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  • Perspectives on Care at Home for Older People ed. by Christine Ceci, Kristín Björnsdóttir, Mary Ellen Purkis
  • Rachel Barken
Christine Ceci, Kristín Björnsdóttir, and Mary Ellen Purkis, Eds. Perspectives on Care at Home for Older People. New York: Routledge, 2012

Researchers, practitioners, and many older adults value care in the home for maintaining continuity and well-being in later life. Studies of home care are important substantively for developing practices that best meet the needs of older adults and those caring for them. Theoretically, research on home care provides insight into the complex boundaries between the public world of paid work and the private world of the home, and between contested notions of independence and dependence in later life. Perspectives on Care at Home for Older People provides rich substantive and theoretical insight on the practice, ethics, and logic of care for older adults in home settings.

This book’s aim is to explore (1) the relationship between everyday life and the discourses and material conditions shaping home care, and (2) the ways communities might best be organized to meet the needs of frail older adults. Mol’s (2008) work on the logic of care is a common frame of reference in several chapters, drawing attention to the qualities that make care “good” (including attentiveness to the particularities of the people involved and the contexts in which care is practiced) as well as to the ways dominant discourses of individualism and consumerism might undermine the practice of good care. Qualitative methods, including ethnography and discourse analysis, provide insight on the ways people negotiate knowledge, power, and social relationships in home care.

Perspectives on Care at Home for Older People is divided into three sections. The first, titled “Home”, aims to develop a theoretical framework for the practice of home care. Mary Ellen Purkis, in chapter 1, engages the meaning of community presented in Marilynne Robinson’s novel Gilead (2004) and Giorgio Agamben’s text The Coming Community (1993) to explore how accommodations might enable frail older adults to live in home rather than institutional settings. Making communities more accommodating, Purkis argues, is a key aspect of humane practice. In chapter 2, Joanna Latimer discusses the contested meanings of home and care. She draws on film, literature, and ethnographic description to explore the affective, processual, and relational aspects of care and their capacity to provide frail older adults opportunities for creativity and vitality. These aspects of care, Latimer suggests, are often eclipsed by the emphasis on individualization, autonomy, and choice in health and social services. In chapter 3, Isabel Dyck and Kim England discuss their study of the ways that formalized care reconfigures the home space. Relations of power – among care providers and recipients, but also emanating from policies and regulations – impact the discursive and material construction of the home.

“Care”, the book’s second section, explores the delivery of home care. Drawing on research with case managers, Christine Ceci argues in chapter 4 that management strategies reflect a view of older adults as rationally calculating actors. Here, the logic of choice inhibits good care because it does not consider the relational situations in which older adults experience frailty. In chapter 5, Davina Allen discusses the implications of shifting professional to family responsibility for elder care. Her research finds that nurses and family members hold different understandings of patients’ needs and interests. Theory and policy, Allen suggests, must account for the divergences and intersections among the various professionals and family members involved in care relations. Kristín Björnsdóttir, in chapter 6, examines the implications of flexible organizational structure for home care nursing. Flexibility enables nurses to accommodate individuals’ needs and interests. If nurses’ interests override those of patients, though, flexibility might threaten the provision of good care.

The final section of the book, “Practices”, explores how policies shape the organization of home care services and the relations among care providers and older adults. In chapter 7, Hanne Marlene Dahl discusses how the logic of self-governance in home care policies constructs care recipients as rational, autonomous service consumers who employ home helpers. In the process, helpers’ identities are silenced and the...

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