Care needs of older migrants: What are older migrants expectations - - PowerPoint PPT Presentation

Care needs of older migrants:

What are older migrants’ expectations and experiences of the welfare state and how do they meet their care needs? Lessons from Norway

Katrine Mellingen Bjerke University of Bergen

Research questions

• How do older migrants from Poland and Pakistan

address their care and assistance needs?

• What are their attitudes towards and experiences
• f receiving public care in Norway?
• How does the dialectics between a culture of

familism in country of origin on one hand, and an emphasis on extensive public responsibility in Norway, on the other hand, influence the care practices developed amongst older migrants in Norway?

Background

• Ageing of the population, an increasing

number of migrants facing old age in Norway

• Increased emphasis on differentiation of the

elderly care services according to age, gender, social status, degree of assistance needs, sexuality and ethnic bakground

Theoretical perspectives

Theories of transnationalism and culture

• Focus on a development of a cultural syncretism, where

migrants combine values from their country of origin and country of destination / settlement in different ways

• Emphasis on how cultural values and practices are combined,

and informs migrants’ attitudes towards and experiences of elderly care An intersectional perspective

• The intersectionality perspective informs my approach as I

explore how gender, age, degree of frailty, ethnic background and resources (education, bureaucratic competence, availability of family members etc) influences older migrants’ ways of adressing their assistance needs both formally (within the welfare state) and informally (within the family or network)

The institutional context

• Scandinavian/social democratic welfare regime (Esping-

Andersen årstall)

• Universal provision of welfare to those in need (needs

tested, not means tested)

• The national health plan for Norway states that services of

high quality should reach out to everyone regardless of their financial situation, social status, age, gender or ethnic background.

• Among the Norwegian elderly there is an increasing

preference for public elderly care rather than the reliance

• n family members
• Dominant media discourses emphasize negative aspects

such as low family solidarity, and inadequacies of public services

Elderly care

• Institutional care services- only for the very
• ld and frail
• Home based care services
• A home nurse comes to one’s house to give

medical assistance (insulin injection, distribution of medicine, changing bandages, etc.) Or

• A home helper comes to one’s house to help with

cleaning, grocery shopping, etc)

Elderly care services

• Undergone processes of increased

bureaucratisation, taylorisation and user differentiation

• These processes have paved the way for

commercial providers

• free user’s choice introduced (Oslo and Bergen)
• A new view of the service recipients as active citizen

consumers (rather than patients or clients)

• A presumption that care recipients have the resources

to exert influence on their own care

The study

Initial study design

• Biographical interviews with 6

people from each gender in each national group who were users of or had experiences with any form of home based care service

• Within these group the plan

was to achieve a certain distribution when it comes to resources, family networks, age and help needs

• Ethnographic observation in a

selection of the interviewees’ homes to observe their daily lives and encounters with care providers

My current empirical data 20 interviews:

• 8 pakistani men
• 3 pakistani women
• 6 polish women
• 3 polish men
• Only a few of them had care

needs, and only two received help from public elderly care

• Ethnographic observation in

public arenas such as the polish church, ethnic communities for the elderly and the mosque

Total 50-66 67+ Women 67+ Men 67+ Pakistani 17,028 3,932 726 278 448 Polish 49,309 5,543 506 303 203

Cultural background

Polish

• tradition of familism and communism (which has

led to considerable scepticism towards public institutions

• Pre 1989 intergenerational living common due

to scarcity of dwellings Pakistanis

• Intergenerational living and family care is the

ideal care arrangement

• Norms of reciprocity

Case presentation

• I shall now present to you some empirical data

from my study

• This is mostly information about different cases,

and I have tried to keep the interpretations in abeyance After the presentation I would like your opinion on:

1) How to make sense of this 2) What are the experiences with elderly migrants in Britain?

General attitudes towards receiving care by the public

Pakistani

«I have lived my life according to Allah so hopefully my health will be good and I won`t need» (Tariq 72, manual worker and and teacher`s assistant, very religious) «It`s like I want to say that the system here in Norway is fantastic the social system for those who need it but to take advantage of the system I am against that» (Fehrooz 69, postalworker) «I would use it I am open to it the children have their responsbilities and since the western way of living is in the way that we can`t decide much or right when it comes to

• ur children they have to work out their own

lives their own children so we can`t demand

• r force them to care for us so that`s fine

with me and I think my wife agrees»

Polish «You shouldn`t ask us what we need and get, rather what we contribute with» (Piotr, 67, engineer) «I would be good to know what is available just in case something happens» (Justyna 67, engineer)

General interpretations

• Pakistanis
• Association with haram?
• Breach of the norm of

reciprocity?

• Fear of being labelled as

a welfare parasite?

• Polish
• Fear of being labelled as

a welfare parasite?

• Desire for knowledge

about how the system works?

Older migrants in Norway

How do they cover their needs?

Ashwariya (65)

• Came to Norway in 1976, family reunification
• Worked in a family business but had to quit due to care

responsibilities for mother with dementia, received care wage at the time

• Describes this as an important sacrifice which she has had to make
• Started working again after her mother passed away but had to

retire due to health problems

• Suffers from arthritis, asthma and had breast cancer
• Has a son who is married to a Pakistani woman, they live in the

ground floor of the apartment

• Does not receive any help from home based care services but has

yearly checkups at the hospital and sees a physical therapist but relies heavily on her husband and daughter in law for daily care

• Describes her relation to her daughter in law as a reciprocal

exchange as she helps her daughter in law with learning norwegian and similar

• Describes herself as not wanting to be a load on the Norwegian

public and states that she prefers to manage on her own

Magdalena (73)

• Grew up in a village outside of Krakow, educated maths

teacher in Krakow

• Moved to Norway in 1986 after she met and married a

Norwegian man, but now lives alone

• Worked as a teacher’s assistant but received a disability

pension due to arthritis

• Receives a home based practical assistance (1,5 hours a

week) with cleaning and grocery shopping

• Has a number of aids (an accomodated residence, hospital

bed, wheel chairs and similar )

• Both her daughters live in Norway, but she doesn`t want to

live near them. She doesn`t want them to feel obliged to visit or help her in her daily life

Noman (75)

• Came to Norway from a rural area of Punjab in 1971
• Previously worked in manual labour but had to retire due to

health problems

• Has heart problems, bad eyesight and general problems with

mobility

• Has four sons (three living in Norway)
• Lives with his wife, son, and daughter in law
• His everyday life consists of waking up early to have breakfast

prepared by his son or daughter in law, then he sits around watches TV until the son and daughter in law gets home from work to prepare dinner

• Compares his life to being «a caged bird»
• Other than a TT card which is a public transportation card for

people who are frail, he doesn`t receive any publically provided care

• He states that he has applied, but mainly for more financial

assistance

Jelena (70)

• Came to Norway to work as a musician in 1979
• Has as son who came to live with her in 1982 but now

lives in California

• Has arthritis, and has suffered a stroke
• When she was in hospital she was advised to apply for

practical assistance from the home based services

• She decided not to because she felt the process of

applying would be too exhausting and she had heard from a neighbour that she wouldn`t receive that much help anyways

• Receives physical therapy
• Has friends and neighbours who help her with cleaning

Akbar (65)

• Came to Norway from the Punjab province in 1969
• Has worked several manual jobs and then as bank receptionist
• Cared for his mother in Norway when she became blind
• Retired early due to diabetes 2 and loss of eyesight (80% but

gotten worse)

• Lives with his wife, has no children
• Receives a nurse every night to inject insulin
• Values the notion of intergenerational living and contrasts this

with his impression of lack of family solidarity among Norwegians

• Feels depressed when thinking about the future without

family members to care for him, particularly if he eventually turns blind

• His wife is doing all of the practical work at home, but she has

cataracts so she cant help with insulin

Experiences with formal care Magdalena

• Is happy with the amount of care she receives,

but she feels there are many who aren`t doing a proper job cleaning. The apartment is often still filthy after helpers have left.

• Doesn`t want to monitor them whilst they clean
• r complain directly to them or to the

municipality

• Her way of showing dissatisfaction is by switching

from the municipal provider to a commercial provider

Akbar

• Is for the main part happy with the care (does not really

want to talk about it)

• He had some complaints about the time of the arrival of

the nurse

• Furthermore, he has some worries about the intimate

nature of the tasks and that there are mostly female providers

• He worries about this when it comes to institutional care

as well; for instance if a female nurse were to help him shower

• This is not in line with the rules of his muslim faith
• However he has learned that one can be pragmatic and if

there are no other options he just has to accept this