The Biopolitical Economy of Dying in Care Homes: A Theoretical Framework

This chapter sets out a theoretical framework to understand the role of care homes in the care of dying people in England. With almost 30 per cent of all deaths being of care home residents, care homes play a strategic role in the national provision of end-of-life care (EOLC). However, theoretical engagement with the role of care homes as institutions for the care of dying people has only been partial. Sociological theories examining staff’s EOLC provision have built on the anti-institutional and anti-medicalisation literature, which privileges localised, interpersonal and single-issue understandings of power over systemic ones. To address this gap, this chapter proposes the biopolitical economy of dying in care homes as a theoretical framework capable of pinpointing three competing functions of the care home system in a capitalist society such as England. These are (1) to keep residents alive (medico-legal function), (2) to curtail costs to NHS England and care home providers (economic function) and (3) to keep residents on the care home’s premises (custodial function). These functions identify how care home staff’s EOLC provisions and decisions are affected by forces external to the care home context, which are economic value production and the state’s management of citizens’ social reproduction.