Changing geographies of care: employing the concept of therapeutic landscapes as a framework in examining home space

Changes in health care service delivery have resulted in the transfer of care from formal spaces such as hospitals and institutions towards informal settings such as home. Due to the degree of this transfer, it is increasingly important for geographers to explore the experience and meaning of these changing geographies of care in order to reveal and understand the impact and effect on particular individuals and places. Recognizing that the home environment not only designates a dwelling but also represents a multitude of meanings (such as personal identity, security and privacy) that likely vary according to class, ethnicity and family size (among other socio-demographic variables), it presents a complex site for study. This paper suggests research directions to further understand the role of caregiving in contributing to the experience and meaning of the home environment by informal caregivers, the majority of which are women. Using a political economy approach, this paper first reviews the reorganization of health care services and discusses how this is reshaping the experience of informal caregivers at home. A review of the place identity literature contextualizes the specific discussion of the literature on the meaning of home, both of which are then critically examined. Next, the concept of therapeutic landscapes is discussed as an idealized framework to explore the health-promoting properties of home on informal caregivers. Questions for research are outlined before conclusions highlight how research on home space can allow a better understanding of the impact and effect of caregiving on family caregivers and the places where they live. Such research can inform the changes and trends in health care service policy.