Selbstbestimmung bei Pflegebedürftigkeit: Drei Fallbeispiele zu individuellen und sozialräumlichen Ressourcen älterer Menschen

[Experiences of uncertainty about the future, poverty risks, and precarious living situations in nursing homes]

The living situation of people in nursing homes, with a specific vulnerability to care-related impoverishment, is underresearched. This article deals with experiences of uncertainty, poverty and a precarious life situation of care home residents in later life. The data basis is supplied by an ethnographic study of ageing and living with chronic health conditions. A range of precarious living situations are outlined on the basis of real cases. Insights gleaned include: people with diverse sociobiographical backgrounds can be affected by insecurity, poverty and precarious life situations as a result of becoming dependent on help and the transition to care homes. Not knowing whether available funds will suffice to cover rising costs until the end of life is a common form of uncertainty about the future. The threat of poverty or becoming dependent on state benefits can exacerbate experiences of loss associated with institutional care, losing autonomy, opportunities for participation, and options for shaping one's life and can further destabilize the overall condition. This anguish remains largely invisible; structural problems are individualized.

Navigating care in rural areas: Strategies employed by older adults with continuing care needs and their impact on social exclusion

The literature recognizes the great diversity of care arrangements among rural-dwelling older people. However, little is known about the complex relationships between spatial, social and infrastructural characteristics of place and the strategies that older people develop to navigate care. Even less is known about how navigating care impacts social exclusion from the perspective of older adults themselves. To fill this gap, in this secondary analysis we draw on data from twenty-one in-depth interviews from two studies conducted in rural environments in Germany and Poland. We identify three main strategies of navigating care in the rural environment: adaptation to circumstances, making use of the environment, and shaping circumstances. We present details from four cases that exemplify how strategies are interconnected with characteristics of place. The relationships between place and navigating care in rural environments is discussed with reference to the overall level of social exclusion experienced by rural-dwelling older adults with continuing care needs.

[Assistance, nursing and participation in old age : Future of domestic care in cases of care dependency]

The future development of home care services for older people in need of care is associated with great challenges. This article begins with a brief summary of the most urgent care problems from the perspective of people requiring care and that of caring relatives. The problems exhibit social and spatial inequalities and are characterized by coordination problems within a fragmented organizational system. Calls for a viable "care mix" are nothing new but have recently gained considerable traction under the label of "caring communities". This model is prioritized by the German government and addressed in its Seventh Report on Older People (Altenbericht). It seeks to assign neighbors and unpaid volunteers a more central role in the provision of care and assistance. In relation to "caring communities" a differentiation between cure and care is also proposed. The article discusses this model and the assumptions about the potential of neighborhood and civic engagement upon which it is based, and analyzes its impact on the nursing profession. It concludes with a critical discussion of the model's prospects of contributing to a resolution of the outlined problems.