The World Economic Forum has called dementia one of the biggest global health crises of the 21st century. In this paper, I make the case that unpaid caregiving by family or close others of persons ...living with dementia should be a matter of public health. Shaji and Reddy proposed this in 2012 in the context of dementia care in India. They explicitly acknowledge the influence of Talley and Crews’ 2007 article on caregiving as an emerging public health concern. However, they narrow their proposal to caregiving for persons living with Alzheimer’s disease and related dementias (ADRD), which I take to be an important first step in building an argument for putting caregiving more firmly on a public health agenda. In order to support my claim, first, I establish that caregiving is a social determinant of health. Second, I counter objections to the addition of caregiving for persons living with ADRD to a public health agenda, as it would lead to public health mission creep. I then argue that a broad understanding of public health can be inclusive of this type caregiving and is preferable as it highlights an issue of health equity, the gendered nature of caregiving. Finally, I make the case that a definition of public health inclusive of the social determinants of health and caregiving is more adequately suited to address the health consequences of the current changing demographic patterns. My argument adds support to writings on migration calling for broadening the scope of public health.
As individuals grow older, they usually require assistance with the daily tasks of self-care. This type of assistance, ancillary care, is essential to maintaining the health of those who need these ...services. In his prudential lifespan account, Norman Daniels includes access to such services making his account an attractive proposal given the current demographic shift. In this paper, I examine the prudential lifespan account through the lens of old age and I focus on the two concepts on which the lifespan account relies. I show that these two concepts, normal species functioning and opportunity cannot buttress Daniels’s lifespan account; at least it cannot do so for older persons. The tensions that I identify in the prudential lifespan account in relation to aging are instructive for the more recent proposals to include aging in a theory of health and health justice. In addition, my analysis allows me to demonstrate that Daniels’s view of opportunity is irreconcilable to capabilities, the latter being more adaptable to the realities of aging. If capabilities appear more promising, it is nonetheless imperative that the specificities of extended care, such as the need for unpaid caregiving, be taken into consideration.
Objective
The objective of this study was to identify essential aspects of exemplary post-discharge stroke rehabilitation as perceived by patients, care partners, rehabilitation providers, and ...administrators.
Design
We carried out an exploratory qualitative, multiple case study. Stroke network representatives from four regions of the province of Ontario, Canada each nominated one post-discharge rehabilitation program they felt was exemplary.
Setting
The programs included: a mixed home- and clinic-based service; a home-based service; a clinic-based service with a stroke community navigator and; an out-patient clinic-based service.
Participants
Participants included 32 patients, 16 of their care partners, 23 providers, and 5 administrators.
Methods
We carried out semi-structured qualitative interviews with patients and care partners, focus groups with providers, and semi-structured interviews with administrators. Health records of patient participants were reviewed. Using an interpretivist-informed inductive content analysis, we developed overarching categories and subcategories first for each program and then across programs.
Results
Across four regions with differing types of programs, exemplary care was characterized by three essential components: stroke and stroke rehabilitation knowledge, relationship built through personalized respectful care, and a commitment to high quality, person-centered care.
Conclusion
Exemplary post-discharge care included knowledge regarding identification and treatment of stroke-related impairment, that is, information found in best practice guidelines. However, expertise related to building relationship through providing personalized respectful care, within a mutually supportive, improvement-oriented team was also essential. Additionally, administrators played a crucial role in ensuring continued ability to deliver exemplary care.
Over three decades ago, Carol Gilligan’s seminal book In a Different Voice provided feminist theorists with a powerful new approach to address the shortcomings of traditional moral theories. With a ...focus on concrete situations, an ethics of care can attend to the specifics of moral dilemmas that might otherwise be glossed over. As feminist reflection on moral and political philosophizing has progressed, another challenge has emerged. Recent feminist scholarship proposes non-ideal theories as preferable action-guiding theories. In this paper, I examine Kittay’s call for a version of care ethics as a naturalized ethics that comes from lived experience, in order to draw out the salient characteristics of the caring agent. This allows me to show how Kittay’s key assertion that “we are all some mother’s child” resonates with Ricoeur’s framing of self-esteem, which is, in turn, anchored on a notion of solicitude. Secondly, I make the case that care ethics can benefit from Ricoeur’s little ethics as it helps buttress the goal of good caring practices. Finally, care ethics, with its emphasis on the universality of care needs, helps to strengthen the central role of solicitude for the political sphere.
Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the ...spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch.
In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act (CHA) to include home care. The ...growing importance of chronic care supports my call for federally regulated home care services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the CHA, are to be upheld within the current social and demographic context, then Canada’s health care system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely.
In post-Fordist economies, the nature of laboring activities can no longer be subsumed under a Taylorized model of labor, and the service sector now constitutes a larger share of the market. For ...Maurizio Lazzarato, Michael Hardt, Antonio Negri, and other theorists in the post-Marxist tradition, labor has changed from a commodity-producing activity to one that does not produce a material object. For these authors, this new type of labor is immaterial labor and entails communicative acts as well as added worker agency. This paper reflects on this new paradigm of labor by examining the paid practices of care defined as the activities performed by individuals who have a mandate to help another adult accomplish the tasks of self-care. Because care workers take care of other bodies, care labor exemplifies an embodied practice. I make use of the corporeality of care to put forward the notion of thin and thick embodiment in order to examine critically the meaning of immaterial labor and to support my claim that immaterial labor, as conceptualized by Hardt and Negri, erases both the materiality and relationality of care labor. Furthermore, typifying care labor as immaterial only serves to maintain its marginalized status.
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