Older People’s Day – Including Older LGBT people

It’s Older People’s Day in the UK on 1st October, and it seems timely to flag the particular issues affecting older LGBT people, who are an under-recognised and under-served group of individuals. Yet their numbers are growing. It is estimated that between 5-7½% of the population have a ‘non-heterosexual’ identity. This means there are between 61,000 and 122,000 ‘non-heterosexual people’ over 60 living in the UK today, and this figure is set to rise to between 881,000 and 1,763,000 by 2030. Older LGBT share many of the issues and concerns of all older people, but their ageing can be made more complicated by their sexualities, gender identities and histories (1).

According to a recent UK survey comparing over 1,000 older LGB people and 1,000 older heterosexual people (2), older LGB people are more likely to be single and to live alone, less likely to have children and are less likely to see biological family members on a regular basis.  Older LGB people are also more likely to suffer from the consequences of a lifetime of minority stress (stigma and marginalisation) and as a result are more likely to drink alcohol, take drugs and smoke than older heterosexual people. They are more likely to have a history of mental health problems, and to have current concerns about their mental health, particularly depression. This can be linked to bereavement following the deaths of partners and/or close friends, which often goes unrecognised (3).  Many trans people are also estranged from their families, and continue to be regarded as mentally ill under the psychiatric diagnosis of ‘gender dysphoria’ making them particularly wary of engaging with mental health services (4).

With less intergenerational support than their heterosexual peers, older LGBT are more likely to need formal social care, and at an earlier age, than older heterosexual people. Yet at the same time, the majority of older LGBT people are very worried that health and social care providers will not be able to recognise or meet their needs.  Many feel they would have to hide their identities from care staff and/or fellow service users (the older people are, the more they carried the prejudices of the past, (5)). Many are worried that they will be unwillingly exposed by their own or a loved one’s dementia (6). Many are fearful that they will spend the final years lonely and isolated, estranged from loved ones, in care homes where their lives and identities are either not recognised or not valued and validated (7).

We need to ensure that all older people are recognised and respected for who they are, and that includes older LGBT people. We also need to know much more about the lives, needs and wishes of older LGBT people, and this is where the ‘Minding the Knowledge Gaps’ project comes in. This project is funded by the Economic and Social Research Council (ESRC) and is co-organized by Andrew King (PI), University of Surrey, Kathryn Almack (University of Nottingham), Yiu-Tung Suen (University of Oxford/Chinese University of Hong Kong) and Sue Westwood (Keele University). The project involves a series of six themed seminars followed by a final conference, aimed at exploring gaps in knowledge and research about LGBT ageing, and identifying ways to address those gaps. For more information, go to the ‘Minding the Knowledge Gaps’ project. A further project of interest is ‘The Last Outing’ . Based at the Sue Ryder Centre, Nottingham University, the study is exploring end of life care experiences and concerns of older LGBT people.

Both projects can be followed on Twitter: @LGBTageing and @TheLastOuting.

References

(1)  Ward, R., et al (eds) (2013) Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, London and Philadelphia: Jessica Kingsley.

(2)  Stonewall (2011) Lesbian, Gay Bisexual People in Later Life, London: Stonewall

(3)  Almack, K., et al. (2010) ‘Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders.’ Sociology. 44(5): 908-924.

(4) Fredriksen-Goldsen, K., et al. (2013) ‘Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population.’ The Gerontologist doi: 10.1093/geront/gnt021First published online: March 27, 2013

(5)  Valentine, G. & Macdonald, I. (2004) Understanding Prejudice London: Stonewall

(6)  Price, E. (2012) ‘Gay and lesbian carers: ageing in the shadow of dementia’, Ageing & Society, 32: 516-532.

(7)  Ward, R., et al (2011) Don’t look back? Improving health and social care service delivery for older LGB users, London: Equality and Human Rights Commission.

‘Transnational families, migration and the circulation of care.’

By Loretta Baldassar & Laura Merla

Every day during his lunch break at around 1pm, Alberto, who lives in Perth, Australia, phones his 85 year old father, Angelo, who lives in Rome, Italy. Angelo, who is not in the best of health, is usually sitting at the kitchen table having his morning coffee and bread roll. “It’ll only be 6am in Italy, but Dad will always be waiting for my call,” Alberto explains. Since Alberto’s mother’s sudden and unexpected death a year ago, Alberto, an only child, has tried to manage his father’s increasing care needs from a distance. He took 6 weeks unpaid leave from work to travel to Italy to arrange the funeral for his mother and put in place care supports for his father. Both Alberto and Angelo see aged care facilities as a last resort option; they are expensive and have a social stigma that reflects badly on families. Angelo wishes to remain living in his own home for as long as he can. Moving to Australia is not an option because of Angelo’s failing health; furthermore, aged migration to Australia is costly with prohibitive requirements. Given the aged care regimes in both countries, father and son adopted the commonest solution and hired a domestic worker, Maria, to work from 9 to 5 each day, preparing lunch and dinner, doing the cleaning and shopping and taking Alberto to his medical visits. Maria has agreed to move into the spare room as a live-in carer if Angelo’s health deteriorates. A long-time family friend, Nadia, the daughter of Angelo’s old friend and neighbour, Nello, sets up a Skype every Sunday when she visits her father (who lives next door). Alberto feels this is the best way to “get a thorough update”.

Every Saturday and Sunday, at around 6am, Maria phones her 10 year old son, Diego, in the Dominican Republic. She arrived in Rome a year ago on a tourist visa. Maria planned to find work as a domestic and raise enough money to bring Diego to Italy. In the meantime, Diego lives with his grandmother Lucia, Maria’s mother. Twelve people currently live in Lucia’s crowded house, including her frail partner Arturo, two of Maria’s brothers, their partners and children, and Maria’s sister Anna’s three children. Anna is a domestic employee in the US. Maria and Anna call Lucia a few times a week to talk with and discuss their children, exchange support with their mother, and talk to other family members present at the time of their call. The two sisters are also in regular contact with their oldest sister, Teresa, who lives in Belgium with her Spanish husband and their three children, and the three women send monthly remittances to their mother. In spite of the distance, Teresa plays a central role in her extended family, and is considered by all as the head of the household that is stretched across thousands of kilometres and several countries. Teresa checks with her brothers and sisters-in-law that Arturo, who suffers from diabetes and has lost his sight, takes his medicines and eats properly, and sends emergency remittances when a specific need arises. She visits her family every year, and during these visits she works with her brothers on the renovation of the family house.

These case studies highlight the way family members from different socio-economic and cultural backgrounds care for each other through a process of asymmetrical reciprocal exchange, across and despite the distance that separates them, and the way that care circulates between them. The idea that care circulates within transnational family networks is indeed central our edited book entitled ‘Transnational families, migration and the circulation of care : understanding mobility and absence in family life’ (Routledge).

With increased mobility and improvements in both travel and communication technologies, more and more people are experiencing transnational family lives. The chapters that make up this volume cover a rich array of case studies including analyses of the inequalities between transnational families who circulate care between developing nations in Africa, Latin America and Asia to wealthier nations in North America, Europe and Australia. There are also examples of intra- and extra- European, Australian and North American migration and care circulation, which involve the mobility of both the unskilled and working class as well as the skilled middle and aspirational classes.

Whether pushed or pulled out of homelands in search of safe asylum, better economic futures or improved lifestyles, increasing numbers of people are separated from their family by distance and national borders. Those family members who ‘stay behind’ or ‘stay put’ (as it were) in their place of birth or ancestral homeland, also become part of social relationships stretched across time and place, even though they might never actually relocate or even move at all. We believe a focus on the disparate trajectories of care circulation helps us to better understand mobility and absence in family life, so that we might theorise transnational families as contemporary family forms in their own right. This book highlights, in particular, how the sense of belonging in transnational families is sustained by the reciprocal, though uneven, exchange of caregiving, in the form of financial, emotional and practical support, ‘hands on’ care as well as accommodation. By doing so, this volume challenges narrow definitions of care to consider the portability of care, a fundamental topic for our contemporary lives.

Sources:

Baldassar L. & Merla L. (Eds) (2013) Transnational Families, Migration and the Circulation of Care: Understanding mobility and absence in family life. Routledge, Transnationalism Series

Baldassar L., Kilkey M., Merla L. and Wilding R. (Forthcoming) ‘Transnational Families’. Revised Wiley-Blackwell Companion to the Sociology of Families.

c/o Professor Loretta Baldassar

Anthropology and Sociology
The University of Western Australia (M255)
35 Stirling Highway
CRAWLEY WA 6009
Australia

WeAreOne by Ambreena Manji

Who Cares?

And behind me I hear the footfalls of countless generations and ancestors. And around me the living community of my people, whose woes are my woes; whose moments of joy are mine.

Kofi Awoonor, Ghanaian poet murdered at Westgate, Nairobi on 21st September 2013

On 19th September 2013, at the Annual Lecture of the British Institute in Eastern Africa in Nairobi, Dr Ann Stewart delivered a lecture entitled ‘Caring about care: Recognising and regulating body work in a global market’. Based on her recently published book, Ann gave a compelling and wide ranging talk about forms of care and asked the question ‘who do we care about and how’? The discussions that followed the lecture were vibrant and engaged, the sorts of critical conversations about labour and about gender that I had hoped would come about in my time at the Institute.

On 21st September, at lunchtime, a terrorist siege began of an upmarket shopping mall in Nairobi, Westgate, a mile or two from the Institute. Everyone reading this will have seen the terrifying images. For well-off Kenyans who have become used to hearing the occasional distant grenade explode in the east of the city, in a crowded church or bar or bus station, the events mark a sea change. Here Kenya’s wealthy elite and the international community are the target and terror is at the heart of our lives. I’ve heard it said countless times this week that, looking at photographs of the attack taken in the mall, many of us recognised shop fronts, escalators, sweet stalls, even marble tiles on which we have trodden. As elsewhere, the mall is at once a response to, and a perpetuation of, a city segregated between the wealthy and the destitute. Reborn each day, sparkling clean, its shelves restocked with international branded goods, the Nairobi mall succeeds in making invisible the messy reality of life in a third world city. It would be deeply dishonest to deny that those who clean the mall, serve its meals, guard it – in short, those who provide us with our accustomed care and comfort – go unseen, unknown, unheeded.

Yet in the past three days we have heard stories of supermarket staff, faced with terrified customers running into the shop when the grenades and gunfire began, shepherding people into store rooms, barricading them in to conceal them from the attackers, hiding them behind boxes in stock rooms. Despite our own bleak assessment of ourselves as deeply divided along ethnic lines, as a society riven by long running racial divisions, in the terrifying and traumatic siege of Westgate mall many have commented on the intersecting unities we have discovered this week. An elderly Indian lady, recently returned home from England to care for her elderly mother in Nairobi, and desperate to do something to help, went down to the perimeters of the mall to serve tea and food to the police and media who have worked without a break for days. There she met an African woman who for many years has come to the mall everyday to sell tea and food to its cleaners, waitresses, guards. For the past three days, these two women have teamed up to cook and bring food to those working outside, plastic bags on the ground, car boot full of supplies wide open and elderly mother, still needing to be cared for, in the front seat watching them work.

But the events of the past three days have also made visible that which the well-off and the comfortable work so very hard not to see. The private security guard paid the minimum wage carried our children to safety through a pool of blood; the waitress whom we never greeted in three years of coffee drinking hid us in the cafe kitchen; the cleaner whom we never knew of ushered us to safety through a back exit.

This past three days, Ann’s question at the BIEA lecture – who do we care about – has been constantly in my mind. And as we slip back into our mutual distrust and distance, perhaps we might remember to ask, who cares about (and for) us?

Ambreena Manji

http://www.biea.ac.uk/director-professor-ambreena-manji/

 

 

Faith, religion, spirituality and care

Regrettably, I am still a reader of the Daily Mail online. Whilst often infuriating, it does occasionally have its good points. Recently, an article on a new book about ‘mind over body’ – ‘The cancer patient cured by a broken radiotherapy machine and the paralysed man who walked again after visiting Lourdes: New book shows incredible influence of the mind over the body’ reminded me of Louise Hay’s excellent ‘You Can Heal Your Life.’ Hay considers the psychological/emotional/spiritual meanings and connections of physical illness, and offers those dimensions as spaces to support healing. All of this, in turn, got me thinking about faith, religion and spirituality as sites of care practices, sources and resources of care, and, then, their relationship(s) with care ethics. I realised that we have not as yet tapped this seam in our critique of care, and so wanted to raise this as a topic, perhaps for further discussion/contributions. Here is a brief bibliography to help get us started:

Care to comment/ discuss?

 

A Darker Side to Care..?

It’s been great to read the diverse blogs on this site and the definite slant given by commentaries on issues of identity and sexuality to the challenge of revaluing care. Some time ago I attended a meeting with some of the other members of this network where we raised the question of what is ‘queer care’. And more specifically, how could we go about finding out how it was practised and what it meant to people? We were interested in the lived realities of care for LGBT people but also whether queer theory could offer a framework for making sense of this experience.
Of the still very limited research on care in the context of LGBT ageing there is every indication that helping relationships are organised rather differently to traditional binary notions of the care-giver and care-receiver. For instance, Ann Cronin and Andy King’s work suggests interdependence over dependence in lesbian and gay relationships.  Research with the trans community by Sally Hines also points to support clusters and collective ways of helping people rather than dyadic carer/caree encounters. While Margrit Shildrick and Janet Price’s joint work on intercorporeality and their notion of ‘two bodies becoming together…’ sheds a very different light on how we think about the body itself and its potential in helping situations. However, the closeness and intimacy signalled by these accounts stand in contrast to findings regarding care for older LGBT people of the more formal/paid variety.
Here, care is an uneasy term, and comes with baggage. This is why it has been all but bracketed off in critical disability studies, with the intention that this may lead to more novel ways of thinking about the helping relationships that evolve between people. Perhaps then a queer approach could also usefully begin by treating care with caution –  after all there’s no saying that ‘revaluing care’ might not lead us to decide it is a less useful term for future understandings of helping relationships rather than necessarily investing it with new worth. Many LGBT people’s experiences invite such a possibility because so much of what is badged as care can be experienced as very negative and damaging. This can range from the wholesale neglect of the individual supposed to be ‘in care’ to a diverse range of sometimes more subtle indicators of disapproval, disgust or rejection communicated verbally, behaviourally, emotionally, viscerally etc. and all of which are enfolded within care practices. To date, these experiences are not well documented, partly because LGBT people in the ‘Fourth Age’ are largely invisible and ignored by mainstream gerontology, as Ann Cronin has pointed out, and often are too concerned for their safety to identify themselves in the context of relying upon care services. Do the assumptions that underpin how we currently think and talk about care serve to perpetuate the cultural silence about this darker side?
Taken collectively, research to date tells us that many LGBT people are afraid of a time when they might require care. Findings in the UK and US have uncovered significant numbers who would rather take their life than be admitted to a care home and many more who report a fear of care that involves body work and the prospect of being exposed to and handled by a care worker (although much of this research has been conducted with fit and independent people being asked to anticipate the need for care rather than describe the experience of it). Ironically, older LGBT people are more likely to require formal care by virtue of being less likely to have children and more likely to live alone, but evidence suggests many delay or refuse altogether the uptake of services due to anticipation of negative treatment and its impact upon their lives. At the very least then, formal care has a serious reputation problem in certain quarters. But research with older LGBT people also suggests it has a dark side – one that is perhaps most visible from certain (queer) standpoints. In our efforts to debate and revalue care maybe we should begin with the perspectives of those who have a close-up on the under-side of care and its darker recesses. And perhaps the place to start in ‘queering’ care is to dispense with the term altogether in an effort to find alternative ways of capturing helping relationships and reconfiguring the terrain of help and support in later life in ways that might feel more acceptable to minoritised groups…?

‘Older carers: invisible but invaluable’ by Antony Smith

  • There are 2.8 million people aged 50 and over providing unpaid care in the UK, including 5% of people aged 85 and over.
  • A quarter of all carers aged 75 and over provide 50 or more hours of informal care each week.
  • Carers save the UK economy an estimated £87 billion a year.

At Age UK we hear from many people in later life who are caring for a spouse, partner, relative or friend. Although many find caring rewarding and an expression of their relationship, carers also tell us that they feel invisible and undervalued. Many are stressed and exhausted. Here is an excerpt from one of those personal stories.

Jenny and James

“James and myself were both looking forward to spending our retirement together, but four months after I retired, James became ill and was diagnosed with memory loss caused by depression. Five months later he became ill again, almost overnight, and was hospitalised. He was 71.

“Eventually I was told, because James had Lewy Body dementia, I’d never be able to look after him and that he had to go into residential care. With a nursing background, I thought I could care for James at our home and believed this would be better for his mental wellbeing, but no one listened.

“Once a social worker was assigned to our case, he said he would try and enable a care package where James could live at home with me. However once our financial assessment was done, and we weren’t eligible for funding support, we were left to get on with things ourselves. I set about arranging a care package, but it was a complicated task to do with no guidance. Luckily, I’m able to use the internet, but I dread to think how I would have sorted anything without it.

“After nearly three months in hospital, James finally came home in Feb 2011.

“Being a carer is exhausting – from the moment James wakes up he needs help with everything from moving and getting dressed to washing and going to the toilet. When I don’t have night cover I’m up about four times a night and can’t sleep during the day as James needs someone with him all the time. Because we hired support workers independently we have the same ones nearly every time. I think that’s really beneficial to James, as changing faces can be particularly disorientating for someone with dementia and they perform very personal tasks.

“I take James to a day centre twice a week and this is welcome relief for me. Unfortunately we’ve just been informed that because of local authority funding cuts the centre will close next year. There are about 20 of us who use the centre, and James really enjoys his time there.

“Every six weeks I also put James in respite care for a week, to give me a complete break. Unfortunately on his most recent trip when I went to collect him he had no shoes on, his glasses were missing and he was wearing someone else’s clothes. I could tell he was frightened and he had bruises on his body. When I got him home I discovered he’d lost 8lbs in seven days. I’ve made a formal complaint and am waiting to discover the outcome, but things like that shouldn’t be acceptable and obviously I haven’t felt like I could put him in that respite home since.

“I feel I have managed to come to terms with my feelings of loss and bereavement concerning James, which were overwhelming at the start, and I just have to get on with things. I try not to think about the future. James is getting weaker, and I’m getting older so I don’t know how long I’ll be able to manage and I don’t know what will happen when our money runs out.”

Age UK Is calling for more support for older carers – from government, local authorities and health professionals – such as a Carer’s Allowance for pensioners, a choice of appropriate services and regular carers’ health checks. You can find out more about our work to highlight the support older carers need, as well as the recognition they richly deserve, on Age UK’s website.

Antony Smith is Development Officer for Equalities and Human Rights at Age UK Antony.Smith@ageuk.org.uk

Older lesbians in residential and nursing care

A central feature of care in the fourth age is the medicalisation of ageing bodies, the emphasis on collective bodily care and the power dynamics involved in that care1. An aspect of these dynamics that has not yet been explored is the intersection of age, gender and sexuality in the provision of personal care in residential settings for older people. Single, childless, older women are most likely to populate these settings2. These women are also more likely to be lesbians, both because older lesbians and gay men are earlier and disproportionate users of formal social care, and because older lesbians are more likely than older heterosexual women to be single and childless3. Lesbians have often found the processes of self-disclosure in health contexts a treacherous terrain to navigate in earlier life, many avoiding screening/treatment and/or choosing not to disclose their sexual identities to medical professionals, particularly during intimate physical examinations4. Some younger(er) lesbians also report feeling vulnerable to the heteronormative gaze in those gay commercial contexts frequented by heterosexual women5.

Residential care for older people – heteronormative at best, homophobic at worst6, is situated at the intersection between these two sites of vulnerability. It is also a site of social exclusion where ageing bodies are hidden away and where dependency can mean it is less likely someone will complain about their care or otherwise assert their rights, especially people from minority communities7.

Care spaces in the home or in sheltered accommodation or residential care have long been recognised as complicating the notion of the public-private divide, being both public work spaces and private home spaces. For an older lesbian this becomes even more complicated. Home care which goes public no longer affords the sanctuary of private identity performance and management. Yet at the same time, because it is home care, often in care spaces where the very old older person is hidden away from the public eye, some of the legal protections which she might have been able to mobilise for herself also do not apply, when the disciplinary norms of social relationships dominate. In this way an older lesbian can be disadvantaged in multiple ways by a home that has gone public and a public space that operates on private, heteronormative, lines.

(1)  Twigg, Julia. (2004) ‘The body, gender, and age: Feminist insights in social gerontology.’ Journal of Aging Studies 1891): 59-73.

(2)  Arber, Sara (2006) ‘Gender and Later Life: Change, Choice and Constraints’. In J. Vincent, C. Phillipson and M. Downs (eds) The Futures of Old Age, pp. 54-61, London: Sage.

(3)  Heaphy, Brian Yip, Andrew and Thompson, Debbie (2004) ‘Ageing In A Non-Heterosexual Context’, Ageing & Society, 24(6): 881-902; Stonewall (2011) Lesbian, Gay Bisexual People in Later Life, London: Stonewall.

(4)  Hunt, Ruth, and Julie Fish. “Prescription for Change: Lesbian and bisexual women’s health check 2008.” Stonewall and De Montford University (2008).

(5)  Casey, Mark (2004) ‘ De-dyking Queer Space(s): Heterosexual Female Visibility in Gay and Lesbian Spaces’, Sexualities, 7(4): 446-461

(6)  Ward, Richard, Pugh, Stephen and Price, Elizabeth (2011) Don’t look back? Improving health and social care service delivery for older LGB users, London: Equality and Human Rights Commission.

(7)  Aronson, Jane and Neysmith, Sheila M. (2001) ‘Manufacturing Social Exclusion in the Home Care Market’, Canadian Public Policy – Analyse De Politiques, 27(2): 154-165

‘Defining and exploring “care practices”‘ by Kathryn Almack

With my colleague Andrew King (University of Surrey), I’m starting work on a paper which aims to explore informal care practices within the lives of older lesbian, gay and bisexual (LGB) people. This will problematize the framing of ‘informal care’ within policy that most often assumes that these forms of care take place either within assumed heteronormative familial relationships and/or within a dyadic relationship, with one person the ‘carer’ and one the ‘cared for’. We are drawing on ‘case stories’ which we’ve developed from our research with older LGB respondents, selected to represent wider issues within LGB communities and illustrative of a range of care practices, including care provided by friends and strangers, reciprocal care and other expressions of care within LGB communities. We anticipate our paper will also contribute to wider debates about the increasingly diverse range of family forms and social relationships that are not easy to name or recognize.

In developing this paper, we are also searching for our theoretical framework within which to situate this; the thoughts on this below are my own, although it will be something that I work on in collaboration and further feedback from members of the networks are welcome.

I’m leaning towards defining and exploring ‘care practices’ –  akin to Morgan’s (1999, 2011) concept of family practices – as a way to investigate and interrogate care and caring relationship and practices and in particular, unpack the meanings of such practices – emotional, relational, moral, and symbolic. The concept of family practices seeks to shifts the focus towards what families do rather than a focus on family structures; but nevertheless also recognising that at everyday levels the ‘family’ is still a term used by individuals to describe their most meaningful relationships. Morgan suggests that this perspective offers the possibility to see the family as ‘less of a noun and more of an adjective or, possibly, a verb’ (1999:16).

Care practices could encompass a whole range of practices that bind people together, that may include conflicts, tensions and ambivalence as well as affection and love. Thus addressing some of the complexities of care – interdependence, reciprocity, conflicts (workings of power/imbalance), resources, identities, moral deliberations, emotions, labour, working across time and space, involving networks as well as individuals and dyadic relationships.

There are of course other ways of theorising care, including carescapes and an ethics of care framework. Carescapes (Mckie et al 2002) seeks to add a dimension to thinking about care across time and space – the concept developed out of concerns focused on the changing yet gendered nature of caring for children and time-space relations implicit in combining caring and working and shifting roles as children grow (but that may have wider application to other relationships of care):

Mapping routes through the shifting and changing multi-dimensional terrain that comprises their vision of caring possibilities and obligations: routes that are influenced by everyday scheduling and by combining caring work through paid work and the paid work of carers (McKie et al 2002: 904)

And of course, an ethics of care framework has been developed and drawn upon to theorise values of care (key references include Tronto, 1993 and more recently Barnes, 2012) – involving both thought and action and placing value on notions of responsibilities of providing good care; valuing connectedness, incorporating values of dignity and respect. It seems to suggest and encompass a moral framework – though not prescriptive – about the delivery of care and how it is delivered. Is that distinct from or similar to the meanings ascribed to relationships through the doing of care?

I’m left with questions that I don’t yet have answers to. Are there overlaps between the three – care practices, carescapes and ethics of care? Is it that they have developed within different spheres and that they do say the same things in different ways or do they offer distinct contributions to debates on care?  All thoughts and ideas most welcome in taking these reflections forward.

 

Name, address, contact details.

Dr Kathryn Almack

Senior Research Fellow

B Floor, QMC

School of Health Sciences

University of Nottingham

Nottingham

NG7 2HA

 

Tel: +44 (0)115 8231204

Email: k.almack@nottingham.ac.uk

 

References:

Barnes, M. (2012) Care in Everyday Life: an ethic of care in practice. Bristol: Policy Press

McKie, L., Gregory, S. and Bowlby, S. (2002) Shadow Times: The temporal and spatial frameworks and experiences of caring and working. Sociology, 36,4:  897-924

Morgan, D. H. J. (1999) “Risk and family practices ” in Silva, Elisabeth B. and Smart, Carol (Eds.) The New Family? London: Sage Publications, pp. 13-30

Morgan, D. H.J. (2011) Rethinking Family Practices. London: Palgrave Macmillan

Tronto, J. (1993) Moral Boundaries: a political argument for an ethic of care. London: Routledge

Care in the first two years of life: OXPIP and the emerging discipline of parent-infant psychotherapy

By Adrian Sell, Executive Director, OXPIP: The Oxford Parent Infant Project

OXPIP is one of the organisations pioneering parent-infant psychotherapy. Founded in 1998 we have been working in Oxfordshire to provide support to parents who are struggling to form a secure attachment to their baby. In the last three years we have worked with over 900 families and consistently improved mental health and the quality of the parent-infant relationship[1]. We work with babies up to the age of two and their parents, normally the mother but we have worked with many fathers as well.

Parent-infant psychotherapy is distinguished by the attention it brings to the mother’s mental health, the baby’s mental health and, crucially, to the quality of the relationship between parent and baby. This focus on the quality of the care that comes from this early experience is critical to our success in addressing intergenerational cycles of disadvantage. We all have a tendency to default to parenting our children as we were parented, even if those relationships were withdrawn, unpredictable or harmful.

Our clinicians are skilled at enabling parents to build and sustain closer relationships with their children. One of the therapeutic tools for achieving this is through modelling thoughtful, empathic ways of relating within the therapeutic relationship. For some of the parents we work with this is the first time they have really experienced being thought about and related to in this way; it can be a powerful tool for change, opening up new possibilities for how they in turn can relate to their babies.

Our team of psychotherapists come from a range of backgrounds including Child Psychotherapy, Adult Psychotherapy and Clinical Psychology as well as including prior qualifications in Health Visiting, Nursing, Midwifery, Social Work and Teaching. All have undergone Infant Observation training, and are trained in the use of video through the (NICE approved) Video Interaction Guidance approach. This mix of backgrounds and approaches gives our work a strength and rigour that forces us to constantly challenge our own preconceptions and viewpoints.

We are part of a growing national movement of people and organisations who are bringing greater focus to the first years of life. Our Executive Director, Adrian Sell is a trustee of PIP-UK a new national charity seeking to support similar services to develop elsewhere. We have backing from Impetus – The Private Equity Foundation where we are one of twenty-five organisations they see as critical social game-changers supporting disadvantaged children to develop to their full potential. We are a member of the Centre for Social Justice Alliance where we are recognised for our effectiveness in tackling the root causes of poverty and disadvantage. We are supporters of the All Party Parliamentary Group for Conception to Age 2 – the first 1001 days

We all instinctively know that the first few years of our life are formative. There is also considerable neuroscientific evidence that has emerged to support this. OXPIP are now at the forefront of developing an evidence base for the positive impact that parent-infant psychotherapy can have. If you want to find out more then please look at our website, get in touch or leave a comment below.

OXPIP: The Oxford Parent Infant Project
Suite J
The Kidlington Centre
Kidlington
OX5 2DL
T: 01865 371080 or 01865 778034
info@oxpip.org.uk
www.oxpip.org.uk

 

Wanting to Participate? Findings from a Study in New York’s HIV Clinics

ReValuing Care contributor Bob Hudson recently wrote about the potential of neighborhood support groups to foster community caregiving. I would like to build upon this by offering a description of findings from an ethnographic project by the New York State Department of Health AIDS Institute conducted between 2010-2011.  In this study, 45 patients and many of their providers from three HIV-specialty healthcare centers were  asked about what “quality care” meant for them.  Patients were interviewed multiple times over a 12 month period, and they were also accompanied through primary care visits to understand how service delivery processes shaped their views.

Findings from the study built on the notion of participation in unexpected ways and included the following key ideas:

1)    Patients used familiar language to talk about “quality,” but adapted such vocabulary in unique, creative, and personal ways based on their healthcare experiences.

2)    They expressed understanding the ‘behind the scenes’ factors affecting healthcare, such as cost and staffing issues.  Patients also framed quality care as activities that they were able to carry out on behalf of the healthcare organization and the work of its staff alongside these factors.

3)    Participation was not only described, but also enacted at the clinic’s service delivery level.  Patients participated in the daily running of the clinic in a variety of ways. A few common forms included taking on administrative responsibilities, providing emotional support, and offering feedback.  Participation was positive and negative, active and passive, solicited and unsolicited. All types impacted delivery goals.

Our research shows that some healthcare consumers have strong ideas about what they want in their care, and they are willing to ‘co-produce’ services to improve the likelihood of successful and satisfying healthcare.  In so doing, they go beyond weighing in through satisfaction surveys to offer hands-on involvement.  Healthcare designers who recognize and harness such tendencies may lower costs, improve management efficiencies, foster positive relationships, and influence health outcomes.  Insights are useful in chronic health management contexts, but there are applications for short term care as well as in other public sector arenas.  The challenge is to build such systems in equitable, inclusive, and respectful ways that does not dictate participation, but offers conditions for it to flourish.

If you would like more information about the study, please contact me at abigail.baimlance@gmail.com.