From Restricted Resources to Ethical Burden-Former Home Care Workers' Reasons for Leaving Their Jobs

The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.

Making assessment protocols workable: Navigating transparency and person-centredness in Norwegian reablement

Western welfare states are facing great challenges as they strive to optimise their health and social systems in response to the realities of an ageing population. Many countries put a stake on reablement services-short-term rehabilitative interventions aiming to help older people regain functional capacity. To ensure a person-centred approach and outcome measures, service providers are recommended to follow a protocol designed for the dual purpose. In this article, we explore how reablement staff perceive and work around these person-centred assessment protocols. Departing from the perspective that standards never operate in isolation, but in social settings already infused with values and interests, we explore the various kinds of work involved in aligning the protocol with ongoing day-to-day assessment practices. The article demonstrates that professionals continuously engage in processes of tinkering to navigate between different values and concerns: they tinker with workflows (articulation work), with clients (identity transformation work) and with protocols (editing work). Exploring the different forms and intensity of tinkering enables us to discuss the practical and moral difficulties inherent in making assessment protocols workable.

What good is anthropology?: Care work in a "useless" discipline

Different forms of care work are essential for the practice of anthropology in South Africa. In this biographical commentary, I describe how I enacted care work in my anthropological practice. I suggest that what is good about anthropology is its potential to be attentive to the multiple ways in which care work is enacted by us as anthropologists, as teachers of the discipline, as well as by our interlocutors.

[Live-ins: A mapping of relevant actors and moral norms at the public health level]

Live-ins: A mapping of relevant actors and moral norms at the public health level Abstract: Background: Live-ins are embedded in a network of multiple actors that shape their current working and living situation. The causes and effects of live-in arrangements go far beyond the actual care relationship and include structures and stakeholders that are interconnected at the Public Health level. Besides a legal responsibility, these actors also have a moral responsibility, which the article focuses on. Aim: The article provides an overview of relevant actors and moral norms in the context of live-ins at the public health level. Methods: The method followed the "Context and Actor Analysis". Actors at the public health level that are relevant for the live-ins' situation were identified, and the responsibilities and tasks presented in their websites as well as their respective target groups were collected. The ethical dimension was extracted from these self-descriptions. Results: The 23 actors address the live-ins directly or indirectly in their various social roles. The self-given tasks and the moral norms deduced from them, for which the actors are particularly responsible, illustrate the importance of justice and respect. Conclusions: The work provides the basis for an urgently needed empirical-ethical analysis on the current state of responsibility-taking. Not only the variety of the live-ins' roles, but also the multitude of actors involved and shared norms illustrate the necessity of close cooperation to be able to fulfil their responsibility.

Training the ageing bodies: New knowledge paradigms and professional practices in elderly care

In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3-year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal-oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide.

Staging Paro: The care of making robot(s) care

Paro, a baby seal robot, is arguably the best-known care robot worldwide. Its clinical effects on people with special needs have been studied for more than twenty years by multidisciplinary teams. However, there are very few studies of Paro 'in the wild', inserted in the routines and pressures of a care home, which is supposed to be Paro's natural environment. Based on fieldwork in a French public nursing home, this article relocates Paro's psychosocial effects - asserted by its corporate and academic advocates to stem from the robot's software and user-friendly design - in the situated practice of care deployed by the nursing staff. Although it is commonly assumed that the robot can interact autonomously, thanks to its AI, it took considerable efforts to enable 'patient-robot' interactions, and interactions were always mediated by care staff. The supervision of the interaction between Paro and its user(s) by at least one care worker, prescribed by its sales representative to prevent the seal robot from being harmed or monopolized by a resident, thus framed the very course and meaning of the interaction, through an entanglement of verbal and tactile guidance. Staging Paro often meant awakening and maintaining interest from confused or passive users, and playing with its ontological flexibility to meet the preferences of its elderly interlocutors.

Family Caregivers as Employers of Migrant Live-In Care Workers: Experiences and Policy Implications

As policymakers globally recognize aging in place as the preferred option for most adults, there is a growing need to supplement family or informal caregiving for frail older adults with formal homecare services, particularly for those who require 24/7 care due to significant physical and/or cognitive impairment. The core objective of this qualitative study was to explore family members' experiences in employing live-in care workers, particularly the nature of their engagement and the quality of their relationships with these care workers. Our analysis of semi-structured interviews with 35 family caregivers revealed four themes: 1) challenges in acquiring support and developing dependency; 2) negotiation of roles, responsibilities, and moral dilemmas; 3) shifting emotions between trust and suspicion; and 4) role confusion, expectations, and disappointments. The study suggests that families might benefit from formal guidance regarding fostering and maintaining positive relationships in the homecare environment. This paper provides nuanced knowledge that may inform the development of such interventions.

User Experiences on the Implementation of Exoskeletons in Care Work

This article describes the results of a field test of an exoskeleton in care work. Qualitative data about the implementation and use of exoskeletons, with the help of interviews and user diaries, were collected both from nurses who used the exoskeleton and managers at different levels of the care organization. On the basis of these data, there are relatively few obstacles in and many opportunities for the implementation of exoskeletons in care work, taken that the introduction, orientation and continuous support for technology use are given enough weight.

Uncertainties about accepting care robots

In the midst of the anticipation of care robots renewing elderly care, care workers are expected to orient themselves in this future, however uncertain. To examine how uncertainty over the appropriateness of care-robot use associates with robot acceptance, different scenarios of robot assistance were presented to a sample of care professionals in two waves 2016-2020. The views of usefulness of robot assistance yielded underlying structures of plausible and implausible care-robot use. The perceived appropriateness of utilizing robots in care was stronger in the plausible robot scenarios. The uncertainty about robots having an appropriate role in care work correlated negatively with the perceived usefulness of robot assistance, but was even highlighted among the scenarios of implausible tasks. Findings further show how uncertainties about care-robot use have been reduced across four years between data collections. In robotizing care work processes, it may be more beneficial to attempt to convince the care workers who are undecided about robot acceptance than to push care-robot orientation to those who strongly oppose care-robot use.

Centering Home Care in Bioethics Scholarship, Education, and Practice

This commentary responds to "Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice," by Coleman Solis and colleagues, in the May-June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors' call for "inquiry into the nature, value, and practice" of home care. We argue that the most urgently needed normative reset for thinking about care work is the replacement of dominant individualistic thinking with systemic thinking. Deepening a focus on the social, economic, and historical forces that shape the state of contemporary care work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal of care.

Sickness absence among migrant and non-migrant care workers in Finland: A register-based follow-up study

AIMS

This study aimed to compare the sickness absence (SA; over 10 days) rates of migrant and non-migrant care workers in Finland.

METHODS

Two cohorts were randomly sampled from nationwide registers and analysed together in a three-year follow-up design (2011-2013, 2014-2016). The pooled data consisted of 78,476 care workers, of whom 5% had a migrant background. Statistical methods included cross-tabulations and Poisson regression modelling.

RESULTS

Thirty-five percent of the Finnish-born care workers had at least one SA during the follow-up. Care workers from the post-2004 EU countries (30%, at least one SA), Russia, the Former Soviet Union and the Balkan states (25%) and the Global South and East (21%) had fewer episodes of SA than the Finnish-born care workers. The two latter groups also had lower SA rates after we controlled for occupation, gender, age, income and region of residence. Care workers from Western Europe and the Global North (36%) had higher SA rates than the Finnish-born care workers.

CONCLUSIONS

The following explanations were discussed: population-level health differences - migrants from lower-income non-EU countries are generally healthier than the Finnish-born population (due to, e.g., the 'healthy migrant effect'); discrimination in recruitment and employment - migrants from lower-income non-EU countries need to be healthier than Finnish-born jobseekers to gain employment (in the care sector or more broadly); and sickness presenteeism - migrants from lower-income non-EU countries underuse their right to sickness allowance (due to, e.g., job insecurity). It is likely that these mechanisms affect migrants differently depending on, for example, their countries of origin and social status in Finland.

Tinkering with (in)visibilities: Caring for older people with surveillance technologies

New surveillance technologies have in later years been introduced in care for older people as part of a broader policy agenda of 'sustainable' welfare state retrenchment, promoting ideals of self-sufficiency and empowerment of older people 'ageing in place'. Drawing on newer approaches to surveillance studies, this article explores care workers' active labour in creating (in)visibility in a complex and ongoing process of tinkering, while negotiating political rationales of empowerment and professional accountability. Hence, visibilities are conceived as coded, reflecting different ideals and rationales. Based on extensive fieldwork in Danish eldercare, we analyse two forms of surveillance: virtual homecare and sensor-flooring, where clients are involved and positioned in different ways in accomplishing surveillance. We illuminate how the process of accomplishing (in)visibility does not only involve tinkering with technology, but also with spatial arrangements in the client's home, and with clients' behaviour. Consequently, we underscore how tinkering may turn out to be a difficult and even conflictual task of negotiating professional authority and accountability in ways that resonate with clients' sense of autonomy and policy ideals of empowerment. Our studies underline how the power dynamics of surveillance in care should not be overlooked, even though they are continuously negotiated in care practices.

The costs of care: An ethnography of care work in residential homes for older people

The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care-giving practices. I show how the scheduling and allocation of resources-conveyed, for example, in formal routines and staffing levels-structure the care workers' time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers' ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.

"We Tried to Take Care of Her, but it Got Too Exhausting": A Study of the Transition From Family Carer to Employer

In Taiwan an increasing number of families are employing live-in carers from abroad to cope with care responsibilities, including the Indigenous Tayal. The aim of this research was to understand the transition from Indigenous family carer to employer with older family members who have extensive care needs. Six Indigenous employers were interviewed, and a narrative hermeneutic analysis was performed. The Tayal caregivers' cases revealed that their transition to employing live-in carers was complex and filled with ethical dilemmas due to their vulnerable positions. They tried to ensure person-centered care for their family members, but by doing this they risked reproducing vulnerability when transferring their own vulnerability to the live-in carer. The results indicate the interwoven nature of care dependency when it is defined by multiple vulnerabilities, Indigeneity and migration, and the multifaceted components of cultural safety.

Adult Worker Model Typologies: Examining Work-Family Policies in Fifteen European Countries

This article aims to advance the discussion of government policies for improving women's work and family life. It focuses on exploring whether it is reasonable to expect that the supported adult worker model will play an important role in guiding governments to reduce the gender employment gap and, at the same time, increase women's resources for strengthening their control over family and work life. This model posits that governments should take a proactive approach to encouraging women to take part in formal employment, such as providing care support measures. To examine the impact of the model, this article develops an 'input adult worker model typology' and an 'output adult worker model typology' using cluster analysis of comparative data covering 15 countries. The findings show that it is important not to overestimate the impact of the supported adult worker model on reducing the gender employment gap or increasing women's control over their lives in most of the 15 countries. The evidence generated from these typologies highlights the difficulties involved in promoting women's welfare despite the use of the adult worker model as a substitute for the male-breadwinner model.

The gender peak effect: Women are most vulnerable to infections during COVID-19 peaks

In this article, we describe a gender peak effect that women's relative share in COVID-19 infections increases when there is a sharp increase in cases, and it reaches the highest level during peak times in each wave of the COVID-19 outbreak. We demonstrate this gender peak effect by analyzing detailed, sex-disaggregated Public Health Agency of Canada (PHAC) data. The data include 1,045,998 men and women who were confirmed cases of COVID-19 from March 2020 to February 2022. We show that women's relative share in COVID-19 infections always increases and reaches the level exceeding men's share when we see a sharp peak in case number. We further show that women's higher share in care work (e.g., captured by occupation and age variables) largely explains their elevated infections during COVID-19 peaks. Effective public health interventions during infectious disease outbreaks must recognize this potential gender peak effect and take appropriate measures to curb women's health vulnerabilities.

COVID-19 and a "crisis of care": A feminist analysis of public policy responses to paid and unpaid care and domestic work

The COVID-19 pandemic has highlighted gender inequalities, increasing the amount of unpaid care weighing on women and girls, and the vulnerabilities faced by paid care workers, often women working informally. Using a global database on social protection responses to COVID-19 that focuses on social assistance, social insurance and labour market programmes, this article considers whether and how these responses have integrated care considerations. Findings indicate that, although many responses addressed at least one aspect of care (paid or unpaid), very few countries have addressed both types of care, prompting a discussion of the implications of current policy responses to COVID-19 (and beyond) through a care lens.

The entwinement of policy, design and care scripts: Providing alternative choice-dependency situations with care robots

The use of robots to assist feeding has become important for people with an impaired arm function. Yet, despite large-scale dissemination strategies, it has proven difficult to sustain the use of this technology. This ethnographic study draws on the script approach to discuss the use of robots to assist feeding. The empirical work was done at locations in Denmark and Sweden. Drawing on document studies, interviews, observation of meals and video footage, we discuss (1) policy strategies promoting ideas such as self-reliance; (2) design visions promoting ideas such as empowerment; (3) and three scripts of care: (a) the script of choice, (b) the script of eating alone and (c) the script of eating together. We argue that scripts entwine and give rise to and prevent the use of robots. The study contributes to the script literature and the care robot literature by substantiating that care robots may generate choice-dependency situations for users. Rather than the somewhat overflowing 'self-reliance' and 'empowerment', alternative configurations of choice and dependency emerge, in which some situations fit users better than others. We conclude that although sustaining the use of feeding robots is difficult, in some cases, useful choices arise for both end-users and care providers.

Filipino Home Care Workers: Invisible Frontline Workers in the COVID-19 Crisis in the United States

Filipino home care workers are at the frontlines of assisted living facilities and residential care facilities for the elderly (RCFEs), yet their work has largely been unseen. We attribute this invisibility to the existing elder care crisis in the United States, further exacerbated by COVID-19. Based on quantitative and qualitative data with Filipino workers before and during the COVID-19 crisis, we find that RCFEs have failed to comply with labor standards long before the pandemic where the lack of state regulation denied health and safety protections for home care workers. The racial inequities under COVID-19 via the neoliberal approach to the crisis puts home care workers at more risk. We come to this analysis through Critical Immigration Studies framing Filipino labor migration as it is produced by neoliberalism and Racial Capitalist constructs. Last, while the experiences of Filipino home care workers during the pandemic expose the elder care industry's exploitation, we find that they are also creating strategies to take care of one another.

A work motivational grounded theory study of workers in caring roles

The aim of this study was to examine and construct a theoretical model of key elements that care workers perceive to have an impact on their autonomy, cohesion, and work motivation. Grounded theory was used for data collection and analysis. There were 20 participants from social welfare service, geriatric care, and women's aid settings (women = 18, men = 2, mean age = 37.6). The analysis resulted in the following categories: (a) Being-a-Cohesive-Team; (b) Agency-Making; (c) Living-Up-to-Expectations; and (d) Developing-Support-and-Feedback. The results identified potential interactions between these factors and suggested how they influenced each other, showing how cohesion, autonomy, and motivation are interdependent and amplified.

The Impact of Micro and Macro Level Factors on the Working and Living Conditions of Migrant Care Workers in Italy and Israel-A Scoping Review

Background: The provision of home-based care for frail older adults in Italy and Israel is predominately provided by live-in migrant care workers (MCWs). However, despite the important role that they play in filling the demand for home care, MCWs often experience labor rights violations. This not only impacts the well-being of MCWs but also leads to lower-quality care being provided to people in need of support. Method: This scoping review used Arksey and O'Malley's methodological framework to map literature. This article aims to analyze the scope, main topics, themes and gaps in the existing academic literature on how micro and macro level indicators impact the working and living conditions of live-in MCWs in Italy and Israel. Scopus, Pubmed, and Web of Science Core Collection were searched for peer-reviewed articles. Search terms were adapted from the Multilevel Framework of Transnational Care Migration (MFTCM). Themes were developed using Braun and Clarke's method for conducting reflexive thematic analysis. Articles were included if they focused on Italy and/or Israel, included analysis on the working and living conditions of live-in MCWs at the macro and/or micro levels, were written in English, and were published between 2015 and 2020. Results: Out of the 1088 articles retrieved, 33 met the inclusion criteria. A total of 18 articles focused on Italy and 14 on Israel, and one focused on both Italy and Israel. The majority of articles in Italy (84 per cent) and Israel (53 per cent) included analysis on care regimes. Only 37 per cent of articles in Italy and 20 per cent in Israel included analysis on gender regimes. At the micro level, 80 per cent of articles in Israel discussed Power/Class Asymmetry, compared to 37 per cent in Italy. In total, six themes were developed. At the macro level, these themes included funding care work, MCWs as a pragmatic approach, care in the home, and valuing care work. At the micro level, the themes included being part of the family, and perceptions on class asymmetries. The findings presented in this review show that MCWs in both Italy and Israel face many of the same challenges in accessing decent work opportunities, despite contrasting employment and migration policies in each country. This can be partially attributed to the undervaluing of care work because of racialized and gendered notions of care. At the macro level, this has contributed to a lack of political will to develop long-term sustainable solutions to create or monitor decent work standards for MCWs. At the micro level, this has led to power imbalances between MCWs and people in need of care and their family members, resulting in MCWs being expected to work hours beyond those contractually allowed, having little to no time off, and experiencing emotional, physical, and sexual abuse. Conclusion: This study provides a review of the most recent contributions to the fields of labor migration and health concerning the MCW markets in Italy and Israel. While there have been many studies in each country that detail the labor rights violations experienced by MCWs, this is the first review that develops themes around the underlying causes of these violations. By thematically analyzing the findings of recent studies and current gaps in existing knowledge, this scoping review assists in building the groundwork for the development and implementation of policy, strategies, practice and research to improve the rights and migration experiences of MCWs.

The Potential of "Watchful" Care: Preventing Suicide with Aloha in Hawaii

As a therapeutic practice of care, "watchfulness" (Garcia 2010) implies a vigilant responsibility and constant mindfulness of others; in Hawaii, this is captured in the concept of aloha. This article explains how watchful care with aloha is discussed and mobilized in community suicide prevention in Hawaii. Rates of suicidality and suicide attempts in the state are high, among young people in particular. My ethnographic research follows a network of workers and volunteers as they incorporate local understandings of aloha into suicide prevention outreach. Following a history of aloha's meanings and (mis)uses in and beyond Hawaii, I draw on ethnographic examples to reveal how care with aloha prioritizes personal connection and individuality, rather than being rhetorically detached or "anonymous" (Stevenson 2014). But as my central vignettes reveal, there are difficulties in the implementation of this kind of watchful care, which ultimately question its utility in suicide prevention.

'You have got to stick to your times': Care workers and managers' experiences of working in extra care housing

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016-2017. This paper reports findings from semi-structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.

How provider organisations interpret regulation in the context of residential dementia aged care

OBJECTIVE

To explore how Australian residential dementia aged care providers respond to regulation via organisational culture, level, processes and interpretation.

METHODS

Observation took place in three provider organisations. Qualitative, semi-structured in-depth interviews were conducted with aged care staff (n = 60) at three different levels of each organisation: senior management from three head offices (n = 17), facility management (n = 13) and personal care workers (n = 30) from eight residential care facilities.

RESULTS

Orientations towards regulation included the following: "above and beyond;" "pushing back;" and "engineering out." Regulation was interpreted differently depending on the level of authority within an organisation where boundaries were managed according to strategic, operational and interactional priorities.

DISCUSSION

Examining regulation within an organisational context and at different staff levels suggests ways to balance dementia care with regulatory control. Both generate stress, mitigated by culture and interdependent role differentiation.

Dementia Care Work in Singapore: Embodied Relations and Power Dynamics

Based on research at a dementia day-care center in Singapore, I discuss how embodied care relations proceed amidst cultural expectations on aging, dementia, and care work. Engaging with approaches that conceptualize "care" as either empathy or control, I argue that care between older people with dementia, their families, and care workers can be understood as a reiterative, dialogic process whereby care participants strive to keep pace with each other, however briefly, due to cognitive decline, care workers' own limitations, and particular family difficulties. Care vacillates between practices of control, surveillance, and recognition, and comprises dynamic rather than enduring power relations.

Reablement teams' roles: a qualitative study of interdisciplinary teams' experiences

Introduction

Reablement is a service for home-dwelling older people experiencing a decline in health and function. The focus of reablement is the improvement of the person’s function and coping of his or he valued daily activities. The health care professionals and the home care personnel are working together with the older person toward his goals. In reablement, health care personnel are organized in an interdisciplinary team and collaborate with the older person in achieving his goals. This organizing changes the roles of home care personnel from working almost alone to collaborating with different health care professionals. There is little scientific knowledge describing the roles of different health care professionals and home care personnel in the context of reablement. This study’s objective is to explore and describe the roles of interdisciplinary teams in reablement services in a Norwegian setting.

Method

Two interdisciplinary teams consisting of 17 health care professionals (i.e. occupational therapists, physiotherapists, nurses, and social educators) and ten home care personnel (auxiliary nurses and nursing assistants) participated in three focus group discussions. In addition, three interviews were conducted with occupational therapists, physiotherapists, nurses, and auxiliary nurses. The focus group discussions and the interviews were all digitally recorded, transcribed verbatim and analyzed using the qualitative content analysis.

Results

The health care professionals’ main role was to be consultants and advisors, consisting of (1) planning, adjusting, and conducting follow-ups of the intervention; (2) delegating tasks; and (3) supervising the home care personnel. The home care personnel’s main role was to be personal trainers, consisting of (1) encouraging and counseling the older adults to perform everyday activities; and (2) conveying a sense of security while they performed everyday activities. The role of interdisciplinary collaboration was a common role for both the health care professionals and the home care personnel.

Conclusion

The health care professionals established the setting, and had the main roles of supervision, delegating tasks, and main responsibility for the intervention. The home care personnel accepted the delegations and had a main role as personal trainers. Their work changed from body care to encouraging and counseling the older person to perform activities themselves in a safe way. The health care professionals and the home care personnel collaborated closely across roles. The home care personnel experienced a shift in role from home care to a person-centered care. This was perceived as strengthening the health care identity of their role.

Professionalised intimacy: how dementia care workers navigate between domestic intimacy and institutional detachment

This article reports an ethnographic study of the handover routines in Germany's first dementia village, with a central focus on how care is balanced between domestic intimacy and institutional detachment. The term 'professionalised intimacy' is used for the vivid interplay between comfort and intimacy that renders the interaction between care workers and residents far more complex than previous theories have articulated. Because of the intimacy involved in community building, however, the promise of personalised care must clash with the bureaucratic structures of an official institution, potentially depriving the care workers of their public, respected identity in the process. The study further suggests that most care workers, in fact, support this division between domestic intimacy and institutional detachment. Even if they subscribe to a dementia village's philosophy of personalised care, their medical training and enculturation has endowed them with a habitus compatible with the modern health profession, with incentives on achieving quantifiable health goals. The dementia village is thus illustrated as a pioneering health care experiment that negotiates rivalling discourses of intimacy, professionalisation, and medicalisation.

Collaboration among eldercare workers: barriers, facilitators and supporting processes

To retain qualified care workers and to ensure high-quality care for residents in eldercare homes, well-functioning collaboration among care workers is pivotal. This study aims to identify barriers and facilitators of collaboration among eldercare workers and to describe the processes leading to well-functioning collaboration. We collected focus group data from 33 eldercare workers from seven Danish eldercare homes. We found that collaboration was hampered by a number of formal and informal divisions among care workers. To ensure well-functioning collaboration, social and professional relations among care workers needed to be dealt with actively by care workers and by managers. The analysis showed that managers are essential for creating a well-functioning framework around the collaboration between care workers by providing guidelines and procedures for working across various divisions, by being attentive to care workers and taking decisive action when needed and by dealing with conflicts in the workgroups.

From Family Involvement to Family Inclusion in Nursing Home Settings: A Critical Interpretive Synthesis

The provision of care work by families plays an integral role in the quality of life of older adults living in a nursing home setting. This critical interpretive synthesis examines family members' perceptions of their roles and responsibilities in nursing home settings and interrogates the structural and relational barriers and enablers to family involvement as they relate to fostering an inclusive environment. Electronic databases and published literature were searched for empirical studies that were conducted in a nursing home setting and described involvement from the perspective of family members. Thirty-two articles published between 2006 and 2016 were included in the review. Although involvement comprised a variety of roles and responsibilities, it was grounded in family-resident relationships, influenced by family-staff relationships, and deeply affected by broader sociopolitical factors. We conclude that involvement should be understood as a democratic process with supporting policies and programs to encourage family inclusion in facility life.

Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring

The growing consumer market in health monitoring devices means that technologies that were once the preserve of the clinic are moving into spaces such as homes and workplaces. We consider how one such device, blood pressure monitors, comes to be integrated into everyday life. We pursue the concept of 'care infrastructure', drawing on recent scholarship in STS and medical sociology, to illuminate the work and range of people, things and spaces involved in self-monitoring. Drawing on a UK study involving observations and interviews with 31 people who have used a consumer blood pressure monitor, we apply the concept beyond chronic illness, to practices involving consumer devices - and develop a critical account of its value. We conclude that the care infrastructure concept is useful to highlight the socio-material arrangements involved in self-monitoring, showing that even for ostensibly personal devices, monitoring may be a shared practice that expresses care for self and for others. The concept also helps draw attention to links between different objects and spaces that are integral to the practice, beyond the device alone. Care infrastructure draws attention to the material, but ensures that analytic attention engages with both material and social elements of practice and their connections.

Precarious Situations of Care Workers in Home-Based Elder Care in Slovenia

Based on policy analysis and individual interviews, the author analyzes the care workers' precarious situations in home-based elder care in Slovenia, a post-socialist, European Union country characterized by a rapidly aging population and delays in adapting a long-term care system to this new social risk. Employment and quasi-employment positions which coexist in home-based care can be sorted along two continuums: between public and market service; between formal and informal work. The author argues that working conditions in home-based care differ according to the position of the care worker on these two continuums, that is, being employed in public services, being self-employed, working in informal care markets, holding a status of family assistant, or being an informal family caregiver. Although the working conditions in public services are deteriorating, the analysis shows that precarity is more severe in market and informal care, while formalization and socialization of care bring about less precarious conditions.

Telemedicine and the senses: a review

Telemedicine technologies have been presented as solutions to the challenges of equitable, cost-effective and efficient health service provision for over two decades. The ways in which the sensory dimensions of medical care and the doctor-patient relationship are mediated via telemedicine can be important contributors to the success, failure or unintended consequences of telemedicine. In this article, we present a review of the relevant literature in social research that provides insights into the sensory dimensions of telemedicine. In addition to considering important relevant work undertaken in the sociology of health and illness, we incorporate perspectives and research from other disciplines and fields that we believe can contribute to the development of scholarship on this topic. We contend that when doctors, patients and other healthcare workers enact telemedicine, sensory judgements have become, in part, a sensing of sensors. Viewing healthcare practitioners and patients as always and already digital data assemblages of flesh-code-space-place-affect-senses, demanding certain kinds of body work and data sense-making, constitutes a productive theoretical approach for future enquiries into telemedicine and other digital health technologies.

Keeping out and getting in: reframing emergency department gatekeeping as structural competence

Sociologists have tended to frame medical gatekeeping as an exclusionary social practice, delineating how practitioners and clerical staff police the moral boundaries of medicine by keeping out patients who are categorised as 'bad', 'deviant', or otherwise problematic. Yet medical gatekeeping, understood more broadly, can include not only keeping patients out of particular clinical settings, but also redirecting them to alternative sources of care. In this article, I draw on qualitative analysis of audio-recorded patient-provider interactions in a United States emergency department (ED) to illustrate medical gatekeeping as a two-step process of, first, categorising certain patient complaints as unsuitable for treatment within a particular setting, and second, diverting patients to alternative sites for care. I refer to these as the restrictive and facilitative components of medical gatekeeping to denote how each relates to patients' access to care, recognising that both components of medical gatekeeping are part of a coordinated organisational strategy for managing resource scarcity. By illustrating how ED providers reveal intimate knowledge of structural vulnerabilities in diverting socioeconomically disadvantaged patients with chronic back pain to clinical sites that are better equipped to provide care, I suggest that we rethink the emphasis on restrictive practices in sociological accounts of medical gatekeeping.

Enabling and controlling parenthood in publicly provided maternity healthcare: becoming a parent in Finland

This article discusses practices of parental support in the maternity healthcare provided by the welfare state. Drawing on ethnographic material from clinics in Finland, I discuss maternity healthcare practices and processes as the specific contexts of subjectification to parenthood in the Nordic welfare state. The analysis shows that in both nurses' (work) experience-based knowledge and population-statistical knowledge, parental competence is achieved largely through the 'natural' process of experiencing pregnant life. Care practices can be seen as enabling parenthood through respect for this process. Clinics encourage parents-to-be to self-reflect and be self-reliant. Emphasis on self-reflection and self-reliance has previously been interpreted as the state adoption of therapy culture, and as a response to market demands for the welfare state to offer to and require of its citizens more autonomy and choice. I argue, however, that the parental subject emerging from the practices of this welfare service cannot be reduced to a neoliberal reflexive individual for whom parenthood is an individual project and who is to blame for individual shortcomings. Equally, they are no mere disciplined product of governmentality being pushed to conform to an idealised parent figure derived from collective ideas of good parenthood.

Family care work: a policy-relevant research agenda

This article addresses the need for policy-relevant research agendas on family care in transaction with formal care and public as well as organisational norms and policies in light of the crisis in caregiving for older adults. We propose a combined institutional and life-course theoretical approach, suggesting seven ways of organising scholarly enquiry to promote understanding of the changing nature of family care in the 21st century, inform policymakers' efforts at supporting family caregivers and improve caregivers' and care recipients' quality of life. These include: (1) moving beyond snapshots of individuals; (2) conducting comparative cross-cultural and crosscohort analyses; (3) documenting social heterogeneity, vulnerability and inequality; (4) capturing individuals' and families' adaptive strategies and cycles of control during the caregiving process; (5) investigating policy innovations and natural experiments; (6) assessing third parties as mediating institutions between regulatory environments and caregiving families; and (7) attending to the subjective meanings of care.

Ageing, dementia and the social mind: past, present and future perspectives

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology.

Physical Illness in Gay, Lesbian, and Heterosexual Marriages: Gendered Dyadic Experiences

The inclusion of same-sex married couples can illuminate and challenge assumptions about gender that are routinely taken for granted in studies of physical illness. We analyze gender dynamics in gay, lesbian, and heterosexual marriages with in-depth interview data from 90 spouses (45 couples) to consider how spouses co-construct illness experiences in ways that shape relationship dynamics. Overall, findings indicate that men tend to downplay illness and thus provide minimal care work, whereas women tend to construct illness as immersive and involving intensive care work-in both same-sex and different-sex marriages. Yet same-sex spouses describe similar constructions of illness much more so than different-sex couples, and as such, same-sex spouses describe less illness-related disagreement and stress. These findings help inform policies to support the health of gay and lesbian, as well as heterosexual, patients and their spouses, an important goal given health disparities of gay and lesbian populations.

Rehabilitative bodywork: cleaning up the dirty work of homecare

Care work for elderly people has been characterised as dirty work, owing to its proximity to the (dys)functions and discharges of aged bodies and the notions of disease, decay and death associated with the idea of old age. However, a wave of reform programmes in Danish municipalities promoting rehabilitative care practices aiming to empower, train and activate elderly citizens provides opportunities for homecare workers to renegotiate their status and reconstruct their work and occupational identities with a cleaner and more optimistic image. Drawing on ethnographic fieldwork in two Danish homecare units, this article analyses how rehabilitative care practices, drawing on a narrative of the third age, provide an optimistic and anti-ageist framing of homecare work that informs the development of new occupational identities for care workers as coaches rather than carers in relation to citizens. Furthermore, rehabilitation efforts change the bodywork of care, rendering it more distanced and physically passive, and rehabilitation efforts also involve extensive motivational work aiming to help citizens to see themselves as capable, resourceful and self-reliant. However, while rehabilitation efforts become a new resource in care workers' taint management; they also entail potentially negative consequences in terms of responsibilising and disciplinary approaches to elderly citizens.

Liminal and invisible long-term care labour: Precarity in the face of austerity

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents' health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions' work in light of Vosko's (2015) and Rodgers and Rodgers' (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions' labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs' task-oriented work.

Parenting work and autism trajectories of care

This study investigates the work and care associated with raising a child with disabilities in the United States. Based on in-depth interviews with parents who have a child with autism, it develops the notion of parenting work and trajectories of care to investigate how parents navigate and coordinate the challenges of getting an autism diagnosis, obtaining educational services, and re-contextualising the possibilities for the future. I argue that parents embody a complex mix of love, hope, and responsibility in parenting work and trajectories of care that expands temporal and social elements of illness work and trajectories initially developed by Anselm Strauss and colleagues. This type of parenting work changes over time and is influenced by social structural forces and relationships in which the care takes place. The re-articulation of these analytic tools also begins to untangle the intricate mix of both medical and social models of disability that parents embrace and continuously negotiate. This study demonstrates how parents accept the medical model of disability by seeking and pushing for a clinical autism diagnosis and subsequent treatments, while at the same time challenge the limits placed on their children by providing them with opportunities, possible futures, and a sense of personhood. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=x0UmGvpcjeQ.

'When you visit a man you should prepare yourself': male community care worker approaches to working with men living with HIV in Cape Town, South Africa

Caring is typically constructed as a feminised practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regards to gendered constructions of caring. Using semi-structured interviews and observational home visits, this study explored the techniques that community care workers employ when working with male clients. The empirical analysis draws on the perspectives of eight care workers and three of their male clients from the Cape Town area. Interviews reveal how care workers and clients perform and negotiate masculinities as they navigate hegemonic masculine norms that require men to act tough, suppress emotions and deny weakness and sickness. Both parties bump up against ideals of what it means to be a man as they strive to provide care and receive support. Community care workers avoid rupturing client performances of hegemonic masculinities which inhibit confession and support. To do this, they use techniques of indirectly broaching sensitive subjects, acting in a friendly way and being clear about the intention of their work.

Liminality in Ontario's long-term care facilities: Private companions' care work in the space 'betwixt and between'

Nursing, personal care, food and cleaning are publicly funded in Ontario's long-term care facilities, but under-staffing usually renders all but the most basic of personal preferences superfluous. This individualization of responsibility for more personalized care has resulted in more families providing more care and opting to hire private, private companion care. With direct payment of companions becoming a growing but largely invisible facet of care, exploring companion's roles is important. Using a six site rapid ethnographic study in long-term care facilities (i.e. observations, documents and key informant interviews (n=167)), this paper argues that private companions occupy a liminal space between policy, family and market, and their role within institutions and in private homes may be the missing link in the care work chain in the sense that it can at once be classified as formal and informal and draws on their own and others paid and unpaid labour.

Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda

The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health/personal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.

Navigating the field of temporally framed care in the Danish home care sector

The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care.

Social and relational identification as determinants of care workers' motivation and well-being

A growing body of research in the field of health and social care indicates that the quality of the relationship between the person giving care and the person receiving it contributes significantly to the motivation and well-being of both. This paper examines how care workers' motivation is shaped by their social and relational identification at work. Survey findings at two time points (T1, N = 643; T2, N = 1274) show that care workers' motivation increases to the extent that incentives, the working context (of residential vs. domiciliary care), and the professionalization process (of acquiring vs. not acquiring a qualification) serve to build and maintain meaningful identities within the organization. In this context care workers attach greatest importance to their relational identity with clients and the more they perceive this as congruent with their organizational identity the more motivated they are. Implications are discussed with regard to the need to develop and sustain a professional and compassionate workforce that is able to meet the needs of an aging society.

The reproduction of gender norms through downsizing in later life residential relocation

Using data collected from qualitative interviews in 36 households, this article examines people's use of social relations based on gender to perform tasks associated with residential relocation in later life. Without prompting, our respondents addressed the social relations of gender in the meanings of things, in the persons of gift recipients, and in the persons of actors accomplishing the tasks. They matched gender-typed objects to same-sex recipients, reproducing circumstances of possession and passing on expectations for gender identity. The accounts of our respondents also depicted a gendered division of household labor between husbands and wives and a gendered division of care work by daughters and sons. These strategies economized a big task by shaping decisions about who should get what and who will do what. In turn, these practices affirmed the gendered nature of possession and care work into another generation.

Invisible hands: the role of highly involved families in long-term residential care

Care work by family and friends is recognized as a cornerstone of community-based care for older adults; however, the role of families in institutional-based care work has been less well understood and researched. Drawing on findings from a critical ethnographic study, this article aims to examine the unique role of highly involved family members within long-term residential care. The study took place between October 2006 and April 2008 in two facilities in British Columbia, Canada. A purposive sample of 11 highly involved family members participated in in-depth interviews and participant observations. The main themes were "Hands-On," "Hands-Off," "Surveillance," and "Interlopers." These themes illuminate the ways in which highly involved family members engaged in care work, including how they positioned themselves and were positioned by staff and administrators. Implications of the study focus on the need to include families in philosophies of care and policies that shape care work in long-term residential care.

Frontline activists: Mexicana care workers, subjectivity, and the defense of the elderly

In this article, I focus on Mexican immigrant women who, as care workers in various care settings in the wealthy city of Santa Barbara, California, attempt to defend aging Americans patients from devaluation and harm. To understand why vulnerable women defend more privileged citizens of the nation, I address Mexicana subjectivity. I argue that neoliberal policies have created multiple vulnerabilities for Mexican women and it is in formal care contexts where these vulnerabilities intertwine with that of their patients. Workers' feelings of shame, complicity, and empathy help explain a defense of the Other. A significant form of defense is informal sector family-based care. This article is based on ethnographic fieldwork conducted between 2009 and 2011.

"It's a Dignity Thing": Nursing Home Care Workers' Use of Emotions

This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions-sometimes in ways consistent with organizational demands, and sometimes not-and they consistently found in their emotions a resource to manage the strains of their work lives.