The Meaning of Care: The Social Construction of Care for Elderly People

255 Pages·2015·1.072 MB·English

by  Bernhard Weicht (auth.)

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
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Weicht,Bernhard,1981–
Themeaningofcare:thesocialconstructionofcareforelderly
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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