Clutter Moves in Old Age Homecare

© Copyrighted Material ww w.a sh ga te. co m Chapter 4 Clutter Moves in Old Age Homecare ww w.a sh ga te. co m ww w.a sh ga te. co m Peter A. Lutz Introduction ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m As a noun, clutter is deined as a disordered state or heap of objects while as a verb it is to move about in a bustling manner or to strew or amass things in a disorderly way (Collins English Dictionary 2003). This interweaving of cluttered things and movements is an appropriate starting point for the present chapter. By iguring clutter moves in old age homecare the aim is to engender a modest contribution to a growing curiosity in movement and old age homecare. It asks what array of socio-technical implications emerge in old age homecare ecologies when analytical attention focuses on how older people and cluttered homely things move together. Clutter may irritate norms about order, productivity and cleanliness and is often considered a cultural taboo (cf. Douglas 1966; Douglas and Wildavsky 1983). An Internet search of the term clutter helps illustrate this point. The most popular phrases include clean the clutter with about 400,000 hits and control the clutter with over 600,000 hits. However, remove the clutter achieves the highest score with roughly 2,200,000 hits. Here removal clearly emerges as one of clutter’s most widespread associations. More generally, this demonstrates how clutter is inherently linked, through idiomatic expressions, with the value of clutter-free living and clutter removal tactics.1 The inclination towards clutter removal is no less apparent in United States old age homecare ecologies. Certified programmes that offer training in home modification for Aging-in-Place, a popular US label that denotes the constellation of infrastructures and processes designed to support home living, is a case in point. Two clear examples are the Certified Ageing-in-Place Specialist (CAPS) programme of the National Association of Home Builders (NAHB) and the Senior Move Management Training (SMMart) programme of the National Association of Senior Move Managers (NASMM). A central ww w.a sh ga te. co m 1 Numerous popular self-help books with instructive strategies for removing home clutter provide further illustration. A few self-explanatory titles will sufice: The ClutterBusting Handbook: Clean It Up, Clear It Out, and Keep Your Life Clutter-Free (Emmett 2005) and Houseworks: Cut the Clutter, Speed Your Cleaning, and Calm the Chaos (Ewer 2006) or Organize It!: How to Declutter Every Nook and Cranny In and Outside Your Home (Kaufman 2006). The list goes on. © Copyrighted Material 78 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m element of these programmes is learning how to recognize, neutralize, as well as prevent so called ‘environmental risks’ for older people at home including the removal of their clutter. Various articles about how to manage home clutter appear regularly in the bi-monthly magazine of the American Association of Retired Persons (AARP). In one of these articles, Dudley (2007) proffers that the do-it-yourself clutter removal trend is related to the emergence of the professional organizer in the United States. Some examples are the National Association of Professional Organizers (NAPO) and support groups like Clutterers Anonymous (CLA) or Messies Anonymous (MA). These aspire to help arm individuals in their own private wars on clutter. Several reality television programmes like Clean Sweep, Clean House or Extreme Makeover Home Edition evidence this general trend. These programmes often depict how a person’s clutter is whisked away overnight and replaced with a cover story look-a-like from the latest home design magazine. This apparent obsession of decluttering in the United States helps to further contextualize this chapter. The ethnographic stories related here aim to reveal how removing home clutter is not always easy or appreciated among older people. In one case an elderly gentleman of 94 found it extremely dificult to rid his home of cluttered memorabilia. None of his four children had much interest in his family things. Simultaneously his nature held him back from just, in his words, ‘bagging it up and throwing it all away’. Several participants spoke openly about their clutter and even referred to it in derogatory terms as ‘old stuff’ or ‘junk heaps’. Yet on closer analysis these cluttered things often emerged as meaningful and ordered. As this chapter will show, the entangled movements of people and their home clutter are closely linked with home ecologies of old age care. The heuristic clutter moves is offered as a means to rethink the relationship between older people, their things and old age homecare including its technologies. Part of this potential stems from the multiple deinitions encapsulated in the term movement. According to the Oxford English Dictionary (OED), three key deinitions are: a change of place or position; a mental impulse especially one of desire or aversion; and an organization, coalition or alliance of people working to advance a shared political, social or artistic objective (Oxford English Dictionary 1992). Hence movement contains both literal (e.g. motion) and igurative (e.g. emotion) dimensions. Incidentally, the OED explains that the term emotion is derived from the Latin preix e- meaning out and the verb movere meaning to move producing the deinition, the action of moving out (Oxford English Dictionary 1992). With this nuance in mind, the act of moving or removing becomes an emotional move per deinition. This is a curious contradiction with the more contemporary usage which depicts emotion as an internal mental or conscious state of feeling. Yet it also underscores how movement is thoroughly entangled with material-semiotic (Haraway 1997) relationships. © Copyrighted Material 79 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m The broader exploration of movement has enjoyed increasing popularity in scholarly pursuits. For instance, Urry has recently coined the phrase mobility turn deined as a ‘post-disciplinary […] way of thinking through the character of economic, social and political relationships’ (Urry 2007: 6). Then, in humancomputer interaction (HCI), there is a long-standing interest in mobile devices and systems. This includes assistive technologies for elderly and disabled people. Meanwhile, movement has played a central role in studies of science, technology and society (STS). Latour’s inluential concept immutable mobiles is one example (Latour 1987). Another is Mol and Law’s reiguring of actor-networks as luids and lows (Mol and Law 1994). Anthropology is no exception. Here the mobility turn originates in studies of migration, space and identity as well as territorial boundaries (cf. Jansen and Löfving 2009). In the book Friction, for example, Tsing employs movement’s literal (mobility) and igurative (social mobilization) dimensions to launch an analysis of the Indonesian environmental movement (Tsing 2005). In relation to old age homecare one recent example is provided by Schillmeier and Heinlein who explore various implications of moving from one domestic residence to another in old age (Schillmeier and Heinlein 2009). So what about technology? The literal or standard view frames it as a broad category of material artefacts, systems, techniques and machines much apart from the social sphere. Pfaffenberger for one recognizes that both popular and scientiic accounts generally adopt this standard view (Pfaffenberger 1992). This contrasts with the symmetrical view of technology as fundamentally sociotechnical relationships consisting of both human and nonhuman actors (cf. Latour 1987, 1999). This latter view increasingly retained in anthropology and STS is also assumed here. The heuristic of clutter moves is an attempt to contribute a symmetrical analysis of people-things in old age homecare ecologies. Hence this does not presuppose a clear distinction between the literal and igurative or Haraway’s material-semiotic in iguring the ways people and their cluttered things entangle one another. The term ecology is also employed throughout this text. It is used to encompass the multiple spatial-temporal entanglements of heterogeneous entities including people and their cluttered things. The OED credits the zoologist Haeckel with coining the term in the late 1800s (Oxford English Dictionary 1992). He derived the term from the Greek words oikos meaning house and logos meaning science. Hence the notion of heterogeneous home ecologies seems within Haeckel’s original intentions for the term where home and old age care practices merge. Meanwhile the phrase old age homecare is employed to fold together multiple ageings, homes and cares. The intention here is not to black-box the multiple practices bracketed by this phrase. Rather it is offered as abbreviated shorthand while the movements of people and things are traced through these heterogeneous ecologies as clutter moves. The ethnographic ieldwork on which this chapter is based employed semistructured interviews, participant-observations and home visits recorded with a handheld video camera over a four-month period. Fieldwork engagements were scheduled on a one-to-one basis. The home interviews involved approximately © Copyrighted Material 80 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m Scientiic Literature on Falling Older People ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m twenty older people. With participant consent, these interviews incorporated a walk-through tour of their domestic surroundings. They often lived alone but when available their paid and unpaid caregivers, including family members, were also asked to participate. More casual follow-up meetings and participantobservations transpired with roughly a half-dozen of the older participants as well as their caregivers.2 Next, a brief review of a familiar move in old age homecare studies is presented: falling older people. It suggests that the gerontological and geriatric literature tends to oversimplify clutter as a hazard leading to the risk of falling. The subsequent sections question such depictions from an ethnographic view focused on other ways people and clutter move around in old age homecare ecologies. ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m This section reviews a series of gerontology and geriatric studies of old age homecare that deal with the risk of falling. As noted this literature typically identiies home clutter as a major hazard in domestic environments. The Centers for Disease Control and Prevention (CDC) offers one of the most compelling statements found. It reports that falls are the leading cause of injury deaths among people over the age of sixty-ive and home clutter is noted as a signiicant environmental factor implicated in one third of these falls (CDC 2007: 29). The remainder of this section elaborates how similar research, primarily from the US and UK, has igured such cluttered movements. Several studies stress how clutter threatens independent living and physical movement at home. For example, Wilson and Rodgers who, upon reviewing research of physical activity and exercise among older people with cardiovascular disease, conirm that cluttered homes are unsafe for exercise and lead to falls and injuries (Wilson and Rodgers 2006: 635). Then, in a British study Wherton and Monk argue that the independence of older people with dementia can be supported by minimizing their home clutter (Wherton and Monk 2008: 2). This link between independence and hazardous clutter is also echoed by Börsch-Supan et al. who stress that falling is a major threat to the ability of maintaining one’s household and independence in old age (Börsch-Supan et al. 2005: 45). Another tendency is the factoring of home clutter as a hazard in the development of various risk assessment schemes. For instance, Messecar et al. in their study of elderly home caregivers’ environmental modiication strategies reference a home modiication intervention scheme that designates the removal of home clutter (Messecar et al. 2002: 358). In another study, Evans and Kantrowitz 2 The American Anthropological Association’s Code of Ethics guided all participant engagements including informed consent. Participant pseudonyms are used throughout this text to protect personal identities. © Copyrighted Material 81 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m use a housing composite scale that relies in part on respondent’s assessments of cleanliness/clutter to measure environmental risk exposure (Evans and Kantrowitz 2002: 310). The overwhelming majority of these studies employ quantitative analysis of rated questionnaire responses from older people as well as care professionals. Here the home clutter category is often calculated alongside multiple other hazards. For example Gershon et al. invited 738 Resident Nurses (RNs) to rate a series of hazards in all out-patients’ households, not only older persons. According to these RN respondents, more than a third of the patients’ households contained environmental hazards including home clutter (Gershon et al. 2008: 6). This study used messy home/clutter as one of ten environmental and physical hazards in the development of their household hazards construct. These were measured in relation to biological, chemical and violence-related hazards (Gershon et al. 2008: 5). Presumably the threat of home clutter warrants comparison to such things as domestic violence and poisonous chemicals. In a similar study that explored reasons for falling, Zecevic et al. utilized a telephone survey to collect the views of seniors and health care providers (Zecevic et al. 2006). A total of 28 categories were measured and included, from highest to lowest frequency: Balance, Weather, Inattention, Medical conditions, Indoor obstacles (including clutter), Surface hazards outside, Slip-trip-stumble, Dizziness, Attitude, Muscle weakness, Vision, Footwear, Motor control, Medications, Old age, Hurry, Stairs, General poor health, Alcohol, Indoors hazardous surfaces, Assistive devices, Inactivity, Chance event, Frailty, Lighting, Poor service, Unfamiliar environment, and Fear of falling (Zecevic et al. 2006: 374). Again, home clutter is mixed together with an entire series of possible hazards that increase the risk of falling. Unfortunately, the distinctions of these categories such as the difference between slip-trip-stumble and chance event are highly ambiguous. With some imagination it is feasible that clutter could be implicated in a few or several of its sister categories, depending on how each respondent perceives clutter. While a correlation between home clutter as hazard and the risk of falling is well documented, there is a surprising lack of description about what the category of home clutter actually entails or why it is there in the irst place. Here are a few exceptions. In their interview study with care professionals and older people, Blythe et al. quote participant(s) verbatim on home clutter: ‘[There is] too much furniture in the home. [Occupational therapists] hate those rugs. [Older people] always trip over them. […] They leave yards and yards of cable and they tend to pull it wherever they go. They get up to go to the loo, answer the phone and they fall over the cable’ (Blythe et al. 2005: 676). With reference to such irritated statements and combined with a panel on falls prevention, these authors prescribe that environmental assessments of home should occur in coordination with older persons’ discharge from the hospital (Blythe et al. 2005: 676). Another quick glance is offered by Moylan and Binder who cite cluttered walkways in relation to community occupational therapy services with programmes designed to assess and modify home environmental risks (Moylan and Binder 2007: 496). Loose rugs © Copyrighted Material 82 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m and cords are also mentioned by Russel et al. in a statistical study of observed or measured risk factors for falling (Russel et al. 2006: 1091). While items such as rugs or telephone cables are explicated in some of these studies the category of home clutter is generally left relatively unpacked, thereby masking the diversity of objects and situations. Here a disjuncture emerges between recommendations for clutter removal and knowledge about the multiple forms and meanings that it may occupy. One plausible explanation is that home clutter is only one factor in a multi-factored risk analysis of falls and thus left undistinguished. However, if moving around with clutter is such a pervasive concern then one must assume there are multiple practices at work to produce its emergence. The quantitative methodology predominantly employed to sample care professionals’ and older persons’ own risk ratings in such studies may also be implicated in the interpretive gap between the category and the contents it enfolds. Presumably, participant responses were collected after fall incidents for statistical analyses. It is therefore feasible that the research categories or terminologies used were unable to fully catch the nuance of interpretations as they occur in practice. In other words, the ranking terms employed may end up cloaking other more subtle processes. Hence, home clutter and hazard or risk in one context may mean something very different in another and thereby go unnoticed in the inal analysis. This in turn may summon the inaccurate portrayal of home ecologies and the various ways people and their clutter relate within them. Such queries are acknowledged in an article by Marshall et al. who opt for the method of home visits. This was instead of telephone surveys to gain a more qualitative assessment of falls in relation to the home and household clutter (Marshall et al. 2005: 99). A second example is found in Zecevic et al. who qualitatively link clutter with the risk of falling (Zecevic et al. 2009). This latter article assesses how the adoption of a case method used in the Canadian transportation industry. This was to investigate safety and accidents could be adopted for the systematic analysis of falling older people. Their research is built around a series of cases framed to identify systematic causes. One case in particular focuses on home clutter as hazard and how it contributed to a fall incident: ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m Case 17: Trip Over the Box. – At approximately 11:00 p.m., an 84-year-old woman fell in her apartment kitchen. She tripped over a heavy box that, earlier that evening, she illed up with sweets and jars of jam. Earlier that week, she was instructed to remove all sweet foods from home, after being diagnosed with Type 2 diabetes. She left the box on the loor near the kitchen entrance. She planned to move the box out of the way in the morning and to give it to her daughter the following weekend. Habitually, the senior leaves items on the loor when she plans to take them out of the apartment. This creates clutter that was present at several places in her bedroom during the investigation. The senior had cleaned out her closet and prepared multiple bags of items for her daughter to take away. On the day of the fall, it was the irst time the senior left an obstacle (box) in the middle of the walking path to the kitchen. After inishing her before© Copyrighted Material 83 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m bed routine in the bathroom, she turned off all the lights in the apartment (to conserve energy) and quickly walked from the bathroom to the kitchen to throw a piece of wrapping paper into the garbage bin. Her right foot hit the heavy box, both feet blocked behind the box; she lost balance and fell forward hitting the carpeted loor with her face. The impact broke her nose; her glasses made deep indentations around her eyes that later caused severe facial bruising. […] At the time of the fall, the senior lived alone (Zecevic et al. 2009: 690–691). ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m This passage is among the more descriptive accounts of home clutter in the gerontology/geriatric literature focused on fall risks among older people. It makes clear that home clutter as hazard entails much more than rugs carelessly strewn across the loor in concert with a mess of telephone lines. To the contrary, home clutter as hazard may also take the form of carefully organized and contained boxes or bags marked for removal. Equally important is the degree of explicitness revealed in the above case when compared with the prevailing quantitative risk assessments. Almost by accident, it anticipates the broader ethnographic exploration of clutter moves and how it interweaves older people and their cluttered collections. For instance, it implicates the healthcare professional’s directives to remove sweet foods, in turn prompted by a diagnosis of type 2 diabetes. It also connects the practice of giving things away that is inherently entangled with family relations while living alone in old age. Such analyses begin to push clutter moves beyond the association with threatened independence or risk assessments which factor clutter simply as a hazard; sometimes even in tandem with poisonous household chemicals or domestic violence. While it is not my intention here to deny the risk of falling, I do suggest that there are other useful cluttered avenues of analysis to move down. Qualitative descriptions such as the one above suggest a fruitful alternative. The next section takes up this challenge. The heuristic of clutter moves is engaged to survey a series of ethnographic stories which highlight ways cluttered things entangle themselves with old age homecare ecologies. ww w.a sh ga te. co m Collecting and Distributing ww w.a sh ga te. co m ww w.a sh ga te. co m The scientiic literature in gerontology reviewed above has more often than not factored clutter and movement as potentially a perilous relationship. Physically moving around in home areas, cluttered or otherwise, is clearly a challenge for ageing human bodies. Yet, what other stories surface besides risky clutter when ethnographic attention is paid to how older people and their clutter moves? This section builds on evidence from ethnographic ieldwork to propose other kinds of clutter moves. In part, this focuses on how clutter is collected within the home while also distributed and entangled within ecologies of old age homecare. © Copyrighted Material 84 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m Collecting and Distributing Cluttered Family Ties ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m The earlier example of a woman tripping and falling over sweet foods she had collected in a box to give to her daughter suggests that clutter is not simply scattered about the home in careless fashion. My ethnographic research also supports this paradoxical assertion: home clutter generally surfaces as ordered collections (see also Makovicky 2007; Swan et al. 2008). Nevertheless, this was not without frustration. Here the ebbs and lows of clutter moves are explored in terms of how they permeate home ecologies including family relations. Meet Patrick. He was a delightful and intelligent 94-year-old widower. His wife had passed away seven years earlier but he still lived in the ranch-style house he had designed and built in the 1950s. He proudly showed me a picture taken from an airplane some years before and displayed in the entrance way. This birdseye view documented a car in the driveway and a sailboat that he had built as well as a ield of Christmas trees ready for harvest. Since the picture was taken he had sold the car and the trees, and had given the boat to his son in California. He had christened the boat ‘Misadventure’ and kept its stamped lifebuoy as a token. His other three children, all daughters, lived within a 15-mile radius. Although close in terms of travel distance, they were all too busy to spend as much time with him as he wished. Patrick explained that in the interim between breakfast and lunch he often read, listened to radio news, did light housework or worked on his ‘cleaning the clutter’ project. This was ‘old stuff’ that he and his family had accumulated over the years. It included newspaper clippings, family correspondence, pictures, clothing, decorations and other miscellaneous objects of some sentimental value. One could say memorabilia illed his house like thick molasses. He relected on his saving nature and linked it with growing up in the Depression years when resources were scarce. He explained that it would not be so dificult to sort through it if he only knew what to do with it all. He had dificulty getting veriication from his main recipients: his children. He had even asked his paid care worker to help him label and sort things into manila ile folders. However, due to his increasingly poor eyesight it was dificult for him to read the labels she had written. He realized that some of his organizational problems could have been solved with a computer. But since he had never learned to use one he did not intend to start now. During one of my visits Patrick directed me to a stone ireplace hearth in the living room where he had arranged and labeled four shoeboxes, one for each of his children. Like the woman’s boxes of sweet food, Patrick’s shoeboxes exemplify how clutter moves between inward concentration and outward distribution. However, this was not careless removal but rather a highly selective process seeped in meaning. Resourcefulness and attempts to save things perceived valuable, no matter how insigniicant, imply an economic dimension to clutter overlooked in recommendations for clutter removal surveyed earlier. Material-temporal luctuations were also observed in several cases where people had accumulated special things that needed a new home. Among my participants I found collections © Copyrighted Material 85 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m of old cameras, typewriters, computers, family picture albums, dolls and stamps to piles of yarn, shelves of quilting fabrics and even a porcelain frog collection numbering over two hundred igures. These were prepared for giving but not throwing away. Yet, as Patrick noted, distributing clutter was often hampered with frustration. For instance, when I asked another 87-year-old female participant if it was dificult to remove her clutter she exclaimed, ‘I am gradually working on it. I try to give it away. I mean the kids and people have given me stuff over the years and I’ve got to put it somewhere.’ The intended receivers are not always interested. Patrick’s shoeboxes illustrate collecting-distributing clutter moves that connect family ties. Such moves also intersect and redeine his home ecology. For instance, what once was a ire hearth is now also a mailroom; what once was an eating area is now primarily a sorting and cleaning the clutter workroom. Indications of risk seem far removed. Meanwhile, clutter moves engaged with self-care imply another form of collecting-distributing. Nesting selves is a key practice that emerges here. Collecting and Distributing Cluttered Nesting Selves ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m Arleen, a 76-year-old widow, is a prime example of how clutter enables self-nesting practices. She was an articulate and eccentric woman who lived alone in a two-loor semi-rural house that was increasingly proving dificult for her to maintain. She suffered from a number of chronic ailments, including type 2 diabetes. She drove a little orange and rusty 1970s Toyota pickup and walked around with the help of two antique shooting sticks used as canes. These are exemplary of her ingenuity. She explained that the shooting sticks had been purchased at Harrods in London many years earlier. However, when she decided she required walking assistance she began employing them as canes. She was proud that she had managed to salvage them for a ‘proper’ use. She also explained that they made her feel more ominous and had accidentally stunned a doctor with them. When I irst met her she insisted that our interview be held in her garden. Luckily it was sunny and warm that day. I later convinced her to allow me to tour her home on a follow-up visit. She agreed, but noted that I was one of the only persons she had ever allowed into her home over the past several years. ‘It’s a complete mess,’ she remarked unapologetically. This proved to be an accurate assessment in my eyes. I had never seen such a thing-rich home. It seemed to be made of clutter and nothing more. Yet, possibly thanks to her shooting sticks, Arleen had never fallen. In the course of the visit we toured her upstairs bedroom. There was no exception to the richness of things. Tea bags and a hot-water cooker rested beside an artist’s easel, complete with paints and drawings stacked on a make shift table. These competed with other assorted papers, magazines and books piled around the room. The unmade bed exposed a pair of wool gloves, a handheld neck massager and ‘ubiquitous cough drops’ that ornamented the linens. These were accompanied by other nearby collections of © Copyrighted Material 86 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m medication bottles, emery boards, tissues and a pair of nail clippers. However, my view of these objects as clutter shifted as she began to explain their utilities. Previously, she had called the room her project room. Prior to that it had been the guest room. The room was furnished with a wood-burning stove left uninstalled due to a foreseeable rate increase in homeowner’s insurance. She described how the room has once been open and immaculate but over time her projects took over. She was proud of the project table that she had built herself; essentially a door supported by two sawhorses. She went on to describe how her projects grew more and more ridiculous and less and less productive as time marched on. ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m Eventually I covered them all up with that sheet to try and reduce the dust on them but it’s still a bit weird.’ She continued, ‘The reason for the stepladder is that… the overhead light bulb burned out and seeing that there are no built-in bookshelves in this house… it now serves both as my light bulb changing spot and my bookshelves. The two beds are matching beds… Once upon a time they were very ornate and orderly with pretty covers and so forth. This was the guest room then but the bed that I was sleeping on in the other room more or less gave out so I moved in here. There is nothing on the bed except the things I need when I sleep like a lashlight and my massager and the ubiquitous cough drops, and oh the gloves in case it’s cold. I also make tea up here, especially in the wintertime. I have these two small bed tables which are made for breakfast-in-bed but I use them as writing tables. I put my three three-cornered pillows behind me and put this table on top of me. Then I put the writing machine on that other table and make tea. It’s my tea-writing ceremony. Like I said, that’s mostly in wintertime. But every now and then, when I just can’t stand whatever the challenges are downstairs, I make myself some tea up here. I think I even once made myself some coffee up here. ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m There are at least two points that emerge here. First is the notion that one person’s clutter is another’s treasure is not entirely accurate. Arleen easily recognized her house as ‘a complete mess’ and that her veiled projects were ‘a bit weird’ but she remained proud about the histories and utilities of her cluttered things. This was also evident with Patrick who simultaneously recognized his clutter as ‘old, old stuff’ but also cherished heirlooms making it dificult to sort and remove. Even more relevant for the argument here is how clutter moves selfcare by nesting things within arm’s reach. Hence there is an ordered eficiency in collecting clutter that economizes body movement. Why go downstairs to make coffee or tea when it can be done upstairs on the spot? At the same time, distributing clutter moves are also apparent. For instance, her partially veiled art and craft projects helped to mix emotional moves of creative identity with memories in the past and present. The favourite armchair offers another variation of nested collecting-distributing clutter moves. Many of my participants had a favourite place to sit. Often this was a reclining chair or armchair positioned in front of the television. But other © Copyrighted Material 87 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m views were also monitored. One participant explained how she positioned her chair so that she could simultaneously look at television, eat dinner and watch the neighbour boys play in the yard across the street. Another participant had aimed her chair so she could watch the harbour with its panorama of boats, mountains and sunsets. Yet, besides sites for monitoring the outside world, they were also collection points for home clutter. Meet Phyllis, in her early nineties. She had just had a stroke a few months prior and was learning to cope with its effects. Her Cadillac was parked in the driveway but she was resigned to the idea that she would never drive again. She was also becoming accustomed to her wheeled-walker. She practised walking without it but was unable to get very far. It framed her body, almost squeezed it, as we sat and chatted. She had positioned it directly in front of her ready for service should she decide to get up. Within arm’s length she had placed a side table. It was stacked with numerous objects and I asked her to comment on these. She began by explaining the different publications to which she subscribed. ww w.a sh ga te. co m ww w.a sh ga te. co m I get the daily paper. It comes seven days a week and delivered to the door. My caregiver picks it up and brings it in when she comes in the morning. I also get several magazines but am beginning to get tired of those. I get the Crisis [the oficial magazine from the National Association for the Advancement of Colored People (N.A.A.C.P.)]. I also get Ebony [a monthly magazine marketed for African Americans]. Oh and I get the Decision from Billy Graham. A lot of this stuff has to do with church. It’s my central headquarters. I keep my Sunday school lesson here too. I taught Sunday school at my church before I became like this. I won’t say an invalid. I used to teach a bible class. ww w.a sh ga te. co m ww w.a sh ga te. co m She explained how she spent a lot of time sitting and praying. She noted a bible that competed for space with a TV remote control, a telephone, a small radio, a ingernail ile, a calendar, a check book, a few pens and pencils, a notebook, a box of tissues, a pair of eyeglasses and several other knickknacks all illuminated by a reading lamp. Phyllis continued, ww w.a sh ga te. co m ww w.a sh ga te. co m ‘If I hear something on the radio or if something comes to my mind that I want to discuss with somebody or if I want to call somebody I write it down in my calendar.’ She started then to look for it. ‘I can hardly ind it now there’s so much here. I’m running out of space.’ I then asked, ‘So when you’re not up and about or in bed it sounds like you’re sitting here most of the time.’ She replied, ‘I am here most of the time. Like I said it’s my central headquarters.’ ww w.a sh ga te. co m While clutter moves helped support Phyllis’ failing body in her domestic surroundings, they also helped to facilitate the ordering of her thoughts but also their intersections into the world. Hence Phyllis’ armchair headquarters is another illustration of collecting-distributing clutter moves that interweave home ecologies. This was facilitated by assembling together multiple technologies such as her © Copyrighted Material 88 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m walker, armchair, newspapers, pens, calendar, radio, television and so on. Here the boundary between things and technologies in the standard view is dissolved. In the next section the analytical shift from clutter things as technology clutter to clutter technology is explored in further detail. From Technology Clutter to Clutter Technology ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m This section outlines the analytical move from technology clutter in the standard or conventional view to clutter technology in the socio-technical or symmetrical view. More speciically, clutter technology is coined to extend the heuristic of clutter moves for rethinking new technologies in relation to old age homecare ecologies. This move stems partly from the paradox mentioned above about how home clutter may be viewed simultaneously as both treasure and clutter or even mess and order. In other words, apparently disordered objects are revealed as meaningful and ordered socio-technical things that support old age homecare. Technology Clutter ww w.a sh ga te. co m ww w.a sh ga te. co m First, let us return to another room of Arleen’s clutter. This time we are amidst a collection of various healthcare machines. She begins by surveying the top of her waist-high dresser. ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ‘Oh yes I use this area here for combing my hair and storing my hearing aids and putting them in and taking them out and cleaning my glasses.’ Then I asked, ‘Are these your hearing aids here?’ as I point to two black cases. ‘Those are the cases for the hearing aids. Would you like to see a hearing aid?’ she asked. ‘Well okay, you could show me one… Is it going to be hard to put it back in?’ I ask. ‘No. It’s just going to be time consuming because everything is time consuming at my age,’ she laughs. ‘Also you have to keep track of the batteries and when they die it starts beeping at you. When it does beep this is how you disconnect it so that you’re not using the battery when you’re not using the hearing aid. There’s a button here that you can… That’s the wrong button. Hum, no, this button tests that it’s on. You can use it when answering the phone or change the frequency. This other button is a simple volume button: You can make it louder, louder, louder, louder! Alright?’ she conirmed. ‘Okay, thank you,’ I replied. ‘Well you’re welcome. Now you’re going to have to wait another day while I put it back in the case. Also I didn’t show you the part that sometimes comes apart. There are always a few little things… Like part of it dropping out when you’re not looking. Alright what else do you need to know here? Oh the wobbly table. That’s the wobbly table,’ she remarked. It appeared like she started to lose her balance. ‘Careful, careful, hold on,’ I urged. I stepped slightly backward and nearly tripped myself over the cord to her hairdryer. ‘Oops, do not trip on that. I don’t usually have it there but that’s my hair dryer. I was using that this © Copyrighted Material 89 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m morning,’ she explained and then pointed across the room. ‘You can see where it says blood pressure monitor?’ ‘Yes,’ I responded. ‘Actually if you want to walk over there I’ll show you that.’ We stepped lightly across the room picking our way around a double bed, stacks of paper and a drying rack with a few clothes still left on its bars. We arrived to a small table and chair in the corner. ‘When you do this… you’re supposed to have this part of your arm at heart level. I sit here and rest my elbow on the box that this thing came in and then I run it. Want to see how it runs?’ she asked. She seemed to be enjoying this. ‘Yes,’ I replied. She continued again. ‘I come in and test my blood sugar and I keep a little record right here. It just went on. Then when you push start it goes up and up and up and you stop it when it’s high enough. Then you wait and it comes down and then it starts blinking and it tells you what your reading is.’ ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m Before we left the room she noted several other items. For instance, there were two identical mobile blood sugar monitors for her diabetes, one of which had recently malfunctioned causing her distress on a family dinner outing. Then there was a large rechargeable lashlight that she used when the electricity fails. However the battery was also failing and she had been unable to locate a new one. Next was the base to a rechargeable cordless phone minus the handset. She had misplaced the handset some days before but could not ind it with the search button because its battery was also dead. These things intermingled with her collected works of Jung, the psychologist. However, many volumes were missing or scattered elsewhere throughout the house. Finally, there was her old and trusted manual typewriter. It was a memento of her writing sabbaticals up in a Canadian mountain cabin when she was younger. ‘No electricity. I had to go in by seaplane,’ she explained. However, several of its keys were failing and the ribbon was broken. No matter because she had adopted the desktop PC, well actually three. The irst two computers had developed viruses so she had been given a third by a friend. Still she kept the other two as backups. She joked as we left the room, ‘Between me and my equipment and my old truck we’re all pacing each other to see who and what gives out how much and when!’ Arleen’s arrangements challenge the standard view of well-polished medical technologies that deliver unfailing systems for assisted living. Instead, such devices inevitably fail, at least temporarily, or break apart only to merge together home ecologies of old age care. Meanwhile, amidst such mechanical deteriorations, Arleen illustrates how her healthcare devices are thoroughly cluttered to achieve a level of old age home (self) care. With the exception of a misplaced hairdryer cord, this is in stark contrast to the portrayals of home clutter as purely hazardous that predominate in the geriatric-related literature reviewed above. Her story exposes how cluttered devices may actually have speciic socio-technical trajectories not readily visible when viewed merely as technology clutter, i.e. distinct mechanical devices scattered around the house in meaningless ways. For instance, Arleen’s pride and self-reliance was evidenced when she explained the ingenious use of the monitor’s box as an armrest while testing blood pressure. The same may be said of © Copyrighted Material 90 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m Phyllis’ armchair and Patrick’s shoeboxes. Each apparent cluttered set of devices have the potential for extended clutter moves, from motion to emotion. This urges the socio-technical notion of clutter technology explored further below. ww w.a sh ga te. co m Clutter Technology ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m The previous examples have already hinted at how home clutter may serve as a relational nexus for various kinds of clutter moves entangling home ecologies of old age care. Phyllis’ cluttered armchair headquarters potentially enabled the movement of prayers and thoughts for others while easing her own bodily movements. Patrick’s shoeboxes collected sentiments and heritage for prospective moves in his past, present and future family connections. Meanwhile, Arleen’s various clutter collections helped ease the motion of her failing body as well as the emotion of her self-reliance and pride. As such, these cluttered assemblages suggest a kind of messy interface or clutter technology for moving around sociotechnical home ecologies of old age care. Here the term clutter technology is offered to denote how cluttered things have the propensity for both permeation as well as the creation of old age homecare ecologies. In one sense, clutter technology is an analytical move that resembles the suggestion by Bell et al. to ‘defamiliarize’ the home as a familiar or normalized space; in other words ‘making by making strange’ (Bell et al. 2005). In turn, they propose that this ‘opens up’ the home as a conceptual space for design thinking. This is also similar to Dourish’s call to ‘see like an interface’, inspired by Scott’s book Seeing like the State (Scott 1998), to better conceptualize how humans and technologies are thoroughly entwined in mundane ways (Dourish 2007). The recent ontological turn offers additional inspiration. One exemplar is the book Thinking Through Things (Henare et al. 2007). Here the authors argue that material things should be explored on their own terms, as heuristics, rather than generic objects or artefacts used to signify some predetermined theoretical concern. This positioning points an ontological inger at the studies of risk assessment outlined earlier. As argued, these studies have generally left the category of home clutter unexplored or boxed-up as a hazardous risk. Alternatively the clutter moves heuristic is employed to reopen and rethink home clutter on its own terms. Similarly, the notion of clutter technology has emerged as a means to reconsider technology in its broadest ecological and socio-technical sense. It is important to note here a handful of recent ethnographic studies in the ield of human-computer interaction (HCI) concerned with the design of domestic computer technologies and focused on home clutter (cf. Kirk and Sellen 2008; Swan et al. 2007; Swan et al. 2008). Curiously, these studies are sponsored by a major multinational hi-tech company and they have supported product developments such as surface interface devices and tabletop computing. These authors tend to focus on the literal collection of home clutter and stress how it is intrinsically linked with people’s ideas about home and order. They assess clutter as an essential component of the home or a ‘home within the home’ (Swan et al. 2008, see also Makovicky © Copyrighted Material 91 Clutter Moves in Old Age Homecare © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m 2007). Similar themes related with the link between home and clutter are of course proposed in this chapter, in particular the concepts of nesting and collecting. To their credit, Kirk and Sellen (2008) have identiied the possibility of clutter as sentimental artifacts. However, the wider conceptual prospects illuminated by clutter moves in old age homecare ecologies are generally overlooked in the HCI literature. Hence, in relation to the standard view of new technology development, the notion of clutter technology proposed here aims to engender further innovative relections on the future design of assistive technologies for old age homecare. ww w.a sh ga te. co m Final Remarks ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m In closing, this chapter has employed the heuristic clutter moves to embark on the analysis of how movements thread together multiple entities in home ecologies of old age care. Most speciically these have included older people and their cluttered technologies viewed broadly as entangled socio-technical assemblages. After a brief review of gerontology and geriatric-related studies on falling, it was established that such literature generally leaves the category of home clutter unturned. A central tendency in such literature is to igure clutter as a hazard in relation to moving around in domestic surroundings. This was then complemented with a series of ethnographic stories from ieldwork on old age homecare. The clutter moves heuristic helped identify a series of movements, most prominently collecting-distributing home clutter. Here the category of home clutter was revealed as part of an intersecting heterogeneous home ecology of things, people and old age care practices that entangle family ties as well as nested selves. The remaining sections developed a conceptual shift from the standard view of technological clutter to a more symmetrical view of clutter technology. The chapter ends with suggesting that clutter technology could be employed to rethink the design of future technologies and their entangled relationships with old age homecare ecologies. This edited volume proposes to interrogate the relationships between new technologies and emerging spaces of care. The question is then what qualiies as new, and in relation to what? The standard view of new technologies generally evokes impressions of invisible wireless digital systems or polished electronic devices: faster, stronger, lighter, cheaper. Modernity at its inest. Apparently there is no end in sight to the many feature variations and embodiments pumped out by the high-tech multinationals every year. Meanwhile, these products appear increasingly similar. New does not necessarily seem as new anymore. Arguably, any degree of newness is largely a matter of perspective and framing. It should be evident that this chapter has not adopted the standard view of new technology. Instead the aim has been to position the heuristic of clutter moves for the rethinking of old age homecare ecologies. Through this analysis the notion of clutter technology has emerged to suggest other ways that materialities are entangled in heterogeneous old age homecare ecologies. If there is anything new here then it must reside in the cluttering or messing (Law 2004) with the © Copyrighted Material 92 New Technologies and Emerging Spaces of Care © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m notion of new technologies. In other words clutter technology is offered to contrast such framings. This attempts to draw attention to the partial failings of material devices while acknowledging their inevitable entanglements with socio-technical ecologies of old age homecare. On the other hand, perhaps the proposal of clutter technology is not so far off the new technologies map. After all, it overlaps with researchers working at the cutting edge of exploratory investigations into cluttered and mundane domestic surroundings. Simultaneously, home-based self-care is one space where sociotechnical practices are being transformed. The home has now emerged as a prominent site for care as welfare institutions around the world shift healthcare responsibilities to the individual. Subsequently the home is increasingly equipped with healthcare devices and transformed into care facilities in their own right. The socio-technical notion of clutter technology aims to offer avenues for the further exploration of such transformations. For instance, in line with the suggestion from Bell et al. (Bell et al. 2005), perhaps clutter technology begins to enable the defamiliarization and further expand the conceptual space of old age homecare ecologies. Here the analytical attention on how clutter moves igures prominently. 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