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Paper short abstract

Dementia care forms a site of relational tensions between stakeholders, due to differences in values, beliefs, needs and tempo's. This paper unpacks temporal tensions, discusses how stakeholders navigate tensions through relational attunement, and examines where attunement reaches its limits.

Paper long abstract

Dementia care at home involves close collaboration between people living with dementia, informal caregivers, and health and social care professionals. Such ‘care triads’ form sites of relational tensions, due to differences in participants’ values, beliefs, needs and tempo’s. Drawing on two empirical studies (Yaron et al., 2024; the ongoing CONTACT study), this paper focuses on temporal tensions as an understudied dimension of dementia care. In addition, it explores how triad participants navigate all four tensions through relational attunement—and where attunement reaches its limits.

Temporal tensions in care triads amount to three asymmetries. The first is caused by differences between the person with dementia’s past and present self (previous versus new preferences and roles). The second asymmetry originates in variations in triad participants’ subjective temporal horizon (e.g. accepting the diagnosis, adjusting to changes). The third asymmetry is tied up with distinct temporalities of the care system (rosters, allocated hours) versus the lifeworld (organic rhythms of everyday life).

Triad participants use various strategies to navigate relational tensions. Their efforts to attune can be seen as a type of affective labor that ultimately aims to retain voluntary connection amid difference and dependency. Such relational attunement is an inherently temporal phenomenon: it takes time and unfolds over time. Yet attunement has limits. Triad participants may find themselves unable or unwilling to attune—through exhaustion, severe distress, or when facing unsafe situations. We discuss what attending to these limits means for how we understand the conditions under which good care in dementia triads remains possible.