Introduction
The fastest growing age group in the developed world is those over 80 years of age (Stenner et al., Reference Stenner, McFarquhar and Bowling2010), which is significant in terms of expected demand on residential aged care (RAC). People move into RAC for a variety of reasons, such as a decline in personal health or the health of a care-giver; difficulties with shopping, cooking, medication and transport; pressure from family members; and a need for more or different care or support services (Cheek et al., Reference Cheek, Ballantyne, Byers and Quan2006a). The attitudes of older people towards RAC have typically been found to be negative. This includes viewing RAC residence as a sign of failure, and as bringing challenges to privacy, independence and autonomy (Cheek et al. Reference Cheek, Ballantyne, Byers and Quan2006b; Löfqvist et al., Reference Löfqvist, Granbom, Himmelsbach, Iwarsson, Oswald and Haak2013). Most older people resist moving into RAC unless they believe it is unavoidable (Cheek et al., Reference Cheek, Ballantyne, Byers and Quan2006a). Löfqvist et al. (Reference Löfqvist, Granbom, Himmelsbach, Iwarsson, Oswald and Haak2013) found the idea of moving to a RAC facility evoked negative and distressing thoughts, and that older people did not expect that this shift would ever be a voluntary move.
Animal activity as therapeutic recreation
The challenges that RAC can present have led to the development of a variety of interventions to promote wellbeing. Animal therapy is one such therapeutic activity that is becoming increasingly common in residential care. The term ‘animal therapy’ refers to a wide variety of activities in which interaction with animals is used with the intention of improving health and wellbeing (Lutwack-Bloom et al., Reference Lutwack-Bloom, Wijewickrama and Smith2005). Historically, terms describing the different types of animal therapy have often been used interchangeably. In recent years it has become generally accepted that animal-assisted therapy (AAT) refers to the purposeful integration of animals into the treatment plan of an individual with specific psychological or physical outcome goals. All treatment must be documented and evaluated (Barker and Wolen, Reference Barker and Wolen2008; Krause-Parello et al., Reference Krause-Parello, Gulick and Basin2019). AAT has been used in counselling, psychotherapy, occupational therapy and physical therapy (Van Fleet et al., Reference Van Fleet, Fine, O'Callaghan, Mackintosh, Gimeno and Fine2015). Animal-assisted activity (AAA) is a broader term that can encompass AAT but also includes informal human–animal interactions, such as visitation programmes to schools, businesses, hospitals and residential care facilities (Dookie, Reference Dookie2013). AAA typically aims to improve social outcomes, and the outcomes of AAA are not usually specified beforehand or evaluated afterwards. AAA provides opportunities for social interaction and mental stimulation, particularly for those in residential facilities. Animal programmes in RAC are typically characterised as a cost-effective form of therapeutic recreation that is intended to provide both physiological and psycho-social benefits to residents (Dono, Reference Dono2005). These visits are generally run by voluntary organisations external to the RAC facility. In this paper, we refer to taking animals into residential care homes for informal visits as ‘animal therapy’, which falls under the broad definition of AAA. We use the term ‘animal therapy’ as this aligns with how the participants and voluntary organisation refer to this programme.
The value of animal therapy as a form of health intervention is widely acknowledged. The psycho-social benefits of animal therapy include decreases in anxiety, isolation and fear of medical procedures, and improvements in communication and happiness (Barker and Wolen, Reference Barker and Wolen2008). Animal therapy has also been associated with reduced depression (Le Roux and Kemp, Reference Le Roux and Kemp2009; Moretti et al., Reference Moretti, De Ronchi, Bernabel, Marchetti, Ferrari, Forlani, Negretti, Sacchetti and Atti2011), improvements in social interaction (Bernabei et al., Reference Bernabei, De Ronchi, La Ferla, Moretti, Tonelli, Ferrari, Forlani and Atti2013) and improved mood (Lutwack-Bloom et al., Reference Lutwack-Bloom, Wijewickrama and Smith2005; Bernabei et al., Reference Bernabei, De Ronchi, La Ferla, Moretti, Tonelli, Ferrari, Forlani and Atti2013). Thodberg et al. (Reference Thodberg, Sørensen, Christensen, Poulsen, Houbak, Damgaard, Keseler, Edwards and Videbech2016) found that participants interacted more when visited by a person accompanied by a dog than when the person was accompanied by robotic animals or stuffed animals. It has been suggested that animals serve as mediators or catalysts of social interactions (Kruger and Serpell, Reference Kruger, Serpell and Fine2006). Animals represent a neutral external subject with unscripted behaviour that may stimulate conversation (Fine, Reference Fine and Fine2000). Holt et al. (Reference Holt, Johnson, Yaglom and Brenner2015) found that animal therapy encouraged intergenerational interaction in residential care; talking about the animals provided a relatively easy topic of conversation that was less bound by generation-specific topics of popularity or trends. Bernstein et al. (Reference Bernstein, Friedmann and Malaspina2000) also found that residents of RAC were more likely to initiate conversation and participate in longer conversations when animals were present. Animal presence in general has been associated with increasing opportunities for social exchange and reducing social awkwardness (Eddy et al., Reference Eddy, Hart and Boltz1988). Animals have also been observed as increasing pro-social behaviours (Kongable et al., Reference Kongable, Buckwalter and Stolley1989).
Touch is a fundamental human need that is laden with both physiological and psycho-social implications (Bush, Reference Bush2001). Older people have been shown to be particularly vulnerable to ‘touch deprivation’ in everyday life (Vortherms, Reference Vortherms1991; Bush, Reference Bush2001). In a RAC context, some of the benefits of animal therapy may be attributable to the opportunity it provides for affectionate touch. Nursing literature distinguishes between ‘affective touch’ and ‘task touch’; affective touch is relatively spontaneous as it occurs outside the performance of procedural tasks (Vortherms, Reference Vortherms1991). In contrast, task touch is compulsory physical touch that is incidentally necessary to perform care procedures (Vortherms, Reference Vortherms1991). Animal therapy may be beneficial because it provides an opportunity for spontaneous touch. Bernstein et al. (Reference Bernstein, Friedmann and Malaspina2000) found that touching the animals significantly added to both engagement in and initiation of conversation.
Recent reviews point to variability in the evidence for improved psycho-social outcomes for older people due to animal interactions (Gee and Mueller, Reference Gee and Mueller2019; Krause-Parello et al., Reference Krause-Parello, Gulick and Basin2019). Several studies have focused on the relative contribution of socialisation through human–human contact compared to human–animal interaction. Early studies suggested the positive effects attributed to animal therapy may be more attributable to the animal's handler than the animal itself (e.g. Beck and Katcher, Reference Beck and Katcher1984; Hendy, Reference Hendy1987). More recent evidence suggests there is an additional benefit of having an animal present during the visit (Johnson et al., Reference Johnson, Meadows, Haubner and Sevedge2003). Marino's (Reference Marino2012) review of the literature sought to understand how crucial the presence of the animal is in AAA and concluded that although there is some effect of animal interventions on outcomes, evidence for the vital role of the animal itself is more ambiguous.
Ethical considerations of animal activity
Most literature has focused on the advantages of AAA for people, rather than considering the impact on the animals (Gee and Galik, Reference Gee and Galik2019). Animal therapy sessions are often considered mutually beneficial encounters (Evans and Gray, Reference Evans and Gray2012), however, there is potential for therapeutic encounters to impact animal welfare negatively (Iannuzzi and Rowan, Reference Iannuzzi and Rowan1991). Issues for animals include fatigue and the potential for stress if they are visiting unfamiliar environments. The use of shelter animals raises particular issues, which must be balanced against the enrichment of the visit for the animal and the increased chances of their adoption when well-handled (Iannuzzi and Rowan, Reference Iannuzzi and Rowan1991). Hatch (Reference Hatch2007) examined animal therapy using shelter animals and found that much of the interaction could be interpreted as stressful from the animal's perspective. This included transport from the shelter to the residential facility, adapting to the unfamiliar environment and unwillingness to interact with unfamiliar people. Although Hatch (Reference Hatch2007) noted that these could be opportunities to train and socialise the animal, this rarely happened as the handlers lacked time or skills to train the animals. Consequently, exposing animals to stressful situations without the resources to socialise them in these situations may not aid the animals’ socialisation.
Research has tended to focus on the physiological and psycho-social benefits of animal therapy to recipients (see Wells, Reference Wells2019). Less attention has been given to the value, meaning and impact of the activity on the residents themselves. The goal of therapeutic recreation activities is to provide meaningful experiences for residents of RAC in order to enhance overall wellbeing. Given this goal, exploring the meaning of animal therapy visits to residents is an important part of understanding whether these visits improve wellbeing. Although some studies have invited qualitative responses regarding animal therapy, very little of this has been generated by the older people who are the recipients of this service. Anecdotal reports regarding the benefits of animal therapy have often come from third parties, such as the service providers or residential care staff and co-ordinators (Banks and Banks, Reference Banks and Banks2002, Reference Barker and Wolen2005; Kaiser et al., Reference Kaiser, Spence, McGavin, Struble and Keilman2002). Qualitative findings tend to be used to inform measure development, or to measure pre-determined constructs, rather than constituting an in-depth exploration of the meaning of animal therapy in the context of the everyday lives of RAC residents. This research used narrative analysis to understand the experiences of animal therapy among older people in residential aged care.
Methodology
Narrative psychology
Narratives are stories told about an experience that structure events in a meaningful way (Stephens, Reference Stephens2011). Ricoeur (Reference Ricoeur1984) argued that we need narratives to create order and a sense of coherence because of the constant flux of our temporal world. Constructing a narrative imposes a linear sequence on previously unstructured experiences (Crossley, Reference Crossley, Lyons and Coyle2008). Narrative psychology examines what these stories mean, by looking at what is included and excluded in the telling. The sequencing of a narrative is also important, because it highlights which ideas, places, practices and symbols are important to people (Feldman et al., Reference Feldman, Sköldberg, Brown and Horner2004).
The stories people choose to tell provide insights into specific cultural rules. These cultural rules guide the way people react to events in their lives, as well as how they claim or avoid identities (Bruner, Reference Bruner1990). Examining these stories allows us to understand the systems and structures of meaning through which we negotiate our place in the world (Polkinghorne, Reference Polkinghorne1988; Silver, Reference Silver and Willig2013). Even profoundly personal stories are embedded in the social, cultural and material circumstances which make certain stories and identities available and others unavailable (Silver, Reference Silver and Willig2013). People use narratives both to understand the world at large, and to understand themselves (Murray, Reference Murray and Smith2008). Broad cultural narratives, drawn on to tell personal stories, allow people to shape their identity actively by explaining their actions and why they behaved in certain ways (Skultans, Reference Skultans2000). Seeking coherence through narratives is especially common when a discrepancy exists between people's preferred selves and their experiences, or between a person's identity and the cultural and societal expectations for identity (Bruner, Reference Bruner1990).
Narrative and ageing
Narrative gerontology views the stories that older people tell about their lives as central to meaning making in later life (Bohlmeijer et al., Reference Bohlmeijer, Westerhof, Randall, Tromp and Kenyon2011). Phoenix et al. (Reference Phoenix, Smith and Sparkes2010: 1) suggest that the experience of ageing itself is characterised by complexity, that it is ‘dynamic, interactive, [and] subject to the twists and turns of life, chance, change, and complication’. Stories are an essential part of the way the meaning of ageing is performed, because age itself is performed (Laz, Reference Laz2003). Further, narratives are constructed in embodied interactions between people (Phoenix and Sparkes, Reference Phoenix and Sparkes2009; Berendonk et al., Reference Berendonk, Blix, Randall, Baldwin and Caine2017). The corporeality of life provides people with the means of acting, but also shapes what their actions can be (Frank, Reference Frank1991). Particular types of bodies identify us in particular ways, e.g. able bodied or disabled, young or old (Holstein et al., Reference Holstein, Parks and Waymack2011). The kind of body a person has becomes deeply embedded in the narrative because their body can be the topic, cause and instrument of their story (Frank, Reference Frank1991; Becker, Reference Becker1997). Storytelling is not only a linguistic process, it occurs between embodied actors, reflecting a lifetime of experience (Berendonk et al., Reference Berendonk, Blix, Randall, Baldwin and Caine2017). This makes narrative analysis particularly suited to researching the experiences of older adults. Ageing bodies bring with them cultural readings that are both externally imposed and internalised (Holstein et al., Reference Holstein, Parks and Waymack2011). Ageing and the aged body have traditionally been devalued in Western culture because of the associations with frailty and loss of control. This is particularly relevant for understanding the narratives of older people who live in RAC because of functional decline. In these settings, new meanings of ageing as a period of active engagement and lifecourse development may be less salient than understandings of ageing as a period of decline and disengagement (Bohlmeijer et al., Reference Bohlmeijer, Westerhof, Randall, Tromp and Kenyon2011).
Analytic approach
Murray (Reference Murray2000) suggests that narrative operates on four levels: personal, interpersonal, positional and ideological. The personal story is the story told by an individual about their own experience. The personal level focuses on the way people use narrative to explain events and make sense of their lives. The interpersonal story refers to the way stories are co-constructed between the storyteller and the audience (Mishler, Reference Mishler1986; Somers, Reference Somers1994). The audience includes the immediate listener (usually the interviewer), as well as future potential audiences. The researcher plays an active role in the research process, influencing how a story is told by the questions asked, and the stories pursued or abandoned (Wong and Breheny, Reference Wong and Breheny2018). The positional level refers to the influence of the broader social context of narratives, as well as the moral and social functions a narrative may perform (Stephens and Breheny, Reference Stephens and Breheny2013). This includes an examination of how narrative is used to perform identity. Lastly, the ideological level explores the culturally shared narratives within which stories are positioned. Stephens and Breheny (Reference Stephens and Breheny2013) collapsed Murray's (Reference Murray2000) positional and ideological levels into one level termed the ‘public narrative’, which examines the shared narratives of social life which have implications for social and moral identity. These different levels provide a way to interrogate the data, but do not reflect how narratives are structured, as all of these levels exert influence at all times (Murray, Reference Murray2000; Stephens and Breheny, Reference Stephens and Breheny2013).
Method
Setting
This research was undertaken with the animal therapy programme of a volunteer-based not-for-profit animal welfare organisation. The visits are primarily intended to socialise animals to make them more suitable for adoption, and secondarily used to promote the work of the animal welfare organisation. The organisation provides animal visits to different community groups. The visits are divided into three types: education, therapy and workplace visits. Education visits focus on building knowledge of animal welfare and animal-handling skills in the community. Workplace visits are described as providing stress-relieving distraction for busy corporates or students: ‘Puppy kisses, kitten cuddles and bunny nuzzles! Can you imagine a better way to help your workplace or university group take a much needed time out from hectic work schedules?’ In comparison, visits to residential facilities are portrayed as ‘therapy’ for those who could benefit from the socialisation and mental stimulation of an animal and volunteer visiting: ‘People might experience motivational, recreational and therapeutic benefits.’ In this way, the welfare organisation portrays residential visits as less about education or developmental opportunities and more in terms of providing a welcome distraction for residents.
This research was conducted in two RAC facilities. In order to understand the process involved in an animal therapy visit, the researcher assisted regular volunteers in the delivery of two sessions in the project planning stage. Volunteers and staff work alone or in pairs. An animal is selected from the adoption or quarantine wing – most commonly a puppy, followed by kittens, adult dogs, rabbits and guinea pigs, rats and adult cats. Animals in this programme do not undergo training specific to the therapy role. There is no formal procedure for establishing the suitability of an animal for therapy, but volunteers are encouraged to evaluate the animal before selection. There are approximately 15 volunteers in the programme, and three paid staff members. Volunteers commit to a minimum of one visit per fortnight. Consequently, most RAC facilities involved in the animal visiting programme are visited by an animal and a handler either once a week or once a fortnight. Each visit lasts approximately an hour, unless the animal is showing signs of fatigue or distress. Some facilities gather interested residents in a common area or lounge for the animal handler, while other facilities also take the animals to individual rooms. At times, staff nominate which residents would like to be visited in their own rooms. The length of an individual visit varies but is usually less than ten minutes. The protocol for a visit directs the handler to introduce themselves and the animal, and to keep in mind that not all people will be interested in interacting with either the animal or the handler. If a resident is interested in holding the animal, a towel is placed on the resident's lap first. In lounge settings, the animal is sometimes allowed to roam freely.
Participants
Participants needed to be living in RAC, able to give informed consent and participate in an interview, and identify as having had some experience of the animal therapy programme. The sample size was intentionally small to allow in-depth analysis, with seven residents participating in the study. Potential participants were screened by staff to ensure they were cognitively and physically capable of participating in an interview and providing informed consent. Suitable residents were introduced to the researcher by management and clinical staff. The researcher described the research process and distributed information sheets. After the researcher had left, RAC staff confirmed the participant was still interested in proceeding with an interview. This provided an opportunity for residents to decline any further contact discreetly. None of the participants withdrew at this stage. The project was evaluated through a full ethical review and approved by the university ethics committee.
Interviews typically lasted between 20 and 60 minutes. They were conducted in a semi-structured format to encourage participants to story their experiences in as much detail as possible. A set of general questions was used as a guide to begin the interviews, e.g. How long have you been involved in the animal therapy programme? Have you had much experience with animals over your life? Supplementary probe questions were used as needed. The interviews were audio recorded and transcribed. Respondents were offered the opportunity to check transcripts prior to analysis. All names reported in this paper are pseudonyms and place names have been anonymised.
Data analysis
The analytic approach used was based on levels of analysis identified by Murray (Reference Murray2000) and Stephens and Breheny (Reference Stephens and Breheny2013). The personal level involved paying attention to the ‘what’ questions of storytelling by unpacking the substantive elements of the story – the plot, characters and content (Smith and Sparkes, Reference Smith and Sparkes2006; Wong and Breheny, Reference Wong and Breheny2018). This focuses on what is described in the story and what is achieved by the telling of the story. For this study, we asked: What does the story tell us about animal therapy in RAC? What meanings are attached to this telling, and what are the circumstances or conditions that making the telling possible? As common narratives were identified, we checked whether these were reflected in other transcripts. Consistent and inconsistent narratives were compared and contrasted to reveal subtleties in the experience of animal therapy. This approach was chosen to privilege participants’ experiences of animal therapy and life in RAC.
Findings
This paper explores three narratives that have been labelled ‘Fleeting pleasure’, ‘It's sad here’ and ‘My life inside and out’. ‘Fleeting pleasure’ describes the experience of animal therapy as brief and infrequent, but enjoyable nonetheless. For some participants, animal therapy was not only a pleasurable experience in the moment of interaction, but also represented something to anticipate. ‘It's sad here’ begins to explore the underlying context that constrains the experience of animal therapy to no more than a fleeting pleasure. ‘My life inside and out’ further explores the value placed on people, activities and events that happen outside the RAC facility. Through this narrative, participants tell stories that take place in different physical and temporal locations to demonstrate who they are beyond RAC.
Fleeting pleasure
When asked to describe the experience of animal therapy in residential care, most participants narrated animal interaction as a simple, straightforward pleasure: ‘I just love it’ (Yvonne). The common thread in all these narratives was the idea of animal interaction in the context of the animal therapy programme as ‘a real pleasure but fleeting pleasure of encountering the animal’ (Cathy). In describing the interaction with the visiting animals, Jean emphasised that physical affection was a key part of what made the experience enjoyable. She linked this to her experience of illness and being bed-bound:
Jean: One of the men brings little dogs in, dear little dogs. And, they're little snugglers as well. It's a wonderful experience when you're not well or in bed, and you're given a little cat or a dog, a little puppy to hold.
Interviewer: Yeah, can you tell me more about what you like about it?
Jean: Partly, belonging to something. I don't know, it's just good … And I think particularly, someone like me who's been bedridden for a while, someone bringing a puppy or a kitten and letting them snuggle up against you is lovely.
The value of animals for Jean is in the tactile nature of the interactions. Jean revisits this idea throughout the interview: ‘Kittens are particularly good because they snuggle up to you … they're too young to know otherwise. They think that's their job, being kittens and cuddlers.’ Although Jean describes the experience very positively, it is reflective of the brevity and perceived infrequency of the visits that she does not elaborate further. When later asked if there was anything she found difficult about the visits, Jean referred specifically to their infrequency: ‘I'd just like to see more of them.’ This was a common response to questions about the programme throughout many of the interviews and reflects the impact of the programme as limited to the moment of interaction. For example, Joan was asked if she could tell the interviewer about the animal therapy visits, and replied: ‘Not much because, they just come in and show them to us and off they go, that's all.’
The impact of these moments of pleasure was characterised as ranging from ‘It really does affect me’ (Annie) to ‘I wouldn't miss it if it weren't here’ (Cathy). Yvonne described looking forward to the visits from the animals several times across the interview: ‘Um, I just really look forward to them coming.’ In this way, the effect of animal therapy did extend beyond the moment of interaction, because it provided Yvonne with an anticipatory pleasure even though she did not know when to expect the visits. Andrew's account contrasts with this, in that he expressed the visits as temporarily raising his mood, but insufficient to make a difference overall:
Interviewer: Do you think having the animals come in here makes a difference to [the experience of living here]?
Andrew: Well, no, it doesn't really. But while they're here, it gives you a lift. Because the infrequency.
The participants were aware that the visits were a service for many residents, providing context for why the visits are so brief: ‘No they don't [last long enough], but she's got other people to see too’ (Yvonne); ‘I try not to be too greedy. I mean, they're here for a job’ (Annie).
Some residents expressed a preference for interacting with a known animal. When asked if she had a preference for seeing the same animal (which is uncommon due to the adoption-based model of the welfare organisation), Yvonne said she prefers to see the same animal more than once ‘because they get to know me, and they run in and jump on my knee straight away’. The continuity of developing familiarity with a particular animal is bidirectional: Yvonne gets to know the animal, but importantly, the animal gets to know Yvonne and this leads to more immediate affection. This is similar to Jean's comment regarding the value of animal visits as ‘partly just belonging to something’. This is at odds with how this animal therapy programme is delivered, as the pool of animals constantly changes, which may help to explain the fleeting nature of the pleasure derived from the experience. As Jean and Yvonne described, ‘belonging to something’ and having the animals recognise them contributed to the experience. Cathy pointed out that not being able to develop a relationship with the visiting animal was a barrier to the interaction: ‘They're not your dog. It's going to be a short visit … you're not going to get emotionally involved with them.’
The pleasure of touch
The emphasis participants placed on touch matches the suggested mechanisms for the effect of animal therapy in the wider literature. Older people can become physically and emotionally isolated even within the RAC environment. Activities such as being bathed can become mechanical rather than caring due to staff time restraints (Holstein et al., Reference Holstein, Parks and Waymack2011). Although residents are touched, it is in the context of ‘task touch’ rather than the type of touch associated with being cared about. Task touch may not alleviate the sense that physical affection is lacking (Holstein et al., Reference Holstein, Parks and Waymack2011). Affectionate touch with an animal may present an opportunity for a caring and non-obligatory interaction for those without other opportunities for touch (Kaiser et al., Reference Kaiser, Spence, McGavin, Struble and Keilman2002). Although residents enjoyed the physical interactions with the animals, the way animal therapy is delivered in the context of socialising animals for adoption may limit meaningful interactions between the resident and the animals. This may explain the discrepancy between studies that use the same animal for all the visits and those using animals for adoption.
Animal therapy is promoted by the community organisation as more significant and necessary for people in RAC who are less mobile or confined to their rooms by chronic illness. Jean and Yvonne provided accounts that fit this representation of the animal therapy recipient in a RAC context. Both women repeatedly emphasised the pleasure of the ‘cuddles’ from animals. Jean explicitly linked her experience of the animal visits to being bed-bound in almost every reference to the pleasure she gains from the visits. The embodied experience of both Jean and Yvonne is one of confinement to their beds and rooms. Neither participated in any of the other therapeutic recreational activities provided by the diversional therapist, such as music concerts or art classes, because they were unable to access them. As the animal therapy programme is provided by an external organisation and can go directly to individual rooms, those who are bed-bound can still participate in both the animal interaction and receive an outside visitor. This suggests that the experience of animal therapy is linked to how confined the person is to the RAC facility, both physically and in terms of identity.
It's sad here
An alternative narrative of the experience of animal therapy was that it provided limited pleasure given the predominant experience of living in residential care as sad. In the following extract, Cathy responded to a question about the extent of her involvement in the animal therapy programme. Cathy's account begins with the fleeting pleasure narrative of these encounters as genuinely pleasurable in the moment of interaction, but also with a clear sense of brevity and a lack of deeper meaning. This develops into an explanation of why the visits cannot be more significant. Cathy does not view herself as a member of the programme, or as the kind of resident that could benefit from the programme. Instead, she shifts the listener beyond the residential care home to discuss other interactions with animals that she finds more meaningful:
Cathy: All I know is that, the [welfare organisation] name appeared once a week on our programme. You've probably seen the entry on that, and, I'm not aware of being part of any programme, I sometimes never see the [welfare organisation] person.
Interviewer: Oh ok.
Cathy: So my interview with you will probably of necessity be quite short because, if you were to ask me about the – what impact animals have on me, the animals that have an impact on me are for example on a day like yesterday (pause) no Sunday, when I walk on the Esplanade. And I never miss an opportunity – and it's put on me sometimes – to talk to the little animals that are being walked, and the bigger animals, and they – I quite often let them make the first overture. It's sad here – perfectly honestly – it's very much just in passing, and stopping for a chat (pause) and, I wouldn't miss it if it weren't here.
When asked if she would like the animal therapy programme to be more structured or more frequent, Cathy responded:
Um … I'm not sure that I would. Because it simply ties me down, to another appointment of being in my room. And, to what extent am I going to get involved with the animal? I'm going to get to cuddle it, and I – seeing them, they bring particularly nice animals, I see them in passing and always stop, but they have no significant role in my life at all … They are just now part of a pleasant, yeah definitely a pleasant aspect, but a very fleeting one. (Cathy)
Cathy used the question of her involvement in the animal visiting programme as an opportunity to lead into a story that moved the listener away from the animal therapy programme. In contrast to the animal therapy visits, Cathy told a story of animals that were an important feature of her life, but this story was located away from residential care. Cathy established her ability to leave RAC from the beginning of the interview using this story, and emphasised her desire and ability to not be ‘[tied] down’ to her room.
Cathy: I'm still managing to be mobile, ah (pause) growing less mobile, growing more tired all the time. Nevertheless, I mean, Sunday's an example where I call a taxi and ah Sunday I – I usually see my family but I wasn't – they weren't able to see me on Sunday because you know Christmas and social engagements and they were invited to a barbeque, and – but I wasn't going to spend the whole lovely day, because Sunday was lovely
Interviewer: Beautiful.
Cathy: and taxi down to Fitzgerald and then, delightful walk as far as the rotunda, and, three really pleasant social encounters, so I mean that was what one gets to long for in here, to meet someone like you for example, that I can talk to you. Because I don't actually get that much chance to talk, so that's why you find people like me pretty gabby (laugh).
Cathy juxtaposed her experiences with animals outside RAC as having an impact on her, while the therapy animals were not considered to be important because of the lack of emotional involvement, as the dog is ‘not your dog’. The distinction that Cathy makes between the animals that do have an impact – the interactions she has with animals outside RAC – and the therapy animals is telling. In many ways, the interactions Cathy has with the animals at the park are like the interactions she has within the animal therapy, as they are also with animals she may not see again and only interacts with in passing. Yet, these interactions are accorded with more significance in Cathy's story. The animals in these two settings have different meanings to Cathy; the animals in the park are significant to her as the interactions happen on her own terms outside RAC. This is further underscored with Cathy's characterisation of the residential care facility: ‘It's sad here…’. In this context, the story of interactions with animals in the park enables Cathy to escape the environment of residential care, and so the interactions take on a different meaning.
Cathy's story of the animals outside residential care includes an element of spontaneity, ‘natural’ settings and an ability to enact agency. Spending a Sunday walking along the waterfront of a busy city is an activity that is typically accessible to an independent and autonomous adult. Locating the story in a world beyond RAC resists an unwanted subject positioning of dependence and decline associated with RAC residence for Cathy. The brief encounter with an unfamiliar animal in RAC does not feature as an important aspect of her life. In contrast, meeting animals in the park provides an opportunity for social interaction with people who can lead the independent autonomous lives to which Cathy links her identity.
My life inside and out
A third narrative illustrates the impetus for RAC residents to locate their identity away from residential care. Like Cathy, Andrew used the questions about animals as an opportunity to lead into stories that moved the listener away from the animal therapy programme and the residential facility. Where Cathy used recent interactions in an external setting to locate her identity in terms of normality and independence, Andrew located his stories in a different time as well as a different place. Andrew used international travel stories, demonstrated his knowledge of a city that he now has restricted access to, and his interest in the news and politics of distant countries to demonstrate his worldliness. He sharply separated his identity before entering RAC from his present situation by exclaiming:
Well I gotta tell you something, in this place it's quite funny. Because I've often thought of writing a book about it, you know, ‘My Life Inside and Out’, you know. (Andrew)
Andrew immediately directed the conversation away from RAC and animal therapy by interrupting the interviewer's first question to highlight his knowledge of technology. His discussion of the animal therapy programme focused on the interactions with the regular volunteer handler and their shared interests in technology and politics:
Interviewer: Um, what do you enjoy the most about the visits?
Andrew: I don't know if it's [volunteer's name] company, or the dogs, or the whole lot, you know. All the visitors, the animals. Yeah I'd say it's the animals, and [volunteer's name], you know, communications.
Andrew describes the volunteer having purchased technology items for him, and his regular invitations to the volunteer that he visits with or without the animals.
Andrew locates his identity outside of and before entering RAC to justify his repeated claim: ‘I mean, as far I'm concerned I've led a pretty full life.’ Although the topic leading to this narrative was Andrew's history of owned animals, Andrew moves the listener away from animals and into a description of his interests and his international travels:
Andrew: …Do you know, what is it, Little Penang?
Interviewer: Yes.
Andrew: Yeah. That's a good place.
Interviewer: Yeah, I went there with my father when he came to visit, because he's Malaysian.
Andrew: And they've got those sort of ah, cakes, they're quite nice.
Interviewer: Yeah, I've heard a lot about, a lot of Malaysian people like that place, which is a good recommendation, yeah.
Andrew: I actually told him, I said, he what's his name now … tall guy, bald head, he's not just an ordinary cook, but, he does it with panache, it's a sort of an art. It's artistry, it's more than, you know. I said to him, I said I've got to tell you something, ‘I've never seen a restaurant like this, in all the places I've been to around the world’ … I'll tell you the worst Chinese restaurant. Don't worry, you have to catch a plane to get there – San Francisco. It's called the Empress of China.
The work Andrew does to achieve an identity that is located outside RAC centres on the culinary experiences of his extensive overseas travels as well as his knowledge of local restaurants. Andrew illustrated his overseas travels by telling stories about the worst Chinese restaurant in San Francisco, soup in California, the best fillet mignon in Montreal, an omelette at 2 am in a French hotel he stayed in, and ‘a very famous Irish meal, it's got whisky in it’ in an Irish pub. With these stories, Andrew establishes himself as worldly.
During these accounts, Andrew refers to being ‘on a different zone with the other world’. Although this directly references different time zones of the international news and political programmes he listens to, taken in combination with his repeated references to overseas travel and to technology, this claim is also one of not belonging in RAC. This underscores the lack of impact animal therapy has beyond the moment of interaction for Andrew. Andrew resists identifying with RAC by firmly locating his interests and identity outside RAC. Given this, it is unsurprising that animal therapy that occurs in this context does not make a lasting difference to Andrew's experience. Stories like Andrew's become essential counter-stories that try to repair the negative judgements that living in RAC is an indicator of irrelevancy.
Discussion
The experience of animal therapy in RAC was described as a genuine pleasure. This was particularly the case for those residents for whom this interaction was one of the few activities to which they had access. Beyond this immediate story of animal therapy as enjoyable, two further narratives, ‘It's sad here’ and ‘My life inside and out’ point to the ways that RAC is more than just a place to live; it is a social institution that has implications for identity. The experience of living in RAC is embedded in cultural norms that devalue people who are frail and old (Abel, Reference Abel1991; Dodds, Reference Dodds2007). For these reasons, older people in this study pointed to the importance of natural interactions for their identity and their ongoing need to establish themselves as relevant within a wider social context.
The significance of natural interactions
Animal interaction in RAC is a structured therapeutic activity; the animal has been brought to the facility specifically to visit the residents. Both ‘It's sad here’ and ‘My life inside and out’ point to the importance of ‘natural’ settings, and an ability to enact agency in storying a positive identity among older people in RAC. The constraints of living in an institutional environment can lead to an increased sense of dependence and lost sense of autonomy (Walker and Paliadelis, Reference Walker and Paliadelis2016). This can challenge the social identity of older people who have previously been independent and mobile or consider themselves to still be this way. As Holstein et al. put it:
after a life in which they have striven to exemplify the values of industriousness, productivity, accomplishment, and self-sufficiency, the prospect of placement in a nursing home is a vivid judgement about incapacity and a threat to loss of adult status. (Holstein et al., Reference Holstein, Parks and Waymack2011: 160)
Locating their stories in a world beyond residential care resists the positioning of dependence and decline associated with RAC residence. The animal therapy literature points to the ways that animals can provide conduits to social interactions (Kruger and Serpell, Reference Kruger, Serpell and Fine2006). The presence of animals may stimulate conversation (Fine, Reference Fine and Fine2000), and it is this kind of natural interaction that is sought out by Cathy during her walks in the park. Enhancing natural interactions and providing a shared topic of interest across generations may support more natural social interactions for older people (Holt et al., Reference Holt, Johnson, Yaglom and Brenner2015). A brief encounter with an unfamiliar animal in RAC is a staged encounter, which may not reinforce a positive identity in the ways that natural social interactions might.
The physical and social setting of RAC influences the experience of the visits and the impact that animal therapy can have. While an animal therapy programme may have the potential to provide social contact and interpersonal interaction, it currently functions as one of what Holstein et al. (Reference Holstein, Parks and Waymack2011: 162) refer to as ‘painfully limited’ activities, lost in professional operationalisations of socialisation. This begins with the way the programme is framed to the volunteers as a service for vulnerable and isolated residents. This framing is not inevitable; it is possible to frame the visits in line with the workplace visiting programme: as a service for unique, interesting people who have restricted access to animals. This goes beyond the practical programme restrictions and recognises the social context of RAC and how it affects the way events and activities are experienced. This might also go some way to explaining the equivocal findings regarding the impact of animal interactions on health and wellbeing for older people. The impact may depend upon the subtleties of the programme and the extent to which it reinforces or undermines a valued social identity for older people.
Establishing relevance
As Holstein and Minkler (Reference Holstein and Minkler2003) point out, negative attitudes towards ageing in general have been replaced with negative attitudes towards older people who are ageing with disability, chronic illness, frailty and dependency. RAC is particularly implicated in this and entry into care has been described as ‘the final sign of failure’ (as cited in Nolan and Dellasega, Reference Nolan and Dellasega2000). Although the rhetoric of active and independent ageing is nominally offered to older people, the experience of those in RAC is one of care and dependence. This is linked to ‘narrative foreclosure’: the belief that the story of one's life is over even though life continues (Bohlmeijer et al., Reference Bohlmeijer, Westerhof, Randall, Tromp and Kenyon2011). RAC may prompt narrative foreclosure if older people believe that this stage of life will include no new personally meaningful experiences (Berendonk et al., Reference Berendonk, Blix, Randall, Baldwin and Caine2017). Some participants bracketed off the life they lived prior to entering residential care from the life they now live in RAC; the former was viewed as worldly and relevant, and the latter as narrow and constrained. Baldwin (Reference Baldwin2015) proposes that care itself is a narrative practice, which includes creating space for those in RAC to fashion new narratives to prevent narrative foreclosure. As narrative is a principal way of making meaning in life, an inability to tell new stories renders experiences in RAC as meaningless. The animal therapy literature views animal interactions as activity that older people do rather than as having implications for who older people are. Narrative analysis has demonstrated the ways that these exchanges are more than isolated social interactions: they are experienced in terms of the ongoing narrative of older people's lives in RAC.
RAC and autonomy
Ray (Reference Ray2008) refers to RAC as a place that is alien and often sad, where a rich internal life may be masked by the appearance of biding time. In the context of RAC, the social roles and identities available to older people can become very restricted. The narratives of the participants of this study point to needs: the need for touch, the need to be recognised as having agency, of having lived full lives, as being part of the larger community, of being in (and knowledgeable of) the present, as needing real and spontaneous human interactions that are not structured, diarised and institutionalised. In this research, the talk around animals and animal therapy became a conduit to express these desires, needs, identities and humanities under threat.
RAC presents a unique environment of the home-that-is-not-home. Thus, the issues of importance to RAC residents are of an everyday nature, such as who gets the best chair in the living room, or who chooses the time for dinner (Kane and Caplan, Reference Kane and Caplan1990). Holstein et al. (Reference Holstein, Parks and Waymack2011: 155) argue that people in RAC rarely must make vital life-or-death decisions but they would like to make ordinary choices and ‘be acknowledged as a person with a past as well as a present’. Thus, value is placed in exercising autonomy even when the choices are not of a serious magnitude (Whitler, Reference Whitler1996). It is these mundane and everyday personal choices that are at risk of being erased in the RAC setting. The way animal therapy currently operates may reinforce this erasure by becoming another activity that is presented and delivered in a way that undermines autonomy. That is, animals are brought into the residents’ space on a schedule that is not their own, based on a decision that has been made between the welfare organisation and the RAC management.
Reflections on the study
This study aimed to understand the value, meaning and impact of animal therapy for older people in RAC using narrative analysis. Narrative psychology recognises the co-construction of a story between participant and interviewer, and in this research the interviewer was a research student in her twenties. This will have shaped the stories that the participants told of their experiences (Wong and Breheny, Reference Wong and Breheny2018). In addition, RAC residence was presented as a primary identity for the participants, as they were recruited because they were participants in RAC animal therapy programmes. This was further underscored by the interviews taking place within the rest homes, most often in the participant's own room. Taking a broader perspective on the experience of animal therapy across a range of settings such as businesses, universities and youth facilities as well as RAC may have altered the accounts given of this service.
Conclusion
Though animal therapy can provide moments of genuine pleasure, for most participants these moments were not enough to alter the way RAC is experienced as a challenge to identity and an undesirable place to age. For animal therapy to avoid reinforcing the lack of control that residents face, programmes need to be delivered in ways that respect the autonomy of older people in RAC and support relationships that are reciprocal and meaningful. Animal therapy programmes do not need to frame older people as passive recipients of therapeutic attention. Facilitating a meaningful choice to participate by making the choice explicit and intentional could partially address this. Further, openness about the purpose of the visits for the animal welfare organisation may also make the visits more meaningful. RAC residents often experience a profound sense of ineffectuality (Gillick, Reference Gillick2006). This is one of the distinctions Holstein et al. (Reference Holstein, Parks and Waymack2011) draw between living at home and living in RAC: in our own homes, we are useful. They argue that being useful, and not just entertained, should be supported in RAC. One of the primary reasons the organisation provides animal visits is to socialise their animals for adoption. Emphasising the benefit for the animals and the welfare organisation would make it clear it is a reciprocal relationship, rather than an act of service provision. Representing the animal visiting as providing care and training for vulnerable animals frames the RAC residents as vital to the service and may help to ensure animal therapy does not become another ‘painfully limited’ activity of RAC.
Ethical standards
This project has been reviewed and approved by the Massey University Human Ethics Committee: Southern A, Application 15/47.
