The Meaning of Care: The Social Construction of Care for Elderly People PDF
Preview The Meaning of Care: The Social Construction of Care for Elderly People
The Meaning of Care The Social Construction of Care for Elderly People Bernhard Weicht The Meaning of Care The Meaning of Care The Social Construction of Care for Elderly People Bernhard Weicht LeidenUniversityCollege,TheNetherlands ©BernhardWeicht2015 Softcover reprint of the hardcover 1st edition 2015 978-1-137-27493-9 Allrightsreserved.Noreproduction,copyortransmissionofthis publicationmaybemadewithoutwrittenpermission. Noportionofthispublicationmaybereproduced,copiedortransmitted savewithwrittenpermissionorinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988,orunderthetermsofanylicence permittinglimitedcopyingissuedbytheCopyrightLicensingAgency, SaffronHouse,6–10KirbyStreet,LondonEC1N8TS. Anypersonwhodoesanyunauthorizedactinrelationtothispublication maybeliabletocriminalprosecutionandcivilclaimsfordamages. Theauthorhasassertedhisrighttobeidentifiedastheauthorofthiswork inaccordancewiththeCopyright,DesignsandPatentsAct1988. Firstpublished2015by PALGRAVEMACMILLAN PalgraveMacmillanintheUKisanimprintofMacmillanPublishersLimited, registeredinEngland,companynumber785998,ofHoundmills,Basingstoke, HampshireRG216XS. PalgraveMacmillanintheUSisadivisionofStMartin’sPressLLC, 175FifthAvenue,NewYork,NY10010. PalgraveMacmillanistheglobalacademicimprintoftheabovecompanies andhascompaniesandrepresentativesthroughouttheworld. Palgrave®andMacmillan®areregisteredtrademarksintheUnitedStates, theUnitedKingdom,Europeandothercountries. ISBN 978-1-349-44594-3 ISBN 978-1-137-27494-6 (eBook) DOI 10.1057/9781137274946 Thisbookisprintedonpapersuitableforrecyclingandmadefromfully managedandsustainedforestsources.Logging,pulpingandmanufacturing processesareexpectedtoconformtotheenvironmentalregulationsofthe countryoforigin. AcataloguerecordforthisbookisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Weicht,Bernhard,1981– Themeaningofcare:thesocialconstructionofcareforelderly people/BernhardWeicht. pages cm Includesbibliographicalreferences. 1. Olderpeople—Care. 2. Olderpeople—Servicesfor. I. Title. HV1451.W4552015 362.6—dc23 2014036799 Contents Acknowledgements vi 1 Introduction 1 2 WhoShouldCare?TheConstructionofCaring Relationships 33 3 WhereShouldCareBeGivenandReceived?The GeographiesofCare 70 4 HowShouldCommunitiesCare?NostalgiaandLongingfor theIdeal 103 5 WhoIsSeentoBeCaredfor?TheConstructionoftheCare Receiver 138 6 BuyingandSellingCare?TheIntrusionofMarketsand Bureaucracy 173 Epilogue 208 Notes 216 Bibliography 218 Index 239 v Acknowledgements OneofthemostimportantargumentsIamtryingtomakeinthisbookis thattheconstructionofthemeaningofcareisfundamentallybasedon andwithinactual,concreterelationshipsbetweenpeople.Similarly,the researchandwritingofthisbookwouldnothavebeenpossiblewithout peopleclosetomeandisthusheavilyinfluencedbymyrelationswith others. I want to thank all those who have participated in the various focus group discussions and who have shared their experiences, ideas, opin- ionsandemotionswithmeandwithotherparticipants.Hearingthese stories has made me reflect on and rethink my theoretical ideas for this study. I also want to thank those people who helped to arrange and organise the focus groups. The work in this book has furthermore benefited from personal, collegial and institutional support from the University of Nottingham in the United Kingdom and Utrecht Uni- versity in the Netherlands. Several people have read and commented on different versions of this book, among whom I particularly want tothankTonyFitzpatrick,NickStevenson,FionaWilliams,SaulBecker, Sara de Jong, Christian Karner, Trudie Knijn, Silvia Radicioni, Johanne Søndergaard, Ellen Grootegoed, Marit Hopman and the anonymous referees. I also thank Philippa Grand and her colleagues at Palgrave Macmillan for their support, trust and patience and Gerard Hearne for hisquickandefficienteditingwork.WhileItakefullresponsibilityfor allerrorsinthisbook,Iamincrediblyindebtedtothefollowingpeople whohavemadeusefulandchallengingcommentsonthechaptersofthe final manuscript: Paul Ramskogler, Edith Waltner, Annelieke Driessen, Magali Peyrefitte, Bernhard Forchtner and Joe Greener. Their insight- ful remarks have greatly increased the quality of the book, and I am particularly glad to be able to call them not only colleagues but also friends. Writing about care is, like any other practice, impossible without the care of other people. Concrete relationships have given me both the opportunity to write and the ideas, questions and comments from which I could start to develop my own arguments. Chiara Massaroni has accompanied me through the final stages of writing this book. For vi Acknowledgements vii thisandforeverythingthatistocome,Iamreallygrateful.Twopeople I am particularly indebted to are my parents, Christine and Johann, who made it possible for me to be who I am and to do what I do, and whose behaviour and practices have taught me much of what I know aboutcare. 1 Introduction Tworetiredmusicteachersintheir80sareenjoyingtheirhighlycultured life together in their refined apartment in Paris when their world dramaticallychangesafterAnnehasastrokeandsufferssubsequentpro- gressivedementia.Complyingwithherdemandtopromisenevertoput herintoahospitalorcarehome,herhusbandGeorgelovinglystartsto careforher,protectherandcomforther.Dissatisfiedwithprofessional caregiversanddisappointedbytheirdaughterandson-in-law’sreactions tothesituation,thecouplegraduallyturntheapartmentintoatempo- raryhospiceinwhichtheytrycarefullytoadjusttoallthechangesand consequencesthatAnne’sillnessthrowsatthem.BothGeorge’sstrength andthecouple’sinteractionsbecomeincreasinglychallengedbyAnne’s deteriorating health, and eventually George decides to relieve his wife of her suffering by suffocating her with a pillow. This story, beauti- fully depicted in Michael Haneke’s film Amour (2012), which, besides other prizes, won an Academy award and a Palme d’Or, identifies sev- eral crucial aspects of the meaning of old age, care and dying. The changesintherelationshipofGeorgeandAnneandthelatter’sincreas- ing dependence on her husband are powerfully illustrated as essential and inevitable parts of human existence and people’s bonds with each other.Watchingitinthecinema,Iaskedmyselfwhetherthefilmcould equally be called Soin (care) instead of Amour. What is the essential difference between love and care, between relating and caring for the other? How much does care depend on loving relationships and do these relationships change during the experience of giving care? The film, which takes place almost entirely in the couple’s apartment, also raises questions about home, belonging and feeling safe. Care is ulti- mately depicted as an inseparable part of the love that two people feel foreachother,andatthesametimelovemotivates,guidesandrestricts George’scarepractices. 1 2 TheMeaningofCare Thisbookengageswiththeseissues,questionsandchallengesinorder to investigate the different aspects, associations and images that con- stitute the meaning of care for elderly people in society. What role do concreterelationshipsandconcreteplacesoflivingplayinshapingpeo- ple’s understanding of care? How do people imagine and situate ideal care for themselves, their loved ones and the general public? What are theconsequencesofthewidespreadfearofbecomingdependentonoth- ers, for both carers and care receivers? Do professional carers and/or services bought in the market change the inherent meaning of care? Whilethesearesomeofthequestionsthatguidedtheresearchforthis book, they are ultimately also very personal questions. In that sense, thisbookisalsoaboutme.WhenIstartedtheresearchandwritingpro- cess, I gradually realised that the topic of care cannot be studied in a strictly abstract and generalised way. Engaging with issues of relating, belonging and imagining one’s ideal life in old age strongly touches one’smoralandethicaldisposition,idealsandfeelings.Doesthis,how- ever,implythatthemeaningofcarediffersforeveryindividual?Inthis book, I will try to demonstrate that while care is experienced as some- thing deeply personal, its meaning is constituted by particular societal constructions.Ideologies,ideasandattitudesaboutcareplayanimpor- tantroleindefiningthesituationandpeople’sunderstandingofgiving and receiving care. Additionally, notions of caring change over time (Jamieson,1998),andBowlbyetal.(2010:15)rightlystatethat [the]waysinwhichweexperiencecarereflectsourage,gender,eth- nicity,healthandsocialstatus,andwillbeinfluencedbyourbeliefs andvaluesaboutfamiliesandrelationships,andhencebywhereand whenwelive. This book mainly focuses on the construction of informal care for elderlypeople.Theterm‘informalcare’istosomeextentproblematic,as itmightsuggestthatinformalcareinvolveslessworkthan‘formalcare’. While recurrently used, there is, ultimately, no accepted definition of the term itself. In my usage, ‘informal care’ refers to practices of elder carecharacterisedbyinformalarrangements,personalrelationshipsand intimate bonds. Informal care in that sense is usually unpaid and pro- vided in domestic settings in an unregulated way. Hochschild (2003a: 214) describes care as ‘an emotional bond, usually mutual, between the caregiver and the cared-for, a bond in which the caregiver feels responsibleforothers’well-beinganddoesmental,emotionalandphys- ical work in the course of fulfilling that responsibility’. However, these Introduction 3 ideal-typecharacteristics are (often discursive) associations andneither exclusive nor conditional. Even paid arrangements, such as the live-in arrangements of migrant care workers in people’s homes, can demon- stratecharacteristicsofinformalcare(seechapters2and3andWeicht, 2010).IncontemporaryWesternsocieties,careisamuchdebatedissue in academia, politics and everyday discourse. Almost everyone will be concerned with care at some point in their life, either as a carer or as someone needing care by others. Yet, care needs are generally seen as an inherently negative aspect of a particular period in someone’s life course. The way we think about being old and being in need of care is characterisedbyanxietyaboutbecomingdependentandhavingtorely onsomeoneelse’scommitment.Responsibilityforelderlyfamilymem- bersorelderlymembersofthecommunityisadefiningfeatureofhow contemporary societies understand processes of ageing, family, social cohesion and mutual duties of dependence and support. Several social analystsclaimthatweliveinade-traditionalisedsociety(BeckandBeck- Gernsheim,2001;Giddens,1998)inwhicholdtraditions,structuresand authorities make way for new moral questions and answers. This sug- geststhatinallEuropeancountriesageingsocietiesandchangingfamily structuresrequirearethinkingoftraditionalfamily-basedarrangements. Professionalcare,bothprovidedpublicallyandonthemarket,hasbeen an important substitute and/or complementary offer to family-based solutions. However, in most settings, informal care arrangements con- tinue to dominate the situation, and in some countries, for example theNetherlands,evenaprocessofde-professionalisationcanbenoticed and is, not least out of financial considerations, promoted by policy- makers (Da Roit, 2010). Williams (2004), in this context, holds that while the longevity and configuration of relationships have changed, people’s sense of commitment has not (for a similar observation, see Fine, 2005). Still, informal arrangements based on family relationships or other close bonds are obviously not the only type of care provi- sion for elderly people. Particularly in the Nordic countries, informal arrangements are accompanied by a diverse and far-reaching net of professionalcareprovision(Pfau-EffingerandGeissler,2005),whilevar- iouscountrieshavealsoexperiencedtheincreasinginfluenceofprivate market arrangements (Meagher and Szebehely, 2013). While profes- sional care arrangements are not the core focus of this book, they will feature in particular in their discursive construction in separation frominformalcare(see,forexample,chapters2and6).Publicallypro- vided care or marketised versions of care might challenge traditional meanings of care, and Hochschild (2012) in particular investigates the
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