Old age, care, and power. : Elderly people's situation, and care relations in neoliberal times

This dissertation examines the status of old age and the nature of elderly care in Sweden, where the welfare state is being transformed through neoliberalism. The overall aim is to study old age as identity and lived experience, and how caring relationships condition the lives of the elderly. The dissertation’s empirical base consists of an ethnographic field study carried out in Gothenburg, Sweden, during the years 2014-2017. In total eighteen women and five men between the ages of sixty and ninety-five participated in the study. Fourteen of the informants are primarily care users and nine of them are informal caregivers. Here elderly care is understood as a broad practice that includes both formal care performed by professional staff, and informal care performed by relatives. The approach is grounded in phenomenology, which centers on personal and bodily experience, and individual interpretations of lived situations. Methodologically the study is informed by Marxist-inspired feminist standpoint theory, where the analysis of the personal and the individual are seen as relating to common conditions. This dissertation combines care research within disability and feminist studies, thereby contributing to a power-conscious analysis in which the complexity of care emerges. Old people are socially constructed as deserving welfare subjects through their merits as working citizens. However, in the realm of actual welfare services this group is very much affected by contemporary neoliberal austerity policies. On the basis of the empirical material this dissertation argues that this dissonance risks creating antagonistic conflicts between different subordinate groups where age, generation, gender, racialization and class become demarcation lines. Another conclusion is that neoliberal governance of the formal organization of elderly care redirects care work to users, and highlights freedom of choice as a goal, while at the same time undermining real opportunities for users’ agency and societal participation. In Home Help Services users’ routines are reshaped according to the planning and work schedules of the organization. An expression of this is how waiting characterizes the everyday lives of users. Waiting means that users are being exposed as one person in a queue of people who need help, but also that they are exposed to their care needs.The material shows that waiting for help can lead to increased impairments but also create new ones. Through the use of assistive- and medical technology these disabling effects are rectified. In this way users’ body time is disciplined and redirected according to the neoliberal clock time of the Home Help Service organization. The study shows how the re-domestication of care, that has followed in the wake of neoliberal austerity, affects old people in an extensive way. Informal caregivers talk about a day to day situation where they need to be on constant stand by, ready to assist. These informants have tried to extend care relationships around their loved ones by arranging needs assessments, but without receiving the assistance they need. The municipally-run family care centers, that all of these informants attend, offer them recognition and to some extent help with the administration of their care work. This study suggests that family support attends to the symptoms of this problem, instead of addressing its root causes. Indeed, there is reason to ask whether the increased recognition and current forms of redistribution concerning relatives that provide care—where family support centers play a significant role—risks legitimizing the re-domestication of elderly care, rather than contributing to more equal and fair care relations