Care of older people in migration contexts: local and transnational arrangements between Peru and Spain

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.

Rethinking care through social reproduction: articulating circuits of migration

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Care workers, care drain, and care chains: reflections on care, migration, and citizenship

In this article, we discuss a case study that deals with the care chain phenomenon and focuses on the question of how Poland and the Ukraine as sending countries and Poland as a receiving country are affected and deal with female migrant domestic workers. We look at the ways in which these women organize care replacement for their families left behind and at those families’ care strategies. As public discourse in both countries is reacting to the feminization of migration in a form that specifically questions the social citizenship obligations of these women, we also look at the media portrayal of the situation of nonmigrating children. Finally, we explore how different aspects of citizenship matter in transnational care work migration movements.

The right of caregivers to access health information of relatives with mental illness

This article reviews the legal, ethical and practical challenges of complying with the Ontario Personal Health Information Protection Act (PHIPA) within the context of a Canadian mental health system that is overburdened and under resourced. The advent of deinstitutionalization has placed significantly increased responsibilities on the families of mentally ill individuals. While research evidences that involving family members in the care of their mentally ill relatives improves treatment outcomes, mental health practitioners constantly face the challenge of engaging family caregivers while also complying with privacy laws. The authors propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives.

Technical revisions to conform to the Caregivers and Veterans Omnibus Health Services Act of 2010. Final rule

This final rule amends Department of Veterans Affairs (VA) medical regulations to incorporate statutory amendments. Certain statutes authorizing VA health care benefits were amended by the Caregivers and Veterans Omnibus Health Services Act of 2010. The statutory amendments affect enrollment in certain health care priority categories and exempt catastrophically disabled veterans from copayment requirements.

Caregivers program. Interim final rule

This document promulgates Department of Veterans Affairs (VA) interim final regulations concerning a new caregiver benefits program provided by VA. This rule implements title I of the Caregivers and Veterans Omnibus Health Services Act of 2010, which was signed into law on May 5, 2010. The purpose of the new caregiver benefits program is to provide certain medical, travel, training, and financial benefits to caregivers of certain veterans and servicemembers who were seriously injured in the line of duty on or after September 11, 2001.

[Effects on carers caring for residents who are limited in their everyday capabilities. A comparison of several measuring points in a pilot study]

According to the section 87b SGB XI (German Social Security Statutes) care worker guidelines, care institutions can employ additional carers for residents who are permanently limited in their everyday capabilities. Studies on the stress experience while caring for the elderly who relate specifically to the additional care givers have, until now, not been available. Previous studies relate to trained nurses. It can be assumed that, if trained nurses already show typical stress reactions, the care givers could be all the more overburdened. For surveying the effects on care givers caring for residents who are limited in their everyday capabilities, an empirical data investigation using the Copenhagen Psychosocial Questionnaire (COPSOQ) was carried out on 30 care givers qualified according to the above mentioned guidelines in nine nursing homes administrated by Curanum AG. Additionally, the study took place in two residential homes of other administrators. As a comparison, 30 nurses were investigated. In the time span from the start of professional conduct until the end of the survey after six months, significant differences in the examined nurses were found only for the item Job Security (p < or = 0.05). In the group of section-87b-carers it was possible to show significant changes in the following items: possibilities for development (p 0.05), influence (p < or = 0.05), social support (p < or = 0.05), feedback (p < or = 0.05) and social-relationship p < or = 0.05). In summary, the psycho-social stress experiences of the section-87b-carers were determined to be considerably worse than those of the professionally qualified nurses, which could be due to the fact that section-87b-carers are less well trained than the professionally qualified nurses after their three years of training. The section-87b-carers continuously look after residents, who are considerably limited in their everyday capabilities, whereas the professionally qualified nurses look after a mixed group of residents. The study thus provides an indication that the use of section-87b-carers--at least from the viewpoint of the people concerned--leads to a tendency of overburdening and therefore, with the current training and accompaniment provided during employment, does not represent a reasonable and sustainable enhancement to everyday life in the nursing residents.

Stratified familialism: the care regime in India through the lens of childcare

This article explores the political and social economy of care in India through a focus on childcare practices, from the viewpoint of the care giver — a perspective frequently ignored or touched on only generally in earlier discussions on development or social policy. It is argued that the care regime is an ad hoc summation of informal, stratified practices. It is shaped by the institutional context, in particular the economic and social inequalities of work and livelihoods, as well as trends and absences in state economic and social policy. Central to the dynamics of care practices in India is the ideology of gendered familialism in public discourse and policy, which reiterates care as a familial and female responsibility and works to devalue and diminish the dimensions of care. By delineating the range of institutions through which everyday childcare practices are organized, this contribution draws out the differentiations and actualities of stratified familialism and care. At one end of the spectrum are those who have the possibility to retain familial carers at home and supplement them with paid and other institutional carers; at the other are those who are neither able to retain family members at home nor fill the care gap through formal institutions.

The politics and power in caregiving for identity: insights for Indian residential school truth and reconciliation

The authors examine the politics of caregiving for identity to enrich scholarship about power. They report on a qualitative study with Aboriginal mothers who parent in the wake of the Canadian Indian residential schools (IRS). Just as this system disrupted familial caregiving to assimilate Aboriginal Peoples, data show some mothers now strive to organize their caregiving in ways that serve decolonization and community empowerment. Building on their expertise, the authors argue that counter-colonial family policy investments to support such caregiving should factor in any just compensation for the IRS system if its population, and not just individual, costs are to be redressed.

"Let us help them to raise their children into good citizens": the Lone-Parent Families Act and the wages of care-giving in Israel

Based on the assumption that the construction of meaning in the process of policy-making is crucial if we wish to understand the gender outcomes of social policy, this article analyzes the parliamentary debates that preceded and accompanied the legislation of the Israeli Mono-Parental Families Act, 1992. It focuses on the enunciation of gender roles and relations in the discourses that framed and justified the Act as well as on how the capacity to establish and maintain autonomous households was constructed and legitimized. Two sets of discourses emerged during the deliberations over the Act, each of which endeavored to interpret the needs, identities, and capacities for action among lone-parent families. The article shows how a specific version of the capacity to establish and maintain autonomous households—that of caregivers who happen to be workers—was privileged in the policy paradigm underlying the Act. The alternative vision—that of workers with caregiving responsibilities—was marginalized and eventually disregarded in the final wording and implementation of the Act. The article concludes with an analysis of the socio-political processes that underlie the prioritization of the version, which was ultimately expressed in the implementation of the Act. It is suggested that a state-level collective identity project shaped by demographic concerns and geo-political factors and changes in the political economy combined to define the needs, identities, and capacities for action of lone-parent families in terms of a model of motherhood in which care-giving trumped paid work.

Partners in care?: views and experiences of carers from a cohort study of the early implementation of the Mental Health (Care & Treatment) (Scotland) Act 2003

Carers are seen as legitimate stakeholders in wider policy processes and increasingly as 'co-producers' and key providers of care. Mental health carers, however, especially those caring for relatives subject to compulsory care and treatment, often feel overlooked and marginalised, caring in complex circumstances with little or no professional support. The Mental Health (Care & Treatment) (Scotland) Act 2003 (MHCT Act) implemented in 2005 aspired to change this for the better. This article focuses specifically on findings from seven focus groups and 10 individual interviews with 33 carers from three Health Board areas and the State Hospital in Scotland. Interviews were conducted at two stages during 2007 and 2008 as part of a wider study. Participating carers were supporting relatives who were under different compulsory measures and so had experience of new procedures under the MHCT Act. The data were gathered as part of a cohort study exploring service users', carers' and professionals' early experiences of the Act's implementation. A topic guide was used to explore the impact of compulsion on carers; the 'Named Person' role; Mental Health Tribunals; the principles underpinning the MHCT Act; and suggestions for improving the law. The study found that new provisions, in particular the Named Person role and Mental Health Tribunals, had resulted in positive change. However, many carers still felt isolated and unsupported. They remained critical of the lack of consultation and involvement at both individual and collective levels. Few were aware of their right to a carer's assessment and many were sceptical that this would make any difference. Acknowledging the study's limitations, we discuss the implications for practice in light of broader policy agendas of personalisation, recovery, recognition for carers and promotion of more community-based mental health services.

Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK

OBJECTIVE

To identify common difficult decisions made by family carers on behalf of people with dementia, and facilitators of and barriers to such decisions, in order to produce information for family carers about overcoming barriers.

DESIGN

Qualitative study to delineate decision areas through focus groups and complexity of decision making in individual interviews.

SETTING

Community settings in London.

PARTICIPANTS

43 family carers of people with dementia in focus groups and 46 carers who had already made such decisions in individual interviews.

RESULTS

Family carers identified five core problematic areas of decision making: accessing dementia related health and social services; care homes; legal-financial matters; non-dementia related health care; and making plans for the person with dementia if the carer became too ill to care for them. They highlighted the difficulties in making proxy decisions, especially against active resistance, and their altered role of patient manager while still a family member. Families devised strategies to gain agreement in order to ensure that the person with dementia retained dignity.

CONCLUSIONS

The following strategies helped with implementation of decisions: introducing change slowly; organising legal changes for the carer as well as the patient; involving a professional to persuade the patient to accept services; and emphasising that services optimised, not impeded, independence. To access services, carers made patients' general practice appointments, accompanied them to the surgery, pointed out symptoms, gained permission to receive confidential information, asked for referral to specialist services, and used professionals' authority to gain patients' agreement. End of life decisions were particularly difficult. They were helped by knowledge of the person with dementia's previous views, clear prognostic information, and family support. Information sheets to help carers to overcome barriers to proxy decision making have been developed; their impact in practice has yet to be evaluated.

Discordance in informed consent response on the basis of demographic factors: brief report

During an outcomes study of spasticity treatment at a developmental center for 62 residents with profound intellectual disabilities, either botulinum toxin A (BTX-A), intrathecal baclofen (ITB), or both were recommended with physical and occupational therapy. Conservators consented to BTX-A more than ITB (p = .021). Court-appointed conservators were more likely to provide consent for treatment than family members (p = .026). Nonparents consented more than parents (p = .009). Finally, Caucasian conservators were more likely to consent to treatment than African American conservators (p = .036), but ethnicity of the resident did not influence consent. Gender of resident or conservator did not influence rate of consent. This report highlights disparities in surrogate consent giving for individuals with intellectual disabilities and indicates a need for more research to ensure that this vulnerable population has access to appropriate treatments.

Incorporating carers' rights in mental health legislation

Mental health laws have traditionally been based on notions of individual rather than collective human rights. This column analyses some of the issues raised by the introduction of legislative provisions promoting the rights of carers. The new Scottish system of "named persons" is outlined, as well as other recent provisions enabling access to information and more involvement in decision-making processes.

Let's help caregivers and children in informal kinship care: de facto custodian legislation

Caregivers in informal kinship care encounter numerous difficulties when lacking a legal relationship with the children in their care. The de facto custodian guardianship, a concept that is relatively unknown in social work, provides an additional legal option to caregivers by allowing them to present their caregiving history during custody hearings. This article introduces the significance of the de facto concept and provides detailed information on its components and limitations. Recommendations are forwarded for social education and practice.

Blurring boundaries, distant companions: non-kin female caregivers for children in colonial India (nineteenth and twentieth centuries)

This paper examines the history of child-care by non-kin, “non-family” members and their representations in colonial India. It focuses primarily on Bengal and relies on several genres of literary documents. Bengal harboured the seat of the British imperial capital in the city of Calcutta until 1911 and its culture was shaped in unique ways compared with other Indian cities. Based on a reading of select literary documents such as European advice manuals and Bengali personal narratives, the paper argues that the relationship between caregivers and children in colonial households attests to the building of new ties and deep ambiguous, multi-dimensional relationships with non-kin members thereby revealing the plasticity of Indian families where sociocultural boundaries were blurred and intimate relationships forged. Beginning with the literary representation of a wet-nurse in Mahasweta Devi's short story Breast-Giver, the paper delves into the world of European and Indian accounts to recuperate the history of the caregivers. It demonstrates that despite the emphasis of recent scholars that the construction of a respectable middle-class identity was based on a sharp distinction from lower social groups, such as working women and prostitutes, the history of child-care by hired domestics reveals the sharing of a common world by different caste-class groups and the interpenetration of the two domains of culture.