From the state to the family: reconfiguring the responsibility for long‐term nursing care at home

Abstract

This paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long-term conditions living at home has shifted from public services to the family. Studies of care-givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault's exploration of power, particularly his idea of governmentality, a genealogy of care-giving in the home in Iceland's health-care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well-being of the nation. At the same time the citizen's responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy-making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries.

Hypervisibility: Toward a Conceptualization of LGBTQ Aging

“…Foucault's work has commonly been cited in theoretical and empirical literature across both LGBTQ studies (Brown and Knopp 2014;Hughes 2008) and within the field of aging (Bjornsdottir 2002;Pickard 2014;Pickard 2010). In both queer and gerontological literature, Foucauldian frameworks have often been used to draw attention to the salience of discourse as a source of power with potential to be both emancipatory and marginalizing (Brown and Knopp 2014;Pickard 2014).…”

“…First, one may consider existing literature on the neoliberal governance of aging, whose insights on the marketdriven regulation of age-related dependence provides indirect evidence for the contemporary disciplining of frail adults who may lack access to conventional Bkin-based^care. For instance, Bjornsdottir (2002) illustrates the growing recognition of the normative family, versus state-administered institutional support, as a source of elder care within increasingly Bcost efficient^neoliberal state regimes, which in turn suggests that older adults lacking such support (but nonetheless requiring care) are likely to be monitored and disciplined. In other words, older LGBTQ adults, by virtue of often relying on either community-based or non-familial sources of care in the context of decline (Brotman et al 2003;Finkenauer et al 2012), may be rendered hypervisible as targets of discipline within welfare regimes that marginalize their access to networks of care not based in heterosexual or conventionally gendered relations of kin.…”

Medical versus social work-places: constructing and compensating the personal support worker across health care settings in Ontario, Canada

“…Twigg concludes that medical care has been constructed as 'necessary', where social care is perceived as 'optional'. Others have also documented this medical -social tension, whereby medical care is disproportionately valued and publicly funded, often at the direct expense of social care (Bjornsdottir 2002;Cartier 2003;Evans and Stoddart 1990;Poland et al 1998;Simms 2003).…”

“…Through the entrenchment of the Hospital Insurance and Diagnostic Services Act of 1957, Canadians elected to guard against the potentially catastrophic financial consequences that hospital care could have for individual patients and their families by ensuring that the care of citizens who were ill enough to warrant hospital-based treatment would be considered a collective financial and legal responsibility. Conversely, social care was seen to take place in the community, and involved the stabilization of chronic conditions by nurses, paraprofessionals, and family caregivers (Bjornsdottir 2002;Cartier 2003). Health conditions that could be treated in the home were considered to be less serious, and responsibility for care was therefore private, and individually financed.…”

Appendix 3: Supporting the Caregiver in Heart Failure

“…Previous studies have highlighted the problems the burden of care on family members can cause, including strains put on physical and mental health, finances, and carer family time. 1,[4][5][6][7][8] Due to the nature of heart failure, the patients we see as part of the Glasgow Heart Failure Liaison Service are often elderly with poor mobility and other debilitating comorbidities. Consequently we often involve the family members to varying degrees in the implementation of some aspects of the patient's care.…”