Paper short abstract:

Using ethnographic insights from fieldwork at a Continuing Care Retirement Community in Los Angeles, this paper suggests that transitions in an elder's care are intense sites of contestation, disturbing not simply the organization of care, but, through it, the recognition of life itself.

Paper long abstract:

Addressing the rupturing transitions Americans make at the end of life between home and medical institution, Continuing Care Retirement Communities (CCRC) seek to handle elders' uncertain aging and dying seamlessly, offering escalations of care - from independent, assisted, to nursing - in one community. This 'aging in place', from retirement to death, allows elders the time to establish kin-like, enduring solidarity with friends and staff, helping to transform the impersonal institution into a unified home. While CCRCs help to integrate elder's transition between levels of care, transitions there nevertheless feel dislocating, because the variant logics of care within independent, assisted and nursing living diversely shape elders' sociality, personhood, and life.

Ethnographically inspired, this paper examines how transitions in an elder's care are intense sites of contestation, disturbing not simply the organization of care, but, through it, the recognition of life itself. These contestations are severe, because elders know that these levels of care do not simply reflect reality, but in fact create it: while it was known that the body in its last months needs professional oversight, the nursing home was also seen to quicken death, as its induced dependence takes away the 'will to live' and as its zone of death makes social solidarity difficult. This paper reflects on how places and their logics of care create life and death through practice and perception. It also suggests transitions at the end of life are critical sites for existential quandary and death's social formation.

Paper short abstract:

Social network and ethnographic data from the fieldwork in a town in Northeast Italy are here presented in order to reflect on how the category of old-age (non)-self sufficiency is negotiated by both the people who happen to be classified as such and their kin and non-kin care-givers.

Paper long abstract:

Socio-sanitary reforms that took place in Italy in the 1970's created a legal construct - a "non-self- sufficient aged person" ("un anziano non-autosufficiente"). In the years that followed, this legal concept would become a social one, made evident by a well-established presence of the word "non-autosufficiente" in the today's Italian vernacular, as well as by the emergence of various systems of formal or non-formal organizational routines created to respond to the needs of the "non-autosufficienti". The aforementioned legal reforms brought about an imagined collective: aged persons who are no longer self-sufficient.

In this paper, I present the data gathered during my ethnographic fieldwork in a town in Northeast Italy, in order to reflect on how the category of old-age (non)-self sufficiency is locally constructed, negotiated and at times contested by both the people who happen to be classified as such and their kin and non-kin care-givers.

The ethnographic data presented here will be supplemented with the network data gathered from a randomly sampled group of the aged inhabitants of the town, who during the time of the survey manifested various grades of physical and/or mental decline. The final discussion of both the ethnographic and network data will be devoted to the reflection on if and how the social network analysis can further facilitate anthropological thinking on the ways in which late life transitions are lived.

Paper short abstract:

This paper examines the practical challenges, competing interests, and moral dilemmas involved in the major transformation of elderly care in China, through the inter-generational negotiations of care provision in labour-migrant families.

Paper long abstract:

This paper examines the practical challenges, competing interests, and moral dilemmas involved in the major transformation of elderly care in China. The cycle of giving and receiving care in the family is at the core of Chinese kinship, and its significance has further increased in the recent decades. The one child policy and mass rural-urban labour migration have disrupted the patrilineal cycle of care, in which sons paid back the debt of parental care by providing for their parents in old age, while daughters transferred the debt to their in-laws. In the context of the rapidly ageing population and the neoliberalist authoritarian regime that renders people reliant on family networks for social security, it is the temporary labour migrants and their families, who face some of the greatest challenges in re-organizing the inter-generational flows of support. The challenges include the spatial and social separation of families, as most working-age people live in the cities, while the elderly stay behind in the villages; the transformation of gendered roles and obligations in the family; as well as the competing demands of investing into the future of the only child, and providing care for the elderly. Examining the inter-generational negotiations over retirement; practical care in spatially separated families; the number of children in the family, and so forth, also brings to light the shifts in kinship hierarchies that take place with spatial mobility.

Paper short abstract:

This paper considers generational identification of, and generational othering by, older people who were variably, ageing in place within their communities, ageing in place within new (supported) living arrangements or ageing out of place in a new locality within an extra care housing complex.

Paper long abstract:

This paper presents findings from a study examining intergenerational relations within one relatively deprived area of a post-industrial city in the North of England. Data were generated through focus group discussions involving a diverse group of older people, including those who were ageing in place within their communities, those who were ageing in place within new (supported) living arrangements and those who had migrated from other localities to live in an extra care housing complex.

We consider how generational identities were constructed by and became meaningful for older people through the invocation of similarities and differences between differently positioned actors within the generational frame. Through the co-construction of consensual understandings of 'good manners', respect, discipline and family life, older people articulated a clear contrast between members of 'their generation' and the non-old. However, this age-othering was nuanced by older people's emplacement. Although all of the participants in the study lived within the same neighbourhood, their community embeddedness and their experiences of age segregation varied. Those older people who had remained 'in place' in their own homes were more likely to express stronger bonds with younger people within and out-with the family. Older people who had moved from the local community into the extra care complex and who were ageing in place in a micro-community within a community, expressed similar suspicion and ambivalence towards other generations to that of the older people who were ageing out of place. The paper will conclude by discussing implications for intergenerational relations and community cohesion.

Paper short abstract:

Using the perspectives of civic ecology and therapeutic landscapes this paper looks at the impact of green landscapes as places and cultural spaces of healing and providing social and psychological sustenance for elders.

Paper long abstract:

This paper looks at the impact of green landscapes as places and cultural spaces of healing and providing social and psychological sustenance for elders. Using the perspectives of civic ecology and therapeutic landscapes it examines a range of transitioning practices and spaces of staying, moving, and (re)settling. It will include in a variety of cultural spaces from allotments in Europe, urban community gardens and creative environments for elders with serious disabilities.

A key part of the paper will take the results of my research on community gardens in New York City and Allotment Gardens in Oxford, England to realistically access the capacity of green spaces to have a healing and care function for elders in a variety of contexts. In the case of Allotments and community gardens the focus will be on the construct of Civic Ecology and its capacity to provide alternatives for psychological support for urban immigrant elders who are re-settling in new cultural spaces.

The idea of healing green spaces and gardens is an old one, dating at least to the middle ages and is still being employed in many kinds of formal rehabilitative settings including hospitals, hospices and prisons). The notion of "elder gardens" has been at the center of revolutionizing and humanizing such spaces in developing the "Eden Alternative", "Green House" and models for dementia care. These new visions of elder inhabited space, seek to reengage the social beings hidden behind medically constructed masks of failed personhood.

Paper short abstract:

Old people living at home, rather than in institutions, enjoy a better quality of life. I challenge this assumption regarding old people with advanced stages of dementia living at home. I contend that family caregivers transform the "home" of cognitively impaired people into a heterotopic space

Paper long abstract:

Old people living at home (instead of being segregated into nursing homes) enjoy a better quality of life, involvement in the community and active social life.

Based on data gathered from Facebook groups, comprised of families caring for older people with advanced stages of dementia at home, I pose that this assumption isn't valid in their case and suggest that families mostly tend to their physical needs. Family members are unable to intelligibly communicate with them, especially during the advanced stages, or they avoid the effort altogether. They restrict them to their rooms, and more specifically, to their beds. Their hands are bound to prevent them from pulling out medical equipment that makes them suffer; and, they are not allowed to wander outside of their designated space (either by locking their doors or by handcuffing them to their bed.) They are unable to revel in the simplest joys of life, e.g. tasting food; since they are being fed with a syringe or worse, artificially fed. They are constantly under the surveillance of family members and professional caregivers (migrant workers from East Asia mostly,) or monitored by home security cameras.

I contend that family caregivers transform the "home" of cognitively impaired people into a heterotopic space. One in which their subjectivity is decomposed; their bodies are supervised constantly, subjected to a strict regime of medical control. They are sequestrated from society, and socially excluded; though at "home," within the "community," rather than at an "institution."

Paper short abstract:

With an empirical focus on municipal eldercare services in Denmark, the paper examines how a political emphasis on functional ability and movement produces certain negotiations, blurs the lines between public/private space, and unsettles how older people should be 'at home' in their surroundings.

Paper long abstract:

The home is often perceived as a stable spatial-material setting that sustains the meaningful arrangement and organisation of its occupants' daily activities and routines. In Denmark, politicians and health experts have designated the home as the place where elderly citizens 'function best'. Thus, it is the central site for health assessments and eldercare services provided by municipal health professionals. However, when these professionals enter a citizen's house or apartment, the boundaries between public and private space become blurred. Specifically, the private home transforms into a public workplace that is judged in terms of its capacity and potential to support ageing in place and productive, continued agency. In these encounters, the home becomes a site of action, conflict, movement, and resistance with the ageing body as a shared focus of attention and negotiation.

Based on empirical material from 15 months of ethnographic fieldwork that followed a re-ablement (or 'everyday rehabilitation') training programme for elderly citizens in a Danish municipality, the paper provides a socio-cultural perspective on the political expectations for functional ability, activity, and ageing in place. By exploring the Danish concept of 'help to self-help', the paper discusses how the evaluation/rehabilitation process unsettles and re-settles the ways in which elderly citizens are secure and 'at home' in their physical bodies and material surroundings. With a focus on the complex movements of power, authority, and subjectivity within the symbolic space of the home, the paper elucidates how the actors involved experience the transition from one form of security to another.

Paper short abstract:

I will question the assumption of a higher quality of life facilitated by ageing in place for people with dementia and their spouses, by exploring their sense of home in connection to the changeable meaning of their home environment.

Paper long abstract:

Aging in place has been an important part of UK policy on aging for a long time. It aims at supporting and encouraging elderly to live at home as long as possible, subsequently creating a higher well-being for the elderly and safe the government money (Sixsmith and Sixsmith 2008). People with dementia and their spouses are especially advised to age in their familiar home environment and avoid making big changes; the familiar environment would work reassuring (NHS 2015).

'Isn't it nice that people call us here? We don't even live here' says Mary to Dan. They are sitting in the dining room of the house they have been living in for forty years. Over the last couple of years their sense of home has changed several times while multiple transitions took place in their daily lives; being diagnosed with dementia, becoming a carer, making alterations to the home, moving into care and Mary passing away.

Drawing up on ethnographic fieldwork at the houses of five couples of whom one has got dementia and co-morbidities and the partner is the primary carer in England, I will illustrate how their sense of home changed over time when going through transitions connected to age, illnesses and relationships, creating reassurance, insecurity and anxiety. This puts into question the assumption of a higher quality life facilitated by aging in place.

Paper short abstract:

This paper draws on ethnographic work with people with dementia and their relatives to problematise "ageing in place" and the taken for granted status of 'home' and the 'community' as singular and static places and networks for embedding care arrangements in later life.

Paper long abstract:

"Ageing in place" policy aims to define formal government and international support for practices designed to enable older people to continue to live independently in the community. Local authorities in many nations hold responsibility to address social care needs of older adults including assessing and providing (or commissioning external organisations to provide) different forms and levels of care. In practice, the resulting assemblage of carers, care workers and technologies situate and limit their support to an older person's home rather than enabling an older person to engage with a wider system of people and spaces in the community.

This paper draws on previous ethnographic work with people with dementia living in their own home and their carers to problematise "ageing in place" and associations with 'home' and the 'community' in care policy and practice.

As people with dementia experienced an increased range and severity of symptoms, they also appeared to experience diminished capacities to navigate and occupy spaces in their home. Carers often reconfigured and adapted rooms to allow a person with dementia to carry out their daily routine. As part of this adaptation, formal care service providers would also issue different assistive living technologies. Transformations in the spaces and technologies of everyday life and care also shaped how people with dementia and carers occupied or abandoned domestic and community spaces and relationships. Such changes require further reflection on how we distinguish between 'living at home' and 'living in the community' as concepts for policy and care provision.

Paper short abstract:

General discussion of the panel's topics.