the payment for services such as cleaning or home care. Paying people to visit was experienced as a loss of self-respect and dignity. These findings point to the nuanced and situated experiences of home visiting services in providing companionship for older people.
There has been much less attention on the perspectives of home visitors in providing these services. Despite the considerable body of research into the positive effects of volunteering on volunteers, there has been little investigation into how volunteers negotiate volunteering relationships with service users. Home visiting services or befriending schemes require considerable personal involvement. Pennington and Knight (Reference Pennington and Knight2008: 306) found that the relationship between the visitor and person being visited evolved over time. The relationship not only became a friendship, characterised as a ‘free, casual and reciprocal’ relationship, but also became family-like. If the volunteer visitor was perceived as kin, the relationship contained all the elements of friendship in addition to fulfilling otherwise inadequate family roles. The voluntary nature of the service is as important to the volunteer visitor as it is to those they visit. Pennington and Knight (Reference Pennington and Knight2008) found that the voluntary nature of the visit was personally rewarding and this distinguished the visiting from obligations inherent in paid work. This accords with the finding of Anderson et al. (Reference Anderson, Damianakis, Kröger, Wagner, Dawson, Binns, Bernstein, Caspi and Cook2014) that the altruistic aspect of volunteering is particularly beneficial. This suggests that volunteering is experienced as distinctly different from other social roles with different benefits and challenges to negotiate.
This challenges McKenna, Broome and Liddle's (Reference McKenna, Broome and Liddle2007) view of volunteering as a way to maintain the competent and satisfying performance of roles after the loss of occupational roles through retirement. According to McKenna, Broome and Liddle (Reference McKenna, Broome and Liddle2007), occupations are the building blocks of roles, which contribute to people's self-identity and sense of mastery, and provide fulfilment through social and productive participation. Age-related life changes result in role loss, which in turn could lead to social disengagement and reduced life satisfaction. However, continued involvement in roles such as friend or a participant of an organisation have a special quality in that they are highly valued even though the amount of time devoted to them may not be substantial.
Whilst the effects of volunteers visiting on service recipients has received attention, there has been much less focus on the perspective of the volunteer. This research examines how older home visitors volunteering for an accredited visiting service understand the relationships they develop with the people they visit. Understanding the negotiation of these relationships will contribute to supporting older people to both give and receive services as they age.
Method
Setting
In New Zealand, home visiting befriending services are a voluntary social service provided by charitable organisations. Age Concern New Zealand is one major provider of home visiting services. Age Concern aims to promote dignity, wellbeing, equity and respect for people over 65. The visiting services are designed to reduce social isolation and loneliness among older community-dwelling people by assigning an accredited volunteer visitor to provide regular friendly conversation and companionship to older people. The service matches older people and visitors, monitoring their satisfaction, working to resolve any issues, and providing ongoing training and support for visitors (Age Concern New Zealand 2015b ). The service has been operating for over 20 years and reaches a large number of older people throughout New Zealand. During the year to June 2013, the accredited visiting service nationally made over 75,000 visits and around 16,500 supportive phone calls, providing support to over 3,600 lonely and isolated older people (Age Concern New Zealand 2013). The accredited visiting service examined in this research is one of 23 visiting services run by Age Concern across New Zealand. It has approximately 41 volunteers and 37 clients; the majority of both visitors and clients are aged 65 and over.
Those who wish to become visitors first undergo a police check. They are then screened for suitability before attending official training which consists of listening skills, helping those with speech and hearing difficulties, and on the parameters of Age Concern's services. Visitors are provided with guidelines regarding permitted and forbidden activities. For example, visitors are not permitted to do any heavy lifting on behalf of the client or to visit when they are sick due to health and safety concerns. They are advised not to handle the clients' medication or money, or to accept gifts of value. The service offers support meetings for the visitors and training through guest speakers. These include identifying early signs of illness or increasing frailty. The volunteers are required to spend a minimum of one hour a week visiting their client, although many give much more time of their own accord. The service co-ordinator maintains regular contact with both the client and volunteer to ensure that they are both happy with the arrangement and to mediate any issues. In a survey of visitor satisfaction, 95 per cent of visitors reported that they enjoy their role, and 98 per cent felt that they have benefited from being part of the accredited visiting service (Age Concern New Zealand 2015b ).
Participants
Six volunteer visitors from an Age Concern accredited visiting service were interviewed. The participants were five women and one man whose ages ranged from 68 to 90 years. All but one participant had worked in the health-care sector at some stage in their careers. Previous experience ranged from nursing and in-home caring to employment in health organisations. All the participants were now retired. All participants lived independently in an urban centre or in a rural setting. All were currently volunteer visitors for at least one person aged over 65 years through the Age Concern visiting service. Participants volunteered to be interviewed in response to an invitation distributed by the visiting service co-ordinator. Participants responded by contacting the researcher directly to arrange the interview.
Procedures
Semi-structured individual interviews were conducted with participants in their own homes. Open-ended questions were developed to initiate and guide the conversation. These questions were focused into three time periods: what led the participants to become a volunteer; how volunteering influenced their life currently; and whether they expected to continue as a volunteer in the future. The interview typically began by asking ‘how did you come to volunteer for the visiting service? Prompts were used to follow up on participants' experiences of volunteering and any difficulties they encountered. The interviews were audio recorded, transcribed and, if requested, a copy of the transcript was returned to participants. A pseudonym was allocated to each participant to maintain anonymity. The research complied with the ethical principles of the Massey University Human Ethics Committee.
Analytic approach
This research is located with a social constructionist paradigm. Social constructionism views meaning as constructed out of people's interaction with the world around them (Crotty Reference Crotty1998). These shared understandings are reflected and reinforced through language. Meanings change over time and are the products of historically situated interchanges among people. The degree to which a given form of understanding prevails across time reflects the variations of social processes such as communication, negotiation, conflict and rhetoric (Gergen Reference Gergen1985). An example of this can be seen in the way the construction of ageing has changed in recent years. Previously, the prevailing social construction of ‘old age’ was of physical deterioration, mental decline, dependency and withdrawal from society (Wearing Reference Wearing1995). This view of ‘old age’ has since been challenged as the aged population continues to grow and social policy promotes understandings of older age that value good health, physical activity, independence and sociability; that is, discourses of positive, productive and active ageing (Stephens, Breheny and Mansvelt Reference Stephens, Breheny and Mansvelt2015).
Discourse analysis
Meaning is revealed through close attention to language. Language is organised into discourses, recurrent patterns of talk that construct the nature of what they describe (Foucault Reference Foucault1977; Parker Reference Parker1992). These discourses contain morally laden messages that categorise how people should be and act (Katz Reference Katz2000; Willig Reference Willig2008). Discourses provide subject positions for the speaker and others. Subject positions provide moral and social identities from which people can be judged and can judge others. Discourses are not isolated, but often refer to, fit within or conflict with other discourses (Parker Reference Parker1992). In this way, discourses enable or constrain behaviour; by regulating what can be said, by whom, where and when, and legitimising some experiences and not others (Parker Reference Parker1992). Consequently, language does not reflect individual or idiosyncratic attitudes or opinions, but wider discourses that structure social expectations for how relationships between people should be conducted. Paying close attention to the contradictions between accounts of social relationships demonstrates the tensions in these relationships. Discourses are not only revealed in talk, they are also revealed through analysis of media, policy documents and promotional materials. Examining these documents reveals the ways that organisations understand their services and position their clients in terms of discourses of ageing. Examining official documents alongside the talk of older people is particularly instructive as it can be used to highlight tensions between sanctioned accounts and understandings grounded in practice.
Data analysis
The interview transcripts were analysed using discourse analysis. Analysis focused on identifying the patterns of talk about the relationship between visitors and those they visit which had implications for how the visitors negotiated their own conduct (Katz Reference Katz2000). Different discourses construct alternative and often contradictory versions of the same event. By analysing such contradictions, the participants reveal the discursive resources drawn on to create their version of events. Passages relating to the volunteering relationship within the transcripts were initially identified and coded by the first named author using qualitative data analysis software ATLAS.ti. Information was coded according to its relevance to the research question: How do the participants construct the visiting service relationship? Codes were then combined to identify discourses present across the texts.. For instance, the codes ‘previous occupation’, ‘qualification’, ‘routine’ and ‘volunteer support’ were combined to identify a discourse of professionalism in the participant's construction of the visiting service. Similarly, ‘friend’, ‘compatibility’ and ‘flexibility’ were part of a discourse of visiting as a personal relationship. Although no formal cross-coder reliability checks were conducted at the coding stage, each of the identified discourses was discussed, further developed and agreed upon by all authors. The ways the volunteer visitors talked about volunteering display shared socially located understandings of appropriate social relationships with the people they visit.
Results
Professionalism
A dominant discourse drawn upon by the participants to describe the relationship between the accredited home visitor and the person they visit was a discourse of professionalism. Many of the participants had been paid carers or allied health professionals prior to joining the visiting service and many discussed their volunteering as a continuation of this profession. This discourse of professionalism is evident through the ways in which home visitors refer to the people they visit as clients, adhere to a structured schedule of visits, conceptualise their fellow volunteers as colleagues and utilise their previous work experience as a form of qualification to be able to perform this job well. This discourse of professionalism constructs the visiting service as a form of personalised professional social support to those in need.
Using the discourse of professionalism, the participants understood the visiting service as a continuation of a professional role and a use for skills developed during employment. Margaret linked her professional experiences in family health care to that of the volunteer visiting service, suggesting the skills she gained are transferable to this volunteer work. Margaret claims this experience allows her to go beyond compatibility and see the relationship as a professional encounter:
If you haven't been used to doing that sort of thing it would be important I think that the visitor had the right person, otherwise she might not stick with it because it's a relationship that builds up hmm. (Margaret)
Margaret suggests that inexperienced home visitors need to be compatible with those they visit as they lack the commitment to relationship-building that professional care-givers have. Professionals are able to interact with people in a personal but respectful manner that could not be achieved by others without this background.
Professional development
The visiting service was also constructed as a place to develop professional caring skills further through training and education. Using a professionalism discourse, the centre training was a source of support, where volunteers could receive feedback on their achievements and consult with other professionals about issues in delivering home visiting services. Visiting through an accredited visiting service provided the participants with official recognition of their qualification to be a visitor.
Oh well you get a little badge (laughs) … Um you get a certificate and it's just to say that you're an accredited visitor. And you have a police check and so, these sort of things I suppose add up that, it gives the people confidence that it's not just some old Joe come to sus out what they've got perhaps or, you know something like that. There's no hidden agenda, um you, you're above board. (June)
Describing the checks required to qualify as a home visitor, June also constructs visiting through a service as more legitimate than informally visiting lonely elderly neighbours.
Routine
Using a professionalism discourse, the visitors likened the visiting relationship to a work routine. The commitment to keep the appointed visiting time each week often took precedence over other commitments such as minding grandchildren:
My daughter rang up and asked if I could have one of them because the other one was at pre-school and I said ‘no I'm sorry I can't, I'm going to see [visitees name]’ and that was cool they just kept her at the shop with them. (Gail)
Here Gail aligns the importance of her visiting schedule with that of her daughter running a business. Keeping to the pre-arranged visiting time was part of maintaining professional integrity that had implications for the visitor's identity as a professional and reliable person:
I'm very conscientious about that, it's almost like a job. Well, not a job but, I mean, it's not a job exactly but, if you take on something I'm very conscientious about making sure I do what I've set out to do or what I've been asked to do. (Joyce)
By drawing on the professionalism discourse, Joyce structures her identity as conscientious and reliable. There are other elements of a job that Joyce is keen to distance her visiting from. Joyce attempts to backpedal when she calls it a job to avoid implying that the visiting is a ‘chore’ or has the status of paid work.
Negotiated boundaries
The participants all negotiated the boundaries of their relationships with the people they visit. The words ‘supposed to’ and ‘should’ were frequently used in reference to how they conducted their visits and comparisons with how they had been trained to conduct visits. Using a discourse of professionalism, these boundaries were constructed by Gail as protecting the visitor from entering into roles which they are not trained in and therefore preserving their professional integrity.
So to protect yourself you don't do um anything like that. If they want to go somewhere and they are, ah stranded, um you contact Age Concern and they will send a social worker out and will do things like that. (Gail)
By describing these professional boundaries Gail is also constructing a skill set that an accredited visitor has. An accredited visitor does not take people places; that is someone else's job. Instead, an accredited visitor can act as a mediator between the person they visit and other people who provide different services. These professional boundaries also keep the accredited visitors from inadvertently taking on the role of social worker or driver and protect the visitors from doing anything that might be beyond their accredited home visitor training. In this way the professionalism discourse introduces the notion of risk and the need to manage risk in interpersonal relationships.
On the other hand, Francesca locates herself outside the dominant construction of professionalism in her description of how she prefers to conduct her home visiting:
I'm not very good at boundaries so that's probably why I find it hard to go in chat to them for an hour or maybe an hour and a half and have a game of chess or whatever, because I don't think that you can really get to know someone in that time. Am I meant to get to know them? Well I think it makes their visit better if they feel they're understood or connected. (Francesca)
Through stating what she is ‘not very good at’, Francesca recognises that the discourse of professionalism structures how the home visiting relationship is ‘meant to be’. Francesca characterises a professional home visiting relationship as having clear boundaries, including restricting visits to one hour and engaging in approved activities such as chatting or playing a game of chess. Through this account Francesca constructs professionalism as constraining home visiting. In this way, Francesca points to the gap between how she has been trained to conduct the home visits and how she feels the home visits should be conducted. Francesca strives to make the visit better, but in this account improvement is not achieved through professionalism and training but through understanding and connection. Francesca questions whether this genuine connection is an approved aspect of the visiting relationship by asking ‘Am I meant to get to know them?’ By positioning herself outside this discourse of professionalism, Francesca provides a clear articulation of the limitations of relationships bounded by professionalism. By doing so she calls into question the extent of genuine connection that can be experienced in a home visiting relationship constructed within a discourse of professionalism.
Personal relationship
An alternative discourse constructed the relationship between the home visitor and the older people they visit as a personal relationship. Constructing home visiting as a personal relationship included socialising together outside structured home visits and bonding over common interests. Participants talked to the person they visit over the telephone in between their visits to maintain contact outside the prescribed visiting hours. They described going out to cafes to enhance their time together, even though this was against the guidelines. This discourse constructed visiting as a reciprocal relationship, where the visitor and those they visit both need to benefit. Using this discourse, the relationship was viewed as an enduring relationship that would continue regardless of the constraints that the visiting service might impose. Rather than a professional and bounded relationship, June highlighted the personal and individual nature of the relationship by describing her incompatibility with one of her visitees:
One of them, after a year I sort of suggested they get someone else because in the end we weren't really that compatible. We weren't really compatible at the beginning and I think that the visitor has to get something out of it as well. (June)
June states that the visiting relationship was incompatible because she was not getting anything out of it. In this account, personal relationships are built upon reciprocity in which both parties have to gain personally from the experience in order for it to continue. Within a professionalism discourse, visitors gain a sense of competence and professional development in return for visiting. Within a personal discourse, this reciprocity is framed in terms of enjoyment. This mirrors Margaret's distinction between relationships maintained through professionalism versus personal regard.
A key aspect of the personal relationship discourse was constructing the visitee as a friend instead of, or as well as, a client. This is illustrated by Margaret's confusion over the correct term when referring to the person she visits.
I've only had four um friends or clients, whatever you like to call them. (Margaret)
By stumbling over the two possible ways of referring to the people she visits, as either friends or clients, Margaret points to the discourses available to structure these relationships. Discourses depend upon the context; in the context of the home visiting befriending service, people visited are constructed as clients of a professional service and as recipients of friendship from a visitor, yet not friends. In the presence of the person visited, the relationship may be constructed as one of friendship. In the context of the interview, Margaret falters over which term to use. This points to the incompatible discourses that structure the maintenance of this relationship; the professionalism discourse arising from interactions with the service organisation and the personal discourse which more comfortably fits in interactions with those they visit. For Gail, however, when asked if she thought she would have been friends with the person she visits if they had met outside the service, there was no doubt as to the personal orientation of her relationship:
Oh yes, yes I'm sure we would have been I'm sure we would have been actually. Yes, it's not just a case of just tolerating each other or her tolerating me because I'm an accredited visitor. (Gail)
Here, Gail characterises a professional relationship as one in which the two would ‘tolerate each other’ for the sake of the service, or the visitee would ‘tolerate’ Gail because of her accreditation. For Gail, the fact that they do more than this is what constitutes a friendship. This accords with a standard of professionalism as the ability to continue on with the relationship without personal regard. Here professionalism marks out the minimum standard of a relationship, whereas constructing the visiting as a personal relationship indicates going beyond this level.
Tension between the professional–personal
In many cases the relationship between the visitor and the visitee began as a professional one organised through the service and regulated by guidelines and training. However, over time, the relationship transitioned into a personal relationship as the two moved from familiarity with one another to friendship. The tensions between these two constructions can be seen as reflecting guidelines imposed by the visiting service in order to regulate the visits and protect the visitors and those they visit. This troubles the proposed purpose of the service which is to be a friend to someone. Below, Margaret describes the impact that timing her phone calls and recording her visits, a regulation of the service, has on the person she visits:
When I was talking to [the visitee] the other day I said ‘oh I've just been doing my figures for [the service co-ordinator]’, course she knows her too, you see, ‘cause that's how we met, and she said ‘what figures?’ and I said ‘oh well you know because I have to write down how many times I visit people’ and she was quite put out … And I thought I probably shouldn't have said anything really. (Margaret)
As the relationship has developed over time it has taken on the characteristics of a friendship, and the re-introduction of the time-keeping positions the ‘friend’ once again as a ‘client’, a positioning that the person being visited rejects by being ‘put out’. In a similar situation, Gail makes a grand statement about her friendship with the person she visits, suggesting that their relationship goes beyond that required from the visiting service:
Even if she got put into a home, which she doesn't want to do, ever, I would go to the home to visit her, the nursing home wherever she went to and that, I would just go until she died really. Unless she asked that I didn't go because they're allowed to do that, they're allowed to terminate the visiting if they wish so yeah. (Gail)
Gail begins with a strong statement of friendship, claiming that she will continue the relationship with the woman she visits until she dies. Following this strong claim, Gail qualifies this by referring to the professional nature of their relationship, in which the ‘client’ has the right to terminate the visits if they wish. The formal ways the relationship is regulated in terms of the rights and obligations of the visitor and the people they visit continue to structure the relationship even when the relationship has developed beyond that of a provider and client.
Personal within the boundaries of the professional
Once the relationship has made the transition from a professional construction to a personal one, the relationship continues to be troubled by its professional origins. Over time, as visitees transitioned to residential care, the home visitors were unsure of their role. Although they were able to continue to visit lonely older people in this setting, rest home residents no longer meet the criteria for funded home visiting services from the accredited service.
June: I visited them at home and then they went to the rest homes. I did for a while and then I found that because the criteria when they get into the rest home now you have to be a bit…
Lucy: So it's a bit more sociable up there so they don't really need you to come in?
June: No and I don't think Age Concern get their funding if you visit them in the rest home. But I didn't mind visiting them.
June developed a personal relationship with the person she visits and therefore continued to visit them at the rest home when they moved. As the accredited visitor service is not funded for such visits, the justification for the visiting is at odds with the basis of the relationship. June is happy to continue due to the relationship she has built, but the professional foundation no longer provides a justification for her continuing relationship. The basis on which the relationship is built has been undermined and June struggles to characterise the relationship as indicated by her trailing off ‘you have to be a bit…’, indicating the care needed to continue visiting under these conditions.
The discourses of professionalism and personal relationship provide contradictory positions to visitors and the older people they visit. Using a discourse of professionalism, the visits are a valuable social service provided to improve the social integration of isolated older people. The visitors are service providers and those they visit are clients. In contrast, a discourse constructing these interactions as personal relationships focuses on the shared enjoyment of the visit. The visitors and those they visit are positioned as friends and the relationship is maintained because of mutual affection. At times, the visitors struggle to reconcile these contradictory ways of constructing the relationships. At the heart of this tension is the nature of the volunteer service itself, which is inherently about providing friendship within a formal organisational setting to combat loneliness and isolation. To understand the discourses identified in the interviews further, we examined the framing of the service provided by the service provider.
Discursive framing of home visiting services
To understand the discursive framing of home visiting services further, we examined the public materials on home visiting displayed on the Age Concern website. The website and online brochures provide separate accounts of the service from the perspective of the clients and the visitors. The distinction between home visiting as a professional service that improves the health and wellbeing of the person receiving visits and as a personal and emotional relationship is immediately apparent in these two accounts. These two discourses are used in different ways. The Age Concern website uses a personal discourse in the reported speech of those who receive the visits. On the website, the extracts from the service recipients focus on the friendship and the personal relationship they have developed with their visitor:
Our clients tell us that they feel happier and less lonely because of having a visitor, and that the service makes a positive difference in their lives. Here are some of the things our clients have told us:
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• I am not so lonely and feel I have a friend.
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• Having a conversation with him makes me feel happier, because he is a very interesting and friendly man.
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• I was lonely; feeling isolated, with no light at the end of the tunnel, and didn't want to be here. Completely alone; no family. My visitor is a good listener, and we have become good friends and I look forward to her visits.
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• I have someone of my own. (Age Concern New Zealand 2015a )
The online client, visitor and referral brochures (Age Concern New Zealand 2015b , 2015c , 2015d ) also include client extracts and statements that focus on the friendships that clients develop with their visitor, for example:
Joan has become a very special friend to me. She keeps in touch regularly, especially if I am unwell. We have lots in common. I am very happy that she has come into my life. (Age Concern New Zealand 2015d )
These accounts focus on the personal relationship that develops between the visitor and the older person, and the emotional reaction to these visits. This perception of friendship becomes the marker of success for the programme as demonstrated here: ‘AVS [Accredited Visiting Service] works! … 92% think of their visitor as a friend’ (Age Concern New Zealand 2015c ).
When describing the benefits of home visiting to the visitor, the account shifts to the use of a professionalism discourse. This account suggests that personal development and service provision are the key benefits of home visiting:
Our visitors tell us
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• It has helped me to have a greater understanding for those who are lonely, have physical difficulties and do not have family close by.
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• I see each visit the smile/warm welcome and know I make a difference.
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• I enjoy it immensely. The person I visit is wise, shares his experiences and makes it obvious that he enjoys what we do.
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• It has made me think of who I am as a person and how I treat people. (Age Concern New Zealand 2015a )
These accounts focus on two aspects from the professionalism discourse, the construction of home visiting as a professional social service that improves the lives of isolated older people, and the ways that providing the service both requires and develops skills in the visitor. These aspects of the professionalism discourse are reiterated in the client, visitor and referral brochures (Age Concern New Zealand 2015b , 2015c , 2015d ). Although both participants in this relationship are constructed as benefiting, the gains received are not equivalent. Using a professionalism discourse, the visitor is developing and learning from the relationship, but the client is positioned as the passive recipient of another's kindness. This positioning is not equal and reinforces the power differential between the visitor and those they visit. These two discourses reflect expected and sanctioned differences in the ways that visiting functions differently for visitors and those they visit. Age Concern uses reported speech to attribute these differences to different roles in the relationship, either as a visitor or a person being visited. Using discourse analysis, we understand these as different discourses constructing the relationship differently for different audiences. They represent contrasting aspects of the relationship that Age Concern wishes to highlight: lonely and isolated older people receiving friendship and active and engaged older people providing para-professional services. Although both visitors and visitees are older people, these discourses provide different subject positions for them. A personal discourse provides a comparatively equitable position of friend for both participants in the relationship. Within a professionalism discourse, the positions are that of a vulnerable elder needing emotional support or active volunteer providing services to an appreciative client. The professionalism discourse functions to separate the provision of service from the receipt of service. This produces distinctly separate subject positions and avoids potential negative attributions of older people who volunteer as inhabiting the same subject position as those they visit.
These clear and separate positions are not easy to navigate in practice. While the online brochures use a professionalism discourse in the accounts describing the benefits of home visiting to the visitor, a personal discourse is used in one instance. A volunteer is quoted as saying:
The lady I visit is very frail. I try to do something nice for her each week. We have great chats and she is a lovely friend. (Age Concern New Zealand 2015b )
Using the professionalism discourse, the woman visited is positioned as frail and dependent on the kindness of the visitor. Using the personal discourse, the visitor is also positioned as enjoying the company and friendship of the woman she visits. This highlights the difficulty of limiting the visitor's subject position to solely a professional one within the context of a befriending service. In the context of evolving relationships between visitors and clients, the interview analysis similarly demonstrates that older volunteers wish to position themselves within a personal relationship discourse at times.
Discussion
The participants in this study use a professionalism discourse to construct the home visiting relationship as a valuable and structured social support service that meets the needs of isolated older people. Visiting is likened to professional caring careers, and the home visiting relationship is constructed as an appropriately formal relationship between the visitor and the older client. In contrast, the personal relationship discourse points to the limitations of home visiting based upon such expectations, and constructs a personal relationship as going beyond this to make a real connection and forge long-term relationships that benefit both the visitor and the person they visit. These two discourses create tension for home visitors as they negotiate these relationships over time. The relationship as personal requires an investment of friendship, enduring commitment and personal regard. This must be juggled in terms of the formality of the agreement, which can call into question the genuine regard between the visitor and the person being visited. The construction of the visitor as a professional, qualified and skilled individual is troubled by the nature of the service which positions the visitees as recipients of friendship, yet not friends. To understand these contradictory discursive framings of the home visiting relationship further, we examined the visiting service online materials in light of the interview analysis. This revealed the ways that these discourses are designed to hail different audiences of older people and to separate carefully the active and healthy volunteer from the frail and isolated recipient of services. In effect, older people who volunteer do not inhabit the same subject position as those they visit.
Research on home visiting services has focused on the ways the relationship is understood from the perspective of the person being visited. In this research we have focused on the visiting relationship as a socially situated encounter constructed in terms of understandings of volunteering in later life. The discourse of professionalism is comfortably situated alongside discourses of positive and productive ageing. Older people made explicit links between their identity as professionals and the transferability of skills from professional careers to volunteer work. According to Pepin and Deutscher (Reference Pepin and Deutscher2011), the engagement in meaningful occupations and valued roles, the development of new interests and restructuring the use of time are essential to maintain a positive identity and to adapt successfully to retirement. This discourse recruits elements of the positive identity of contribution to structure the experience of volunteering in later life. This discourse supports an identity as a conscientious and reliable person, contributing to the wellbeing of others less fortunate. This makes available a positive identity for older people able to contribute in these ways, but potentially denigrates the experience of those unable to contribute (Stephens, Breheny and Mansvelt Reference Stephens, Breheny and Mansvelt2015) and those who are in need of caring services (Breheny and Stephens Reference Breheny and Stephens2012).
In contrast to a discourse of professionalism, some older volunteers viewed a genuine connection as limited by routine, structure and boundaries. A personal relationship was viewed as going beyond professional service provision. Crossing the boundaries of the professional relationship opened up different ways that the relationship could develop, including the visitor bringing the outside world to the person they visit. According to Lester et al. (Reference Lester, Mead, Chew-Graham, Gask and Reilly2012), this is also an important factor in the visiting relationship. Similarly, Pennington and Knight (Reference Pennington and Knight2008) found that a volunteer's decision to transgress the boundaries of the relationship was an important element in its continued evolution. This development was often a function of the volunteers' sense of agency, feeling appreciated and enjoying the visits. Once transgressed, the relationship invariably evolved to become closer and more meaningful for both the visitor and the older person they visit. This understanding of visiting as a reciprocal and personal relationship matches the expectations and preferences of those receiving these visiting services (Andrew et al. Reference Andrew, Gavin, Begley and Brodie2003). The difficulties in managing the evolution of a home visiting relationship may be compounded as social support services are increasingly formalised and structured to increase uniformity of provision and reduce risk.
The discourse of a personal relationship arises out of a mutual need for both parties to maintain social networks and attain genuine friends in later life when social integration and personal friendships may reduce. Maintaining social networks through regular relationships is an important aspect in positive ageing. Constructing the relationship as a professional one allows older people to fulfil expectations for contribution (Martinson and Halpern Reference Martinson and Halpern2011; Thompson Reference Thompson2013). Constructing the relationship as personal allows visitors to construct their ageing as positive through their participation in meaningful relationships. Andrew et al. (Reference Andrew, Gavin, Begley and Brodie2003: 353) point directly to tensions between these expectations of service provision and friendship and further claims that ‘Both befriending and friendship relationships are governed by limits, rules and codes of conduct’. Like Andrew et al. (Reference Andrew, Gavin, Begley and Brodie2003), our analysis reveals that these limits, rules and codes of conduct may at times be in conflict. Our analysis adds to this in two ways. Firstly, it provides the perspective from the home visitors and, secondly, it demonstrates the way that these expectations and tensions arise from the discursive construction of these services. These discursive constructions are reflected and reinforced in the service provider's online materials. This points to the importance of critical attention to the ways that such materials frame what it means to be both a provider and recipient of home visiting services.
Negotiating these tensions cannot be solved by constructing visiting services solely as a personal relationship. Andrew et al. (Reference Andrew, Gavin, Begley and Brodie2003) suggest that the voluntary nature of the relationship is key to those receiving visiting services: that the visitor chooses to come. In addition, the regularity and routine of the visit is also important, an aspect reflecting a professional approach to home visiting (Chal Reference Chal2004). A way forward that provides a positive and valued position for both the provider and the recipient of these services is a discourse of interdependence (Breheny and Stephens Reference Breheny and Stephens2012). Interdependence acknowledges both members of the relationship as necessary for the benefits to accrue to either of them. The people being visited are equally participating in the visitor's life. This is apparent in the ways the older visitors construct service as a means to meet new people and make new friends as their own social group decreases. A discourse of interdependence may go some way to addressing the imbalance in positioning available through the current discursive framing of service provision and service receipt. Pennington and Knight (Reference Pennington and Knight2008) conceptualise the visiting relationship as an evolving journey that begins with the provision of companionship within the boundaries of the service guidelines. As the relationship progresses to that of a friendship, the transgression of those boundaries is a characteristic of the process.
This research provides a close examination of older people's construction of their volunteer visiting relationships. Although this research was conducted with a small sample of older home visitors through one visiting service, this is a national service and all branches of the service are subject to the same guidelines. Similar services are also provided in other developed countries. The tensions between home visiting as a professional service accredited to particular standards and the management of meaningful relationships is likely to be found across organisations that provide formal visiting services to address loneliness and social isolation. These findings reflect the particular nature of visiting services as few other volunteer services require the same degree of personal interaction whilst being subject to the same professional guidelines. The context of such services are key to interpreting their discursive construction. Individualisation of Western society and geographical mobility has altered the expectation and capacity of families to provide support to older people (Machielse Reference Machielse2015). This, coupled with the professionalisation of support services, requires careful negotiation. Services to address social isolation must ensure the safety of the visitor and the recipient of services, and through this process discourses of professionalism are reinforced. Stephens et al. (Reference Stephens, Simpson, Holmes, Collins, Silver and Bhar2016) examined the complexities of young students befriending residents of aged-care facilities. In this situation, formal training had not been given and lack of training did produce discomfort at times. However, negotiating these situations helped build a genuine connection between the visitors and the residents. Whilst suggesting that training might alleviate some uncertainties in befriending, Stephens et al. (Reference Stephens, Simpson, Holmes, Collins, Silver and Bhar2016) acknowledge that introducing evidence-based training and rigorous documentation may produce other changes in the relationship.
Effectively recruiting and retaining volunteers for such services is key to their sustainability (Gonzales, Matz-Costa and Morrow-Howell Reference Gonzales, Matz-Costa and Morrow-Howell2015; Stephens et al. Reference Stephens, Simpson, Holmes, Collins, Silver and Bhar2016). Understanding the nuanced elements of this relationship will enable service co-ordinators to meet the needs of these volunteers better and ultimately support older people to maintain a valued identity as they age. Interviewing service co-ordinators and those receiving home visits would also provide an opportunity to develop our understanding of the ways that home visiting services are constructed to meet the needs of a range of people, and how tensions in these expectations are managed at the level of service organisations.
Conclusion
Home visiting and befriending services are increasingly suggested as a way for active older people to support isolated older people in the context of an ageing population. Home visiting services improve the lives of socially isolated older people, and providing these services provides opportunities for volunteer visitors as well. Navigating these relationships requires an understanding of the contradictory accounts of visiting as a professional service and a personal relationship. Precisely because this service is inherently about building relationships, the formal service orientation can create tensions for visitors and those they visit. Developing clear organisational expectations and guidelines for service provision may not help the visitors negotiate these relationships. Instead, this research highlights the need to understand the ways these home visiting relationships are constructed. Attending to the possibilities of these relationships, their capacity to shift over time and the identity effects they promote would better serve both the home visitors and those they visit.
Acknowledgements
The writing of this paper was supported by a grant from the College of Health, Massey University, New Zealand. The financial sponsor played no role in the design, execution, analysis and interpretation of data. This research was evaluated by peer review and judged to be low risk. Consequently, it has not been reviewed by one of the University's Human Ethics Committees. The authors are responsible for the ethical conduct of this research. The research was conducted in accordance with the Massey University code of ethical conduct. The authors all contributed to the design and conduct of this research. The first-named author collected the data. All authors contributed to the analysis and all approved the manuscript for submission. There are no conflicts of interest in the conduct of this research.
