Thematic Panel 18: COVID-19 and Long-term care for older people – international policy responses and learnings

Elena Bogdanova, European University at St.Petersburg (EUSPb)
and Tine Rostgaard, Stockholm University and Roslkilde University

The COVID-19 pandemic took the long-term care systems around the world by surprise. Facing unknown virus, each country developed its own urgent and ad hoc measures of coping with the challenge. Some introduced strict quarantine measures, others avoided such restrictions. Overall, measures were mainly aimed at the nursing home sector, neglecting the home care sector, and measures often did not consider the effect for members of staff. The effect of COVID-19 on long-term care users and staff has varied by countries and may depended on different factors, including institutional features, cultures of care, integration of health and social care etc. Different countries entered the pandemic at different stages of evidence of how it spread, with different resources for coping with the infection, different cultural models of care, and relying upon different organizational modes of care provision. Therefore, the issue of successful resistance to the pandemic in a time pressure situation is an important empirical and theoretical question, which requires broad discussion, sensitive to a variety of circumstances. With this Thematic Panel, we invite single-country and comparative studies about COVID-19 policy responses and learnings from the long-term care sector.

Symposium 13: Disputed temporalities: long-term care services in times of Covid-19

Convenors: Matxalen Legarreta (University of the Basque Country UPV/EHU) and Tomasa Báñez (University Barcelona).

Long-term care services are intended to meet care needs of the most vulnerable population. For this reason, COVID-19 especially affects them. However, the response to the pandemic differs depending on the context, given the structural and sectorial specificities as well as political and socio-cultural factors (Daly, 2020). In all cases, intensifies tensions between clock time, that governs care services, and process time, which characterises care (Davies, 1993). Our proposal attends to how Covid-19 is shaking the temporality of long-term care services, by comparing south and north Europe and using qualitative and quantitative data. We hope to share our findings, and to enlarge our research network.
Comas d’Argemir, Sagastizabal and Lores study the incidence of changes produced in the time- frames of residences (schedules, vacations, attention times …) and problems for reconciling work and family life, caused by them. They use qualitative data to carry out a comparative analysis in the Spanish context,
Roca, Cayuela, Rico and Alcázar, by using a qualitative methodology and from a temporal perspective, analyse the discourses of the involved agents in three community based care services at Spain, day centres, home care service and personal assistance, to find out how the work hours have changed.
Degavre, Casini, Desmette and Mélotte, by using a longitudinal and quantitative methodology, examine how the outbreak has affected the specific situation of in-home nurses in Belgium regarding their work/family balance and highlighting the reasons that lead them to consider, or even decide, to change jobs or organizations and whether these reasons have changed due to the COVID-19 outbreak.
Giordano explores the consequences that time schedule adjustments had on front-line elderly carers, from the material collected before and after the striking of the pandemic in Brussels, which includes in-depth interviews and semi-structured questionnaires to a sample of public and private elderly care providers.

Paper authors:

  • Working in a residence in times of Covid-19: dislocations in work times and in life time
Dolors Comas d’Argemir, University Rovira i Virgili
Marina Sagastizabal, University of the Basque Country UPV/EHU Fernando Lores, University Complutense de Madrid
Redefining Space and Time of care during the COVID-19 in Spain
Mireia Roca University Rovira i Virgili
Salvador Cayuela Sánchez University of Castilla la Mancha
Juan Ignacio Rico Becerra University of Murcia
Ana Alcázar University of Granada
  • The covid-crisis: a risk for work/family balance and career for in-home nurses?
Florence Degavre, CIRTES UCLouvain
Annalisa Casini, CIRTES UCLouvain
Donatienne Desmette, CIRTES UCLouvain
Patricia Mélotte, CRPSI/ULB
  • Home care service providers in Brussels: time adjustments in times of COVID-19 and the consequences for front-line elderly carers
Chiara Giordano, Université Libre de Bruxelles

Discussant: Raquel Martinez-Bujan (University of Da Coruña) and Encarnación Gutiérrez Rodríguez (Justus Liebig University)

Symposium 12: Rhythm is Gonna Get You: the Tempo of Care Policy and Practice

Convenors: Catherine Needham (University of Birmingham) and Matthew Lariviere (University of Sheffield)

Discussant: Dr Jason Danely (Oxford Brookes University)

One of the characteristics of time is its rhythm: the tempo of events, interventions and innovations. The papers look at different elements of care policy and practice to bring out more explicitly the rhythms which shape the experiences of people in the care system.
In her paper, ‘Quick, quick, slow – The time tactics of adult social care reform’, Catherine Needham draws on empirical research with policy makers in the UK to surface the time tactics that are at work within policy reform. She suggests that the lack of progress on care reform to date can be understood in terms of the clash of reform tempos between different stakeholders.
In ‘Comparing the UK’s four care systems: context, change and time’, Patrick Hall (University of Birmingham) draws on interviews with senior and local policy makers in England, Scotland, Wales and Northern Ireland, to compare the tempo of care practices in the four nations – and the clash between notions of modernity, progress and tradition.
In ‘Artificing care: Resolving contemporary care problems in imagined techno-futures’, Matthew Lariviere explores discourses focused on the tempo of innovation in care technology. He highlights tensions between a burgeoning evidence base of negative trial results and the promised potential of technologies to transform care in consistently unrealised and re-imagined futures.
In ’Progress towards co-production practices in care services’ Nanna Møller Mortensen (Aalborg University) draws on a Danish qualitative case study to explore implementation difficulties and timescales for co-production in care services. She highlights the use of implementation phases in order to discuss the possibility of triggering progression between phases, towards more co-produced public services.

Symposium 11: The negotiation and regulation of time in formal care arrangements

Convenors: Diane Burns and Cate Goodland (University of Sheffield)

The majority of organisations offering formal care services operate within a context shaped by neoliberal market conditions. In response, for-profit and non-profit care providing entities variably design and/or adapt their business models, managerial processes and operational arrangements with the aim of striking a balance between achieving organisational longevity and serving the needs of people using their services. Issues of organisational fragility and poor care quality are a global concern, effecting many countries. An indicator of good quality in formally arranged care is that provision is both timely and responsive to people’s needs. However, many scholars have illustrated that the level of in-job autonomy care workers require to enable responsivity, is often restricted by managerial processes, rigid care schedules and objectives to use care workers’ time in the most cost-efficient way.
Papers in this proposed symposium are highly relevant to the conference theme. Various aspects important to the negotiation of time within formal care arrangements will be un-packed, examined and discussed. The symposium will focus on the issue of time in the context of care delivered in people’s homes and in long-term care settings. This approach will allow a fuller exploration of time within particular organisational context and from the different perspectives of employers, managers, and care workers – along with people receiving care and trade union officers organising in the sector. Using in-depth ethnographic, case study and interview methods, the papers draw on research data gathered from a range of nursing home, home care, and support providers in the UK and Germany to illuminate the ways in which time is both utilised and controlled, and the subsequent effects for care worker jobs and wellbeing.
The convenors and discussants are members of an international network linked to the UK ESRC-funded programme: Sustainable Care: Connecting people and systems (PI Sue Yeandle).

  • Paper 1: The control of care workers’ unpaid time in innovative home care provider organisations.
Dr Diane Burns, Sheffield University Management School and Dr Cate Goodlad, Centre for International Research on Care Labour and Employment, University of Sheffield, UK

This paper examines how innovative home care businesses structure their operations by controlling time within the design of care worker jobs and operational arrangements they assemble. Drawing on case study data of 4 innovative high achieving home care companies in the UK, we identify how time is differently functioned. In particular, we identify how paid and unpaid care worker time is constructed within employment contracts and the labour process. Through this lens we show how the central features of temporal controls stabilise and destabilise care and discuss the opportunities and risks consequently engendered for individual care workers and care companies.

  • Paper 2: Working unpaid hours in ‘customer-centred’ nursing homes: Implications for workers’ care and personal time in Germany and Sweden
Dr Lander Vermeerbergen, Radboud University/KU Leuven; Juliane Imbush and Professor Valeria Pulignano, KU Leuven; Professor Aoife McDermott, Cardiff University, UK; Ella Petrini, KU Leuven

An increasing number of nursing homes have adopted a ‘customer-centred’ care model. The few studies examining the impact of such organisational models for workers point to over involvement with residents’ lives and a huge increase in work intensity. In this paper, we examine how this influences (unpaid) care and personal time of workers at home and in the nursing home job. We collected 30 narrative interviews and daily diaries on (unpaid) working time with workers in six nursing homes in Germany and Sweden.

  • Paper 3: Live-in care: Migrant care workers’ negotiation of time across boundaries and boarders
Obert Tawodzera, Researcher and Doctoral Student, Professor Majella Kilkey, Dr Magda Lorinc, University of Sheffield; Professor Louise Ryan, London Metropolitan University; Professor Shereen Hussein, Dr Agnes Turnpenny, University of Kent

In live-in care settings, care arrangements are formalised through an employment contract between the family and the care worker (often on zero-hours contracts), where the care worker both lives and works in the private home of their employer. Drawing on in-depth interviews with 27 migrant care workers in the UK, this paper unveils the challenges, complexities and nuances around how formal and informal time is experienced and negotiated in live-in care arrangements. We show how care worker’s responsibilities and duties often drift into more informal arrangements, including picking up domestic work tasks. As a result, time is governed by the task rather than the clock (Daly, 2001) leading to long-hours of work and a blurring of the boundary between work-life and personal-life. Consequently, for migrant care workers the time available to care for their own family members who often live across national borders, become compromised and compressed.

  • Paper 4: Mobilising a time-poor workforce: how time affects union resistance in social care
Grace Whitfield, Researcher and Doctoral Student, Centre for Decent Work, University of Sheffield

This paper focusses on the role of time in shaping trade union mobilisation in England’s social care sector, drawing on interview data with care workers, support workers, company managers, and union organisers. The workers were employed at four companies: a home care provider, a residential nursing home, and two support providers. The findings demonstrate that overwork in the sector – long shifts or large numbers of short calls – stymie the mobilisation efforts of unions, with organisers describing difficulty accessing time-poor workers and difficulty embedding union activism in workplaces.

Discussants: Professor Norah Keating (University of Alberta) and Helena Hirvonen (University of Eastern Finland)

Symposium 10: Intersectional perspectives on care and care needs in older adults

Convenors: Ricardo Rodrigues (European Centre for Social Welfare Policy and Research) and Susan Phillips (Queen’s University Faculty of Health Sciences)

Socially mediated definitions of time spent care giving and receiving are deeply gendered. Thus far only limited consideration has been given in the care literature to intersecting social characteristics of gender and social location (e.g. socioeconomic position, geographical location, etc.). Intersectionality, understood here as overlapping categorizations and (dis)advantages, is at the core of the FutureGEN project, whose broader aim is to analyse gender inequalities in health and care from a cohort perspective. This symposium brings together papers that address intersectionality in care needs (e.g. disability) and in care giving and receiving in old-age, therefore appealing to an audience that encompasses care and health scholars. The time dimension is incorporated both in terms of time needed for care and historical time, through cohort analysis. The first paper (lead author: Susan Phillips, Queen’s University) titled “Systematic review of methods used to study the intersecting impact of sex and social locations on health outcomes” sets the scene for the relevance of intersectionality by discussing methods to address intersectionality in quantitative research, with applications beyond health and care for older people. The paper titled “Sex, ageing and disabilities: cohort trajectories of functional decline among older adults in Europe 2004-2017”, (lead author: Stefan Fors, Karolinska Institute) uses quantitative methods to show how disabilities in later life in cohorts of women and men have evolved between 2004 and 2017 across geographical locations. This is followed by a paper titled “Gender differences in access to community-based caring resources in old age: An examination of the effects of widowhood and living arrangements” focusing on the impact of widowhood on use of care for women and men of different socioeconomic backgrounds (lead author: Stefania Ilinca, European Centre for Social Welfare Policy and Research). The symposium concludes with the paper titled “Caregiving across European cohorts between 2004-2015: is there evidence of changing gender patterns across care regimes?”, which analyses evolving gender differences in caregiving across different geographic locations (lead author: Ricardo Rodrigues, European Centre for Social Welfare Policy and Research). In addition, we plan to have Prof. Francesca Bettio (University of Siena) as an external discussant for this Symposium.

Symposium 9: Aging at home in times of the corona pandemic: disruptive temporalities

Convenors: Sílvia Bofill-Poch (University of Barcelona) and Paloma Moré (University of A Coruña)

This symposium deals with the reorganization of care work times within households from the perspective of paid and unpaid long-term caregivers during the corona pandemic. Applying a temporal analytical perspective (Durán, 2007; Folbre, 2004; Ramos, 2007; Adam, 1995), we will explore to what extend care work times have been altered in a context where the provision of care services has been temporarily altered and the caring role of the family strengthened. The symposium will also address the needs (whether public or private) and assumptions shaping changes in care work times, as well as the effects of such changes on the reproduction, or even intensification, of gender, class or race inequalities. The symposium brings together, from a critical feminist perspective, papers on both, unpaid family careers and paid domestic workers, offering a comparative perspective on time policies and care regimes between Southern Europe (Spain) and Latin America (Chile). Regarding family care in the Spanish case, sociologists Sara Moreno-Colom and Vicent Borràs (Autonomous University of Barcelona) will present a paper entitled “The Spanish ideal ‘of being taken care at home by relatives’ meets lockdown”, and sociologist Marcela Jabbaz (University of Valencia) and anthropologist Montserrat Soronellas (Rovira i Virgili University) a second one about “Changes in care times of family careers of dependent adults during the pandemic”. These two papers present the theoretical debate on the social organization of care and the uses of time from a gender perspective, together with the work-life balance debate. The paper by Chile-based anthropologist Herminia Gonzálvez (Central University of Chile), “In the frontline: social care for the elderly in pandemic contexts”, focuses on care policies and familistic care regimes in order to reflect on the unequal ability of households to cope with increasing caring responsibilities. Finally, the paper by Spain-based anthropologists Carmen Gregorio (University of Granada) and Ana Lucía Hernández (University of Zaragoza),”Domestic workers: the meaning of their work-life times in the COVID19 crisis”, raises questions related to changing domestic workers’ care work times by focusing on their employers’ new fears and time demands. The symposium addresses a broad audience in social sciences.

Discussant: Alessandro Gusman, University of Turin 

Symposium 8: Transnational care within the European Union in times of COVID-19: Perspectives from Central and Eastern Europe

Convenors: Petra Ezzeddine (Charles University) and Michael Leiblfinger (Johannes Kepler University)

Transnational care migration was affected in numerous ways during the COVID-19 pandemic: Closed borders limited the ability of care workers to travel. Travelling itself was accompanied with an additional risk of contagion. Live-in carers were asked to extend their rotas and not to leave the households in an effort to protect the elderly in their care. They also faced psychological burdens of worrying about their own families and weighing those worries against maintaining an income as migrant live-ins abroad. Governments reacted to (potential) care(r) shortages with various measures. The specific temporal work arrangements (circular migration or repetitive temporal migration) were shaped by the biopolitical measures (e.g., frequency of obligatory testing) at borders. This ‘permanent temporality’, which usually enables care workers to coordinate their own reproductive and productive activities during care migration, seems to be collapsing in times of crises. Four papers covering care migration from Central and Eastern Europe discuss these developments: Uhde and Ezzeddine show how the pandemic shed light on the everyday functioning of the transnational political economy of social reproduction based on regional inequalities within Europe and discuss Czech care mobility faced with changing border regimes and biopolitics during COVID-19. Safuta’s contribution is based on the online activity of Polish migrant live-ins working in Germany during the first months of the pandemic and shows how those workers dealt with old and new challenges related to their transnational living and working conditions. Leiblfinger, Prieler, Rogoz, and Sekulová investigate the impact of COVID-19 related policy responses for transnationally organised live-in care in Austria and its most important sending countries Romania and Slovakia as interconnected care mobility. Seiffarth focuses on Romanian live-in care workers in Italy, one of countries hit hardest by the pandemic and a country relying heavily on care at home, which in turn highlighted the vulnerabilities of those working closely with the at-risk elderly population. Our interdisciplinary panel brings together junior and senior researchers in the field of care migration as well as the perspectives from both sending and receiving countries.

Papers:

  • The Transnational Political Economy of Social Reproduction in Central Europe; Zuzana Uhde (Czech Academy of Sciences) and Petra Ezzeddine (Charles University, Prague)
  • A transnational care market in pandemic times: Migrant care workers in Germany between a deadly virus, households in need and agencies in demand; Anna Safuta (University of Bremen)
  • Confronted with COVID-19: Migrant live-in care during a pandemic; Michael Leiblfinger (Johannes Kepler University Linz), Veronika Prieler (Johannes Kepler University Linz), Mădălina Rogoz (International Centre for Migration Policy Development, Vienna), and Martina Sekulová (Slovak Academy of Sciences)
  • Crises as catalysts? The case of Romanian migrant care workers in Italian home-based care arrangements; Marlene Seiffarth (University of Bremen)

Discussants:
Ewa Ślęzak (Cracow University of Economics) and Bernhard Weicht (University of Innsbruck)

Symposium 7: Temporal dimensions of digital technology in the long-term care of older people

Symposium convenors: Helena Hirvonen, University of Eastern Finland

Changes brought by ageing societies have raised the question of the need for health and social care policy reforms and shifts from state-sponsored to market-driven service systems across the globe. Formal provision of long-term care of older persons increasingly operates within a context shaped by neoliberal market conditions. Need for increasing efficiency, along with goals of user-centered and transparent service provision are encouraging service providers to take on new technological solutions. As a consequence, services for older persons are becoming increasingly reliant on digital platforms, tools and applications. This alters the work practices of care work as well as the daily life of older persons. Overall, the key question seems to be how to deliver high-quality yet cost effective and equally accessible services. Digitalization affects care and work, the means, process as well as the experiences of the different actors involved in the long-term care of older persons. In the middle of it all, time remains an essential resource for both those providing and those receiving care.
The symposium is relevant to the conference theme as it highlights the importance to understand the connections between temporality and digitalization, and how these mutually contribute to how care and care services manifest. The four papers address the intertwinement of digital and temporal based on the latest research on the topic. The aim of the symposium is to bring forth a compelling and critical discussion on how digitalization affects the perceptions, control over, negotiations, and the actual allocation of time in long-term care of older persons. The symposium discusses the phenomenon from a variety of viewpoints, with a primary focus on formal care work, and the perspectives of both care workers and service users.
The convenor of the symposium is a member of the Academy of Finland funded Centre of Excellence in Research of Ageing and Care, Research group ’New Technologies, Ageing and Care’ (PI Sakari Taipale).

Description of papers and their presenters:

  • Paper 1: Temporalities of digital care
Annette Kamp, Roskilde University (co-authored with: Sidsel Lond Grosen, Roskilde University; Agnete Meldgaard Hansen, Roskilde University.)

The paper explores how digitalization of care work that aims at supporting the paradigm of personalized, rehabilitative care, affects temporalities of care. ICT is assumed to imply acceleration, intensification and fragmentation of work. However, temporalities are shaped, constructed and juggled in daily practise. This ‘juggling of time’ in specific cultural and professional contexts is the point of departure for contextual development based on ethnographic study of the digital technologies in Danish Eldercare.

  • Paper 2: Sense of Belonging Disrupted – Care Work Gone Online
Antti Hämäläinen, University of Jyväskylä (co-authored with: Mia Tammelin, Jyväskylä University of Applied Sciences; Riitta Hänninen, University of Jyväskylä & Helena Hirvonen, University of Eastern Finland)

The paper is based on a study of digitalization in 24/7 residential care units, where mobile applications are increasingly used to organise workCare workers resort to digital application in efforts to ‘make time’ for care in a service environment that aims for efficient delivery of services. The paper points on the one hand to the risks of blurring of work-life interface as a consequence of growing use of digital platforms that reorganize the spatial and temporal spheres of care work. On the other hand, new opportunities to build a sense of community emerge through digitalisation.

  • Paper 3: Migration related vulnerabilities in the time of independent agency – Struggling with digitalised social welfare services in Finland.
Ulla Buchert, University of Helsinki

The paper discusses the transition from street-level to screen-level bureaucracies and the agency expected from the service users. The embracing of independent digital agency seems to drive people with intersecting vulnerabilities dependent on informal help, which may endanger their privacy, compromise realisation of their social rights and expose them to abuse.

  • Paper 4: Considering the ‘Ageist Factor’ in Designing Policy and Digital Technology for Older Adults
Ittay Mannheim, Tilburg University

The paper presents recommendations of a policy brief based on on-going research in ‘Euroageism’ Horizon 2020 ITN. Ageism is a potential barrier that affects use, adoption and design of digital technology and related policies. The paper highlights the importance of older adults’ involvement, consideration of their needs and desires, in development and implementation of (health related) digital technologies.

Discussants:

Eveline J.M. Wouters, Fontys University of Applied Science & Tilburg University

Virpi Timonen, Trinity College Dublin

Symposium 6: Nordic elder care in transition – exploring dynamics of change

Convenors/discussants: Mia Vabø (Oslo Metropolitan University) Annette Kamp (Roskilde University)

Since the golden age of welfare expansion, ranges of reform steps have been taken to make elder care services more cost- efficient. Many steps have been inspired by NPM– a global wave of reforms based on market-oriented logics aiming at enhancing organizational efficiency and accountability, but failing to address other political/administrative values such as fairness, equity, safety and reliability.
NPM doctrines have been widely criticized by social scientist, exactly because they are disconnected from the political and practical world they aim to change. However, this critique have often taken reductionist forms, implicitly assuming that all changes belong to NPM paradigm, thus disregarding how NPM intertwines with classical bureaucracy aiming at legal security or with structural reforms inducing professional logics. They tone down how ‘old’ relational modes of care lingers on or how care practices are challenged or revitalized by new global visions of ‘active ageing’ and person-centred care and reablement.
In this symposium, we emphasize the need for more context- and time-sensitive approaches. Rather than seeing contexts as static ‘scene settings’, we regard contexts as made up by multiple agents who are actively interpreting what is going on.
Moreover, we regard contexts as temporally interconnected: Drivers of change may be located in the past, present and future time and may influence reforms as ‘path breaking’ events, by ‘collision of trajectories’ and ‘reactive sequences’. Time is not necessarily a progressive movement forward, but can often mean going backwards.
Papers presented will highlight how complex and shifting contexts influences the practical world of front line staff and the ones they care for. Papers will pay attention to the way in which tension and dilemmas are interpreted, resolved and handled – in processes of needs assessment and service allocation; in inter-professional practices and in interaction with care recipients.

Paper presenters and tentative titles:

  • Lea Graf: Is NPG the new black? The interplay between new and old modes of governance in Nordic elder care systems
  • Helle Cathrine Hansen: New reform trends in the making: the process of rebuilding trust in public home care.
  • Maya Flensborg Jensen: Valuating care for ageing bodies: valuation devices and negotiations of care in the context of reablement
  • Betina Dybbroe: Changing knowledge regimes and professional practices in rehabilitative care
  • Christine Øye. Keeping fitness at a distance: Maneuvering in the complex terrain of public day-care institutions in the era of
    `active aging`.

Symposium 5: Ageing in place

Convenor: Costanzo Ranci, Politecnico di Milano

In the last decade, the most common strategy adopted in many European countries to deal with the care deficit has been ‘ageing in place’. However, ageing in place has many limitations. It requires an adequate housing context and the existence of an active informal social network. Moreover, it brings about substantial risks for frail older people themselves, including the risk that permanence at home may increase their social and spatial isolation. Effective measures should be therefore developed to protect frail older people from these risks and to guarantee them the best possible quality of life and care as they age.
This symposium is aimed to present and discuss the main results of a research carried out in 2019-2021 in Italy about ageing in place. Three papers based on empirical research will be presented: the first is about the relationship between frailty and risk of loneliness; the second one explores the care arrangements of frail older people living alone; and the third addresses the housing and living conditions of such people. All these papers are based on 120 interviews of frail older people living alone in different contexts (urban/rural contexts; northern/southern areas). Based on these contributions, the symposium will start a debate about loneliness and frailty in older age, and policies addressing the care needs of people experimenting such situation. Two international scholars are invited to open the discussion on such issues.

Program:

  • Marco Arlotti and Stefania Cerea, Frailty and loneliness among older people living alone
  • Giovanni Lamura, Gabriella Melchiorre, Care arrangements of frail older people living alone in Italy
  • Flavia Martinelli, Antonella Sarlo, Francesco Bagnato, Time and space in care

Discussants. Tine Rostgaard and Margarita Leon (to be confirmed)