Home and community care, Retirement living, Nursing homes

One aspect of the data, one common theme, which should not surprise, but does, is this: every single one of these people is incredibly miserable here.  My conclusions in this paper will be drawn not just from the interviews I’ve done with the married residents, but also with the other residents I’ve come to know and have written about in my field notes.  Even the nicest, most forbearing, patient, and unfailingly polite among them, JB, summed up the entire experience of being here as “disgusting.”  And it’s not the quality of the care, or the staff, or the cleanliness of the building, or the amount of light they receive through the windows, or the food, but rather the very fact that they are not at home, that they are institutionalized, and that they never, ever forget that.  The institution repeatedly reminds them of their traumatic experiences, when they were helpless and terrified. Some suffer the pain of watching a spouse deteriorate and die, and all of them seem to feel desolation, isolation,  and loneliness, even though they are constantly surrounded by often very noisy people and their machine.  But even so, these experiences are not at the heart of the matter.  What is the heart of the matter?  What is the single most unbearable feeling  universally shared by the people who live here?  I'm talking about the ones who still have their faculties, who have not gone over into the fog of Alzheimer’s (which is not to say that demented people are content, because they clearly are not, but they are not entirely conscious of their discontentment)?  The universal condition is frustration with their diminished autonomy.  Each one of them is struggling mightily to hold on to their self-determination and watching it slip, inexorably, away from them.  This is the problem.  This is what changes marriages.  This is how the institution affects marriages.  What is a marriage when the married persons no longer feel that they own themselves, that they have given themselves, their decisions, their minds, their bodies, their routines, over to a larger entity, a mostly benign entity to be sure, but an institution all the same, an institution that exists primarily to justify itself, and not to care for the spirit, body, and mind of each resident?
What I am concluding here is that married couples bring their problems and patterns with them into the nursing home, and that marriage is often much more than simply a dyadic experience.  When a couple enters a “home,” their children almost inevitably get involved and shape their parents relationship as much as the aides and the nurses do.  The staff at SWVA make a concerted effort to protect the privacy of married couples, but the institutional environment and the regulations take a toll.  Considering the increasingly  long lives of the global population, and the strong possibility that more couples will end their lives in long-term care facilities, it would behoove us to consider whether or not we consider this an ethical and human way for our elders to spend their last years.  At the very least, nursing homes ought to dispense with their institutional elements to the greatest degree possible, and strive to create a more home-like environment that would offer the maximum privacy and dignity possible.

The European Welfare State crisis since 2008 has shown the weakness of these European welfare systems to cope with a health crisis such as COVID-19, which in turn has not guaranteed the rights and wellbeing of older people. This article aims at shed light on the scarcity of resources in Spin for its care homes and nursing homes system, while analyzing its integrated care failure and the urgent legislative measures implemented to overcome COVID-19 health crisis. At the same time, this paper advocates for a reflexion on ageist practices, so as to foster a debate on the ‘deinstitutionalization’ process of older adults in Spain. In this COVID-19 context, it has become utmost in implementing an older adults’ policy to guarantee older adults rights as vulnerable population; likewise, which has already been done in respect to laws protecting children rights.

Özet: Evde bakım hizmeti son yıllarda öne çıkan ve giderek yaygınlaşan bir
uygulamadır. Bu uygulamada, aileler ve toplum, yaşlı bireyleri koruma, bakım,
destek ve tedavisinde anahtar rol oynamaktadır. Bu çalışma ile yaşlılara evde
bakım hizmeti veren aile üyelerinin (kadınların) deneyimleri ışığında bakıma
muhtaç olduğu tespit edilen 65 yaş ve üzeri kişilere sunulan evde bakım
hizmetinin Trabzon özelinde değerlendirilmesi amaçlanmıştır. Öncelikle,
yapılandırılmış bir görüşme formuyla bakım veren kadınların ve bu hizmeti alan
yaşlıların sosyo-demografik görünümleri ortaya konmuş; ardından yarı
yapılandırılmış bir görüşme formu ile evde bakım hizmeti veren kadınlarla
mülakat yapılmıştır. Mülakat neticesinde elde edilen verilerin analiziyle, evde
bakım hizmetinin kapsamı, sunumu, yaşlı ve bakım veren kişi açısından olumlu
ve olumsuz yönleri, bakım verenlerin beklenti/talepleri vb. ortaya konmuştur.
Anahtar kelimeler: Yaşlı, yaşlılık, engelli, evde bakım, bakım veren.
An Evaluation of “Home Care Services” based on Experience Female
Caretakers with Their Eldery Patients
Abstract: In recent years, home care service is a prominent and increasingly
widespread application in which, families and communities play a key role in the
protection, care, support and treatment of the elderly people. This study aims to
evaluate the home care services given to the elderly people who are identified as
65 years old and odd, and who are in need of home care in the light of female
family members- caregiver’s experince especially in Trabzon province. First,
socio-demographic views of caregiver and elders have been revealed by means
of using a structured form; and then the data, which has been collected through
the interview done with caregivers, was demonstrated. Through the qualitative
analysis of the collected data, the coverage of home care services, presentation of
these services, positive and negative aspects in terms of both caregivers and
elderly people, expectations/demands etc. are revealed.
Key words: Elderly, elderliness, disabled, home care, caregiver.

The purpose of this manual is threefold. First, to help those seeking to start a ministry with the elderly. It offers some tried and tested suggestions for taking those first steps. Second, we aim to encourage those already involved. Third, the manual is written to challenge those who have forgotten or are not aware of the needs of the elderly. It presents a mandate for changed attitudes and actions.

Towards the end of the 1970s the concept of ‘community care’ was emerging as the preferred alternative to institutionalized service provision. For feminist writers it presented a potential problem in that the family was identified as the location within which this community-based care would be provided and that the ‘burden’, therefore was likely to fall on women. Community care has been presented as the ideal form of provision on the grounds of cost-effectiveness, moral responsibility (family members have a duty to care for one another) and as a safeguard against the abuse of individual that may occur in institutional settings. The ‘community care’ bandwagon continued to gain momentum throughout the 1980s. The National Health Service became separated and there was subsequent criticism of the fragmentary nature of social provision. The Griffiths Report of 1988 identified the role of social service as an enabling body rather than a service provider. In keeping with government policies, Social Service Departments were to make use of both private and voluntary sectors in purchasing services, and this was adopted in the 1990 National Health Service and Community Care Act.

Life in a community is marked by a social fabric that gives meaning to one's life. Older adults shifting to institutional living face the problem of an abrupt change in their social environment, often paired with a loss of social identity that had been constructed within the social fabric. In many Asian countries, including India, a considerable number of older adults shift to institutions for reasons other than the need for medical support. Traditional research on older adults living in institutions focuses on the role loss and psychological discomforts of institutional living. The current study is a counter-narrative on how the social fabric of the institutions serve as a platform in which older adults form ties and relationships to construct a new meaningful identity. The research has employed a mixed methodology approach and a sequential exploratory design, sampling 62 older adults from two randomly selected institutions for seniors in Ernakulam, Kerala. The findings suggest that older adults experience a role loss and identity crisis during the initial transfer to institutions, which is gradually compensated to an extent through networking and identifying oneself as a member of the institutional family. In-degree centrality from fellow residents and out-degree centrality towards fellow residents and professionals in the institution significantly impact the 'Satisfaction with Life' of the respondents. The findings suggest that institutionalised older adults rely on reciprocal ties and relationships to rediscover their roles and identity, which in turn help them age successfully.

Nursing homes have been criticised for not providing a home for their residents. This article aims to provide insight into (1) the features of home and institution as experienced by residents and caregivers of a secured ward in a nursing home, and (2) how interventions implemented on the ward can contribute to a more home-like environment. For this purpose, a participatory intervention study, involving both caregivers and residents, was carried out. We collected data through qualitative research methods: observations, in-depth interviews and diaries to evaluate the interventions over time. We adopted an informed grounded theory approach, and used conceptualisations of total institutions and home as a theoretical lens. We found that the studied ward had strong characteristics of a total institution, such as batch living, block treatment and limited privacy. To increase the sense of home, interventions were formulated and implemented by the caregivers to increase the residents' autonomy, control and privacy. In this process, caregivers' perceptions and attitudes towards the provision of care shifted from task-oriented to person-centred care. We conclude that it is possible to increase the home-like character of a secured ward by introducing core values of home by means of interventions involving both caregivers and residents.

Drawing on the literature of metaphor, movement and memorialisation, this paper focuses on the ‘final journey’, a metaphoric journey undertaken by dead residents which allowed workers in care homes for older people to cope with the amounts of death that they encountered working in care homes for the elderly. Movement plays a key role in the routine functioning of the home and the metaphoric language of a journey is an important conclusion to the stages that have preceded this. It helps explain the care that surrounds death and dying within the care home. Workers’ experiences show that there is a rich oral tradition which symbolism, spirituality, ritual and memorial language explain and at the same time creates continuity for workers within care homes. I argue that the search for meaning is important for staff as they continually face the deterioration of people during their working lives. Further, the use of a metaphorical journey is a practical device for remembering and is imbued with the caring culture of the home and the individual beliefs of the workers involved.

Purpose: Older people are seen as needing to receive support from other people as they age. But what are the experiences and expectations older people have of being “support receivers”? Design and Methods: Community-dwelling childless elders (n = 38, aged 63–93) were interviewed about their experiences and expectations of support, as they comprise a group “at risk” of lack of support. Responses were analyzed within a narrative gerontology framework of positioning theory as to how receiving support was “positioned” and how it related to growing older. Results: Participants defined support in widely diverse ways; it was not a straightforward concept. Receiving support could be warranted by particular circumstances such as illness, made acceptable by the qualities of the support giver, and/or by being part of reciprocal exchanges across time. Support receiving was resisted when associated with difficult interpersonal dynamics or assumptions of incapacity. It was also in tension with preferred positions of being “independent” or of needing “no support.” Participants positioned “oldness” negatively and as both equivalent to the need for support and as a potential outcome of being a support receiver. Implications: This research shows that support can be hard to define and hard to receive. Needs assessors and researchers asking “Do you have enough support?” need to consider how support is positioned to better target appropriate help. Assumptions about at-risk groups can be misleading; many childless participants had a lifetime of self-support or an intentionally developed “web of contacts” at a size that suited them, even if they looked unsupported to others.

The bulk of care provided to elderly people living in the community and needing assistance is provided informally by family and friends. This paper investigates themes from an interpretation of interviews with informal caregivers about their experiences of caring for a frail, ill, or disabled elderly person at home. These themes include mobility, routine, and interrelationships of scale. The caregivers' narratives illustrate the interconnected nature of physical, material and social, emotional aspects of care, and the profound spatial and social impact of providing informal care to a family member on their everyday lives. These are often at odds with political and social constructions of what it means to care at home. Concepts of space, place, and time are shown to be a helpful framework through which to understand issues and experiences of caring. The social and the physical aspects of the many interconnected scales and places which caregivers negotiate on an everyday basis both shape and are shaped by caregiving.

Two projects were established to help elderly people with mental health problems move from continuing care hospital wards to local authority residential care homes. The projects were part of a larger programme established in the 1980s to test new policy and practice options. Each hospital resident was interviewed and assessed prior to commencing any programme of activities designed to prepare them for resettlement in the community. Data came from hospital patients themselves, from staff and from interviewer observations. Most of the people who moved from hospital were reinterviewed and reassessed approximately 9 months after discharge. The evaluation revealed that quality of life in residential homes was certainly not inferior to hospital but was less expensive. The residential homes offered more lively and psychologically pleasing environments than hospital. Residents'levels of participation were higher according to staff, and residents had more social contacts. The quality of social contacts also appeared to improve. The two projects thus provided a cost-effective alternative to hospital for elderly people with mental health problems.

This paper explores reasons for choosing Malaysia as a retirement location.In-depth interviews were carried out with 30 international retirees.Pearce's concept of the Travel Career Ladder (TCL) guided the data analysis and results discussion.The dominant motivation themes clustered in the seeking of self-fulfilment needs.Issues as to overlaps between motives and stages in the TCL are discussed.‘Malaysia My Second Home’ is an international retirement migration programme aimed at attracting the lucrative retiree market to choose Malaysia as their residence. This study implemented the concept of the Travel Career Ladder (TCL) (Pearce, 1991), with a purposeful sample of 30 participants who had retired to Malaysia. Questioning was directed towards their motives for selecting Malaysia and the analysis indicated that the majority of the motivation themes clustered in the seeking of self-fulfilment needs. Among motivation themes discovered are meaningful second life, positive instant thoughts, central travel location, positive retirement book description, food variety, tranquillity and simple life, political stability and security, and ease of communication. The study also revealed a challenge in applying TCL to its findings as some motivational themes simultaneously represent various TCL hierarchies. The theoretical, marketing and managerial implications of the study are discussed.

Sin categoría Tags $ En muchísimos países del mundo, los gobiernos se enfrentan con el reto de responder al cambio demográfico que consiste en el aumento del número y de la proporción de adultos mayores en la población. ¿Qué está pasando en los servicios de cuidado para ancianos frágiles en los paíes europeos, y qué elementos pueden orientar el desarrollo en otros lugares, pensando en lo que ha funcionado y en lo que no ha funcionado? ¿Podemos transferir las ideas que han tenido éxito? ¿Somos capaces de aprender de nuestros errores, o las diferencias entre los países significan que cada uno tiene que empezar desde cero y abordar los temas de forma independiente? Estos temas son el enfoque del programa Eurosocial, que intenta promover el intercambio de conocimientos y experiencias entre Europa y América Latina. La Unión Europea, bajo su programa Eurosocial II, ha financiado un programa de visitas de estudio y seminarios con SENAMA, el Servicio Nacional para Adulto Mayor de Chile, para revisar y evaluar los estándares de calidad de los servicios para adultos mayores en varios países europeos y considerar si y cómo éstos pueden informar y afectar el desarrollo de servicios en Chile. Contexto Contexto Una visita de estudio en 2014 a los servicios de Suecia, Países Bajos y Luxemburgo, realizada utilizando lo que se ha aprendido durante visitas anteriores en Francia e Italia. Participaron en las visitas directores de SENAMA, quienes fueron colocados en un contexto más amplio gracias a los aportes de expertos europeos de servicios de cuidado a adultos mayores de Europa y de Latinoamérica, a través de encuentros con funcionarios de la Unión Europea y la participación en una conferencia que involucró a adultos mayores, cuidadores, políticos y proveedores de servicios procedentes de toda Europa. Las visitas y los encuentros con organizaciones incluyeron: proveedores de servicios de cuidado residencial, de centros de día, de cuidado en el domicilio y en la comunidad, comisarios, responsables de las políticas, instituciones de investigación y formación, inspectores. También hubo ocasiones de hablar con adultos mayores, voluntarios y personal (profesionales) que se ocupan de los cuidados. Estos encuentros fueron útiles porque dieron tiempo para comprender y discutir de temas claves en el servicio de cuidado. Resultado de la revisión de los servicios Resultado de la revisión de los servicios Quizás el elemento más sorprendente de la visita de estudio fue la admisión que los servicios en el pasado se habían equivocado, porque no habían comprendido bien la situación. Funcionarios de los gobiernos, proveedores de servicios, cuidadores familiares y-más importante-los adultos mayores, todos mencionaron los errores hechos y los problemas de los sistemas de cuidado ya existentes. Nuevas iniciativas intentaron superar estos errores o reemplazar sistemas o servicios que ya no eran adecuados. Se argumentó que los servicios del pasado se habían desarrollado como servicios 'ad hoc', dando lugar a una gran fragmentación. Ahora los gobiernos de toda Europa están luchando para lograr la coordinación entre salud, cuidado social y servicios de vivienda, y entre los hospitales y los servicios de cuidado de largo plazo, residencial y de comunidad. Los servicios formales se habían basado a menudo en las preferencias de los profesionales, lo que aumentaba la dependencia de los adultos mayores de los servicios. Contrariamente, hoy el enfoque está cada vez más basado en lograr que los adultos mayores sean capaces de cuidar si mismos, dándoles la posibilidad de elegir, escuchándoles e involucrándoles en el diseño de su cuidado.

Residents in private old age homes (POAHs) usually adopt a sedentary lifestyle, making them prone to physical deconditioning. This study examined the effects of a short-term mobility exercise programme on the balance and mobility of elderly residents residing in POAHs in Hong Kong. Subjects recruited from three POAHs were matched in demographic characteristics and ambulatory status before assigning them to either a mobility exercise (M) programme or control (C) programme of general exercise. Both programmes consisted of 18 sessions that were conducted three times a week over two months. The subjects' mobility and balance performance before, mid-term, at completion of the programmes and three months afterward was evaluated using the 4-metre walk (4MW) test, timed up-and-go (TUG) test and the Berg Balance Scale (BBS). Ten and
eight subjects completed the M and C programmes, respectively. The M group did not demonstrate improvement in 4MW, TUG or BBS score at completion of the programme. At 3 months after the programme, only the C group experienced a significant decrease in BBS score (p = 0.02). The short M programme did not significantly improve the mobility and balance performance of elderly residents of POAHs, but the performance appeared to be maintained for three months after the programme stopped. Randomized studies on longer programmes with revised protocols are recommended.

本研究從災害因應韌性觀點，分析影響老人福利機構水災撤離行為之因素。以二○○九年莫拉克、二○一○年凡那比颱風水災撤離經驗為研究對象，本研究於二○一○年深度訪談六家老人福利機構、一個地方緊急應變中心，以及三個救難隊。研究結果如下：(1) 及時撤離因應韌性之影響因素包含體系因應韌性，如政府對極端災害預警是否有標準作業程序、正式網絡救援能力是否及時到達，以及包含屬於機構因應韌性之非正式網絡是否能有效動員、是否有標準作業程序、住民行動能力與機構人力整備狀況。本文建議長期目標，正式社會支持網絡應致力於針對極端氣候研發減災及調適策略與工具，短期目標，正式社會支持網絡則應培養機構災害因應韌性（如，看河川水位）；另外，建議效法日本模式，培養以（機構）自助、（鄰里）共助為主，（正式社會支持網絡）公助為輔的文化；(2) 撤離工具安排和避難收容因應韌性影響因素包含屬於機構因應韌性之機構動員非正式社會網絡能力、人力物資整備能力，以及屬於體系因應韌性之動員正式社會網絡能力。多數受訪機構認為自己處理較能了解自身需求，亦即，機構因應韌性較體系因應韌性重要。本文建議政府扮演輔助角色，包含以較強的機構為典範，建立輔導弱者之機制。

Aim: To describe the evaluation of the NBN enabled telehealth pilot of Feros Care’s My Health Clinic at Home (MHCAH which involves daily vital-sign monitoring which is triaged by a telehealth nurse and video-conferencing.
Methods: A mixed methods, prospective, uncontrolled study design was used to capture learning on the processes of implementation and the impact of the project on clients. Data sources included surveys with service users and providers, pre-post test clinical data, audit data, documentary evidence from meetings and interviews and focus groups. 
Results: Overall, 181 of 200 clients recruited to the trial between April 2013 and June 2014 were included in the evaluation. Most clients (64%) self-referred into the pilot with the goals of monitoring their own health (68%) and identifying problems before they became serious (65%).Clients reported that as a result of participating in MHCAH, they better understood their vital sign monitoring (48%) and consequently: could better manage their own health (48%); were better informed (44%) and more confident (25%) to discuss their health with their doctor. Clients also reported making medication changes (17%), positive dietary changes (34%); and increased their physical activity (33%). Overall, client self-rated general health improved (mean improvement 0.303, SD= 0.80, 95% CI 0.16 – 0.45, 118 df, p=0.000), with more participants reporting that their health is “excellent” or “very good” health at the end of the trial. Clients also reported making fewer doctor visits (24%), which was supported by the comparative data at baseline and discharge (p=0.000); fewer visits to the emergency department at the local hospital (p=0.021) and fewer non-local hospital admissions (p=0.000) compared with the preceding year. There was no significant reduction in local hospital admissions (p=0.171). All health practitioner engagement was poor despite a willingness of clients to video-conference with a range of services. Cost was a barrier to most clients continuing to use MHCAH. Few clients were willing to pay more than $10 per week to use MHCAH, whereas the weekly cost of providing the service is $111.76.
Conclusions: While a causal link cannot be demonstrated, the findings suggest that MHCAH empowers clients to better understand and manage their own health, and may be associated with improved health outcomes and reduced service use. Having regular, daily access to a telehealth nurse reassured clients, and triggered changes to services and behaviour that are likely to have influenced outcomes. The ongoing costs of MHCAH appear high, however if the potential benefits demonstrated by this trial are realised, then the downstream savings could substantially outweigh these.

The perception of nursing homes today have been peppered with visions of the past such as sedated, drooling elderly people unable to care for themselves to the modern emphasis by television litigation attorney advertisements claiming that all of the elderly are being abused and neglected by nursing home staff. Most people do not understand the complexities surrounding the world of nursing home regulations and the highly litigious nature in which these fragile institutions operate. One of the prevailing visions of elderly in nursing homes are highly, medically sedated patients in capable of performing the most basic of activities of daily living. Psychoactive drug use, on residents in nursing homes who are unable to consent to treatment, is often used as a method of control and convenience rather than to treatment medical symptoms.

The segment reported that 60-80% of all readmissions were found to be unnecessary transfers for diagnoses that could be prevented by early identification. Additionally, the stress that comes with transferring a patient can lead to further complications that could have otherwise been avoided.
Here are three of my strategies that I think can help you and your team

This chapter aims to bring the retirement home into the conversation about care services in African societies. While there are indeed not that many retirement homes operating on the continent, they nonetheless exist and are part of the urban landscape. The homes de vieillards constitute one category among the various spaces of care available in the city. Hospitals, rehabilitation centres, compounds of tradi-practitioners and nganga (healers and diviners), orphanages, but also places such as churches (see Hoffman, Chapter 9), family houses (see Obrist, Chapter 6 and van Eeuwijk, Chapter 3), associations for the elderly, and informal support groups where care is provided in less formal ways, can all be called “spaces of care”. By focusing on how retirement homes are situated within these various spaces of care and the overall urban environment, and by focusing in particular on how movement in and out of these spaces occurs – i.e. why are elderly people in retirement homes, for instance? – this chapter addresses larger themes such as intergenerational relations in contemporary Africa, urban infrastructure, and public services. An ethnography of urban space, care, and the elderly will unsettle the image of the African city as a space of youth, will hopefully provide a new grid for “the urban experience”, and will contribute to the anthropology of old age/ageing, which has long focused on health problems and intergenerational relations. While for obvious reasons youth have been a privileged category in anthropological analyses of postcolonial African urban lifeworlds, an approach to the city’s “spaces of care”, and in particular an analysis of the social spaces where senior residents are being cared for, brings novel perspectives on urban livelihoods.

Dutch nursing homes are currently confronted with two seemingly incompatible goals: a more client-centred approach and the necessity to reduce costs at the same time. It is becoming increasingly apparent that healthcare logistics can contribute to providing high-quality care and support at a reasonable cost. Moreover, care and support which takes the client’s preferences as starting point. A literature study revealed that there is very little in terms of a framework for healthcare logistics that embodies both aspects. Therefore, the authors developed a conceptual framework that meets both requirements. Existing insights on client-centredness and healthcare logistics were used to develop the framework, which offers a structure for both future research and practice in healthcare logistics in nursing home care. This paper reveals that further empirical research is needed to better understand how variability, volume and predictability are interrelated and how they influence the plannability of healthcare activities in terms of what, when, where and by whom.

The aim of this article is to present the results of qualitative research, 5 case studies of husbands with Alzheimer's disease and the image of daily home-based care for them, provided in family homes by wives. The research question posed in this report was: what is home-based care for a husband with Alzheimer's disease from the wife's perspective? The research results revealed the main category: home-based care characteristics, along with 8 codes, such as: (a) husband's condition, (b) wife's day, (c) husband's day, (d) care, (e) barriers/ difficulties of the wife, (f) functioning of the husband, (g) barriers/difficulties of the husband , (h) overcoming problems. The results of the research revealed that husbands with Alzheimer's disease are the most important point of reference and the focus of attention for 24 hours a day in the everyday lives of 5 case studies informants. Husbands, their character , current skills, difficulties, and requirements are constantly present, although their masculine presence is changed by the disease process. The results of the research showed the nature and image of the progressive process of falling ill, the loss of various functions in husbands in the narrative of wives, and illustrated the functioning of males, the involvement in a care of members of the immediate family, and in some cases incoming caregivers and nurses. Additionally, research has shown a picture of home-based care saturated with routines, barriers and hardships, and the burdens of wives assuming more life roles than just taking care of their husbands. Moreover, the results of the research also showed a lot of understanding from the wives' perspective, loyalty, and warm feelings towards seriously ill husbands, manifested in dedication in the constant care, reformulation of one's own life in accordance with the needs of husbands.

Dansk resume:
Denne artikel bygger på et antropologisk feltstudie hos svækkede ældre mennesker, som boede i eget hjem, og som blandt andet modtog hjemmesygepleje (Ludvigsen). Studiet fokuserede især på de ældre menneskers sociale relationer, hjælpen de modtog, deres medicin og sundhedsaktiviteter i form af blandt andet fysisk træning. Derudover blev de ældres forståelse af døden behandlet, og hvordan de tilpassede sig deres levevilkår som ældre. Artiklen tager udgangspunkt i teorier om medborgerskab (Marshall, Schwartz, Sørensen, Jöhncke, Rose & Novas, Petryana), og hvordan det at være medborger i et samfund indebærer rettigheder, pligter og krav. Ældre, som er afhængige af velfærdssamfundets hjælp, er ikke undtaget for pligter og krav, og forpligtelserne strækkes langt ind i denne sene fase af livsforløbet. Jeg argumenterer i artiklen for, at de ældre informanter med baggrund i deres ønske om at være en god medborger, og ikke en modborger, i vid udstrækning søger at tilpasse sig de krav og forpligtelser, de møder fra samfundets side, eksempelvis om medicinindtagelse, træning og indgå i et samarbejde med deres hjælpere. Som en integreret del heraf smelter også konkurrencestatens mål (Pedersen) om effektivitet og virkningsfuldhed sammen med disse krav og forpligtelser. Ældre medborgeres ønske om at forbedre deres helbredstilstand er ofte overensstemmende med de aktuelle samfundsmæssige mål. Artiklen viser, at det med tiden bliver sværere for de ældre informanter at leve op til krav og forpligtelser, hvorfor de trækker ”ældrekortet”. Som følge heraf reformulerer de ældre deres medborgerskab til en status som ”gammel”, samtidig med at de udvælger forpligtelser, som de fortsat behersker. Den antropologiske forståelse af medborgerskabet som deltagende, pluralt, flydende og gensidigt viser, hvorledes de ældre informanter kan definere deres medborgerskab ud fra personlig formåen. Det betyder, at de ældre fortsat kan føle sig inkluderede, samtidig med at de ydelser, de modtager, tilkendegiver substantiel inklusion i samfundet.

English summary:
This article takes its point of departure in anthropological fieldwork conducted among elderly fragile people, who lived in their own homes while receiving home nursing (Ludvigsen) and other services provided by the welfare state. The study especially focused on elderly people’s social relations, their medicine and health activities as e.g. physical training. In addition, the elderly people’s understanding of death was addressed. The article draws on citizenship theories (Schwartz, Sørensen, Jöhncke, Rose & Novas, Petryana), which show that being a citizen implies rights, duties and demands, and that elderly people dependent on help from the welfare state continue to comply with such duties. This paper highlights that elderly informants want to be good citizens and therefore adapt and act in accordance with duties and demands of the society, including aims of the competition state such as efficiency. The article sheds light upon the process of getting old and not being able to meet societal duties and demands. Consequently elderly informants reformulate their citizenship changing their status to “old”, choosing duties they are still able to comply with. An anthropological understanding of a citizenship as participating, plural, fluid and mutual shows that elderly people, when redefining their citizenship, maintain a feeling of inclusion, as well as help of the welfare state and/ or the family do.

Keywords: citizenship, home nursing, welfare state, rights, duties, competition state.

Findes i Tidsskriftet Antropologi nr. 73: Velfærdsstaten 2

RÉSUME

Le VIH/SIDA et le vieillissement constitue un thème émergent important et pertinent pour la gérontologie. Les expériences des personnes âgées vivant avec le VIH relatives au logement sont encore très peu connues. Le présent article explore cette problématique en examinant les données issues d’entrevues portant sur les expériences relatives au logement de 11 adultes âgés (de 52 à 67 ans) vivant avec le VIH/SIDA à Ottawa (Ontario). Les histoires des participants ont révélé des préoccupations relatives aux trois thèmes principaux: l’acceptation dans les maisons de retraite ou dans les centres d’hébergements de soin de longue durée, le manque d’accès aux logements subventionnés et l’itinérance. Les participants rapportaient ressentir un manque de reconnaissance et de la confusion concernant leurs perspectives d’habitation. Ces résultats suggèrent qu’un changement se produit peutêtre dans les besoins de logement de personnes qui vieillissent avec le VIH. Cette population émergente apporte des défis aux idées dominantes sur le vieillissement. Nous concluons qu’une attention accrue est nécessaire au niveau de la recherche, des politiques et de la pratique pour aborder le problème du logement chez ce groupe d’âge de personnes vivant avec le VIH.

ABSTRACT

HIV/AIDS and aging is an important emerging topic with relevance to gerontology. Currently, little is known about the housing experiences of older adults within the context of HIV/AIDS. This article explores the issue and examines interview data concerning the housing experiences of 11 older adults (52 to 67 years old) living with HIV/AIDS in Ottawa, Ontario. Participants’ stories revealed concerns relating to three major themes: acceptance into retirement homes and long-term care communities, barriers to accessing subsidized housing services, and homelessness. Participants reported feeling that they lacked recognition and experienced confusion about their future housing prospects. These data suggest that a shift may be occurring in the housing needs of people aging with HIV/AIDS. This emerging population presents challenges to mainstream ideas of aging. We conclude that increased attention is needed in research, policy, and practice to address housing issues among this age group of people living with HIV/AIDS.

The aim of this study was to undertake a detailed exploration of sleep in the context of 24 hours in a care home environment, exploring the subjective experience of residents and the perceptions of staff. Qualitative research in four care homes for older people consisting of semi-structured interviews and ethnographic observations. Interviews were conducted with 38 residents and 39 staff, and were analysed using a grounded theory approach. The findings have highlighted some challenges and opportunities for developing practice in care homes to improve residents' sleep. In addition to pain and physical disabilities, the physical environment and practices in care homes can affect residents' sleep and night-time experience. Improving our understanding of residents' and staff's experiences at night in care homes can inform the development of good practice in night-time care and contribute to a positive culture of person-centred care.