Search

The present article is based on an ethnographic research project exploring the constitution and reproduction of exchange relationships between residents and caregivers in Swiss nursing homes and elaborating on their significance within end-of-life trajectories. The results show that despite scarce personnel, time and cost resources in old-age long-term care, exchange relationships in the sense of non-liquidating transactions are of major significance both in daily interactions and in the context of acute dying in the nursing home. Residents as well as caregivers invest in relationships that build on an informal ‘giving and giving back’. Invested goods or services are manifold and often immaterial, both on the caregivers’ and on the residents’ side. The main informal investments are: 1) permitting affection and emotional involvement 2) sharing personal information, and 3) offering extra-time. The paper demonstrates how actors exchange these goods to establish an informal dimension in their care relationships and how this dimension may influence end-of-life practices in the nursing home. Focusing on informal parts in exchange relationships allows considering care relationships from a theoretical perspective that has gained little attention so far, both in anthropological exchange theory and in disciplines concerned with care relationships.

Was ist zu diesem Thema bereits bekannt? Narrationen sind ein wichtiges Instrument im klinischen und pflegerischen Alltag. Sie schaffen für Patient_innen Raum zum Erzählen und Einordnen ihrer subjektiven Erfahrungen. Wie wird eine neue Perspektive eingebracht? Im Laufe von Professionalisierung und Fokussierung auf Evidenzbasiertheit ist das Narrative in den Hintergrund geraten – auch in der psychiatrischen Pflege. Die Forderung nach einer bewussten ‚Narrative Health Care‘ ist eine Ergänzung zur ‚Evidence-based Health Care‘ und bezieht sich auf etablierte Erkenntnisse aus der Narrationsforschung. Was sind die Auswirkungen für die Praxis? Mehr Raum für Erzählungen im pflegerischen Alltag zu schaffen, braucht nicht viel Aufwand und kann dazu beitragen, Menschen gezielter in ihrem Genesungsprozess zu unterstützen und die Reflexion der eigenen Praxis anzuregen.

Diversitat ist in der Fachliteratur gegenwartig das zentrale Konzept, um die Verschiedenheit von Lebensumstanden und Lebenswelten von Menschen zu erfassen, mit denen Fachpersonen bei der Erbringung wohlfahrtstaatlicher Leistungen interagieren. Dieser Beitrag fuhrt begrifflich und konzeptionell ein, was mit Diversitat gemeint ist und wie Versorgung auf verschiedenen Ebenen damit umgeht. Er tut dies aus der Perspektive der Gesundheitsversorgung und anhand von Einblicken in die stationare Langzeitpflege im Alter. Eng verknupft mit Diversitat ist die Frage nach Ungleichheiten und deren komplexen Interdependenzen, wie sie das Intersektionalitats-Konzept thematisiert. Wohlfahrtstaatliche Versorgung strebt danach, Ungleichheiten entgegenzuwirken und Diversitaten angemessen zu berucksichtigen. Chancengleichheit in der Versorgung, Kompetenzforderung bei Klient/-innen und im professionsspezifischen Handeln sind die drei Ebenen, auf denen angesetzt wird, um diversitatssensitiv versorgen zu konnen. Besondere Herausforderungen sind dabei die Personenzentriertheit der Interaktion zwischen Fachperson und Klient/-in, die Vulnerabilitat der Klient/-innen sowie zunehmend die Notwendigkeit transkultureller Kompetenz.

This special issue on migrant dying and death showcases the work of a number of authors exploring a newly emerging field of study within European research and policy contexts. Indeed before the 200...

This paper presents ethnographic data on a migrant-specific nursing home ward in Switzerland. It shows that the structurally pre-defined segregation of residents sharing a common characteristic affects care practices along three dimensions: performances of sameness/otherness, informalisation of relationships and language/understanding. Yet, ‘death work’ showed little difference to non-segregated wards. However, relatives’ practices in dying trajectories were less congruent with nursing home ‘doing death’, and collisions may evolve. The need for negotiations associated with running a segregated ward seems to elicit enhanced institutional reflexivity with potential to increase the ability of institutions to provide diversity-sensitive services to all residents. KEYWORDS: Nursing home, end-of-life care, doing death, migration, diversity, ethnography

This paper examines the notion of familiarity in live-in elder care settings and how it is challenged, changed, and reestablished. Live-in care is a strategy to prevent disruptions and preserve familiarity in enabling older persons in need of extensive care to stay at home – and thus, to enable ageing in place. This paper problematizes this strategy based on interviews with family caregivers who engaged a migrant live-in care worker in Switzerland. The key argument is that live-in care arrangements constitute an all-embracing form of inserting formal, paid-for care service delivery into the informal, private, intimate space of home. The live-in care arrangement not only challenges the familiarity of the home space, but also seems to ask for strategies of adaptation to familiarize the unfamiliar. Therefore, the introduction of live-in care is consequential for all involved parties and requires largely underestimated efforts to adapt to the new home space. Keywords: care migration, familiarity, home, home care, live-in care, long-term care, old-age care, transnational care.

A recurring theme of the public discourse on immigration in Europe today is that migrants are primarily young people, of working age. Against this short-sighted view, the main contribution of this book is to propose that processes of ageing and dying constitute a critical juncture in the settlement of migrant-origin communities, precipitating novel intercultural negotiations in societies characterized by post-migration diversity. Bringing together seven studies reflecting different institutional and (trans)national contexts, the chapters fall under two main themes. A key issue when facing death is the organization of adequate care for the dying, which may be a challenging task in pluralized settings involving both migrant patients and migrant carers. Facing the end of life furthermore involves the practice of rituals in order to make sense of the transition from life to death. Whether through care or ritual, the studies presented here show that the need to reconcile different cultural, religious and administrative norms relating to death is infused with ontological insecurities which may result in new or renewed interrogations of identities and belongings. This book was originally published as a special issue of the Journal of Intercultural Studies.

This article focuses on challenges of transnational aging and family care among „guest -workers‟ from Italy and Spain. It is based on two qualitative studies on aging in migration and experiences of family care. These migrants‟ situations tend to be socioeconomically underprivileged, yet they have the option to either stay in Switzerland or return to Italy or Spain. Our results show that an additional option is available by combining elements of both national systems of reference. However, these options are often costly and have shortcomings which are particularly relevant when ill health conditions demand intensified care. By then, decisions taken within the context of transnational ways of living have farreaching consequences that affect not only the elderly migrants but also their adult children. The empirical data presented in this article illustrate how specific constellations of caring options emerge from the Swiss „guest-worker‟ migration regime and from transnational practices and choices made in earlier years. Keywords: aging migrants, Italians in Switzerland, family care, social security, life course, narrative interviews

Die aktuelle Gesundheitsforderung im Alter spricht eher die Mittelschicht mit gutem Bildungs- und Sozialkapital an. Deshalb werden nun im Rahmen des interkantonalen Projektes «via – Best Practice Gesundheitsforderung im Alter» in Pilotgemeinden spezielle Massnahmen zur besseren Erreichbarkeit von benachteiligten und schwer erreichbaren alteren Menschen ausprobiert und umgesetzt.

This paper focuses on the normative notion of ‘good death’, its practical relevance as a frame of reference for ‘death work’ procedures in institutional elder care in Switzerland and the ways in which it may be challenged within migrant ‘dying trajectories’. In contemporary palliative care, the concept of ‘good death’ focuses on the ideal of an autonomous dying person, cared for under a specialised biomedical authority. Transferred to the nursing home context, characterised by long-term basic care for the very old under conditions of scarce resources, the notion of ‘good death’ is broken down into ready-to-use, pragmatic elements of daily routines. At the same time, nursing homes are increasingly confronted with socially and culturally diversified populations. Based on ethnographic findings, we give insight into current practices of institutional ‘death work’ and tensions arising between contradicting notions of a ‘good death’, by referring to decision-making, life-prolonging measures, notions on food/feeding and the administration of sedative painkillers.

Background ‘Kneipp Therapy’ (KT) is a form of Complementary and Alternative Medicine (CAM) that includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities, and healthy eating. Since 2007, some nursing homes for older adults in Germany began to integrate CAM in the form of KT in care. The study investigated how KT is used in daily routine care and explored the health status of residents and caregivers involved in KT. Methods We performed a cross-sectional pilot study with a mixed methods approach that collected both quantitative and qualitative data in four German nursing homes in 2011. Assessments in the quantitative component included the Quality of Life in Dementia (QUALIDEM), the Short Form 12 Health Survey (SF-12), the Barthel-Index for residents and the Work Ability Index (WAI) and SF-12 for caregivers. The qualitative component addressed the residents’ and caregivers’ subjectively experienced changes after integration of KT. It was conceptualized as an ethnographic rapid appraisal by conducting participant observation and semi-structured interviews in two of the four nursing homes. Results The quantitative component included 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (all female, 42.0 ± 11.7 years). Residents were multimorbid (8 ± 3 diagnoses), and activities of daily living were restricted (Barthel-Index 60.6 ± 24.4). The caregivers’ results indicated good work ability (WAI 37.4 ± 5.1), health related quality of life was superior to the German sample (SF-12 physical CSS 49.2 ± 8.0; mental CSS 54.1 ± 6.6). Among both caregivers and residents, 89% considered KT to be positive for well-being. The qualitative analysis showed that caregivers perceived emotional and functional benefits from more content and calmer residents, a larger variety in basic care practices, and a more self-determined scope of action. Residents reported gains in attention and caring, and recognition of their lay knowledge. Conclusion Residents showed typical characteristics of nursing home inhabitants. Caregivers demonstrated good work ability. Both reported to have benefits from KT. The results provide a good basis for future projects, e.g. controlled studies to evaluate the effects of CAM in nursing homes.

Im Migrationskontext werden verschiedene Fragen im Hinblick auf familiare Pflege im Alter aufgeworfen: Welche Formen nehmen familiare Unterstutzungs- und Pflegearrangements an, wenn Familienmitglieder verstreut in zwei oder mehr Landern wohnen? Welche Vorstellungen und Erwartungen spiegeln sich in den Betreuungs- und Beziehungssettings? Was bedeutet die neue Qualitat von familiaren Beziehungen fur die bisher fast ausschlieslich nationalstaatlich ausgerichteten sozialen Unterstutzungsstrukturen? Der Beitrag geht diesen und weiteren Fragen nach mittels der Analyse von familiaren Arbeitsleistungen des Sorgens („care“) um altere MigrantInnen in grenz- und generationenubergreifenden Konstellationen.

»Ein Leben hier gemacht« haben viele der ehemaligen italienischen »Gastarbeiterinnen« und »Gastarbeiter« in der Schweiz. Sie haben geheiratet, Kinder großgezogen, sind alt geworden, aus der Erwerbstätigkeit ausgeschieden. Was dieses Altern ausmacht, das wird in diesem Buch aus einer biographisch-rekonstruktiven Perspektive erörtert. Die Fallanalysen von sieben Ehepaaren bieten einen differenzierten Einblick in die unterschiedlichen Ausgestaltungen des Lebens in der Schweizer »Gastarbeit« und deren Bedeutung für das Altern in der Migration. Damit leistet die Studie einen Beitrag zu einem bisher wenig beachteten Bereich der Migrationsforschung.

Dans les centres d’hébergement et de soins de longue durée en Suisse, les pratiques actuelles entourant la mort (« faire la mort ») (Soom Ammann et al. 2016) sont fortement influencées par le concept normatif occidental contemporain de la « bonne mort », qui met l’accent sur la détermination de l’individu à mourir dans la dignité, la pleine conscience et l’acceptation (Hart et al. 1998). En même temps, la prise en charge institutionnelle de la vieillesse est confrontée à des changements sociétaux tels que l’augmentation de la diversité parmi les résidents et le personnel soignant et l’admission très tardive de résidents ayant souvent des problèmes de communication liés à leur santé. À partir des données recueillies lors d’une recherche de terrain ethnographique à long terme dans des centres d’hébergement et de soins de longue durée en Suisse, cet article illustre la façon dont les efforts du personnel soignant pour permettre une « bonne mort » ne s’arrêtent pas à la mort biologique du résident, mais s’étendent aux pratiques de préparation du cadavre « joliment ». Exposant deux cas de soins post-mortem, nous décrivons d’abord les pratiques du personnel soignant telles qu’elles sont usuellement mises en oeuvre dans le cas d’une « bonne mort ». Puis, nous recourons à un cas perçu comme une « mauvaise mort » pour discuter des pratiques consistant à rendre une mort « meilleure » rétrospectivement. Nous avançons que — surtout si les proches n’ont pas exprimé de souhaits particuliers concernant les soins post-mortem ou si les pratiques de l’établissement au sujet des soins post-mortem ne sont pas hautement détaillées —, les membres du personnel soignant peuvent disposer d’une certaine latitude d’interprétation pour donner au corps du défunt un aspect qui corresponde également à leur propre conception d’un « cadavre de belle apparence ». Nous avançons que cette pratique est un élément important des stratégies professionnelles des membres du personnel pour faire face à leur expérience répétée de la mort et de la fin de vie dans un centre d’hébergement et de soins de longue durée. Nous concluons que les pratiques de soins post-mortem que nous avons décrites, qui consistent à (re)créer une « bonne mort », devraient être considérées comme faisant partie intégrante de « faire la mort » dans les centres d’hébergement et de soins de longue durée dans une société occidentale contemporaine fortement diversifiée telle que la Suisse., In Swiss nursing homes, current practices of “doing death” (Soom Ammann et al. 2016) are strongly influenced by the contemporary Western normative concept of “good death,” which focusses on a self-determined dying in dignity, awareness and acceptance (Hart et al. 1998). At the same time, institutional old age care is confronted with societal changes such as rising diversities among both residents and caregivers and the very late admission of residents with often health-related communication restrictions. Using data from a long-term ethnographic field research in Swiss nursing homes, the paper illustrates how caregivers’ efforts to enable a “good death” do not end with the biological death of the resident but further extend to practices of preparing the dead body “nicely.” Presenting two cases of post-mortem care, we first describe caregivers’ practices as typically performed in a case of “good death.” Then, we use the case of a perceived “bad death” to discuss practices of making a death “better” retrospectively. We argue that, especially if relatives do not express wishes for after-death care and/or if institutional regulations on post-mortem care are not highly detailed, caregivers may use a certain scope of interpretation to arrange the dead body in a way that also corresponds to their own notions of a “nice-looking dead body.” We argue that doing so is an important element of staff members’ professional strategies to cope with their repeated experiences of death and dying in the nursing home. We conclude that the described post-mortem care practices of (re)constructing a “good death” should be considered as an integral part of the nursing homes’ overall “doing death” in a highly diversified contemporary Western society like Switzerland., En Suiza, en las residencias para ancianos, las actuales prácticas en torno de la muerte («preparar la muerte») (Soom Ammann et al. 2016) están muy influidas por el concepto normativo occidental contemporáneo de «bien morir», según el cual el individuo toma la determinación de fallecer dignamente, con plena consciencia y aceptación (Hart et al. 1998). Al mismo tiempo, la asistencia institucional de la vejez se confronta con cambios sociales como el aumento de la diversidad entre los residentes y el personal asistencial, y la admisión tardía de residentes con problemas de comunicación ligados con su salud. A partir de datos recogidos durante una investigación de campo etnográfica a largo plazo en las residencias para ancianos en Suiza, este artículo ilustra la manera en que los esfuerzos de los proveedores de cuidados destinados a facilitar el «bien morir» no se limitan a la muerte biológica del residente, sino se extienden a las prácticas de preparación del cadáver «adecuadamente». Se exponen dos casos de cuidados post-mortem, para describir primero las prácticas de los proveedores de cuidados tal y como se realizan normalmente en el caso de una «buena muerte». Y recurrimos a un caso percibido como una «mala muerte» para discutir las prácticas que consisten en volver una muerte «mejor» retrospectivamente. Sugerimos que --sobre todo si los parientes no han expresado ningún deseo particular sobre las atenciones post-morten o si los reglamentos de la institución sobre el este sujeto no están muy detallados-- , los miembros del personal sanitario disponen de cierta latitud par dar al cuerpo del difunto un aspecto que corresponde igualmente a sus propias concepciones de un «cadáver con bella apariencia». Sugerimos que esta práctica es un elemento importante de las estrategias profesionales de los miembros del personal para confrontar sus experiencia repetidas de cuidados post-morten que hemos descrito, que consisten en (re)construir una «buena muerte», deberían ser considerados como parte integrante del conjunto de funciones de «preparar la muerte» en las residencias de ancianos en una sociedad occidental contemporánea muy diversificada como es Suiza.