Gerontological colonialism or Affordable quality care in paradise?

Transcription

1 Die Gesundheitswelt der Zukunft denken Gerontological colonialism or Affordable quality care in paradise? Karin van Holten, Careum Research, Kalaidos University of Applied Sciences, Department of Health Science Christine Bally, Institute of Biomedical Ethics and History of Medicine IBME, University of Zurich Rotterdam, June 29, 2017, 14th IMISCOE Conference Careum Forschung Forschungsinstitut Kalaidos Fachhochschule Departement Gesundheit Pestalozzistrasse 3, CH-8032 Zürich T , F , forschung@careum.ch, Platzhalter für Partnerlogo

2 Critical Discourse Analysis (Jäger 2012) 1. Subject matter Emigration of elderly people to nursing homes abroad 2. Discourse plane and sector Analysis of the discourse strand of elder care abroad on discourse sectors of traditional mass media 3. Accessing and preparing the materials Systematic database search (factiva) 4. Analysis Structural analysis of the discourse strand Detailed analysis of typical discourse fragments Synoptic analysis Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

3 Subject matter and discourse plane Analysis of the discourse strands of elder care abroad on discourse sectors of traditional mass media Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

4 Entanglement with other discourse strands Structural Analysis Demographic Shift / Socio-Demographic Developments Health / Elder / Dementia Care Health and Long-Term Care Policy Long-Term Care Expenditures Shortage of Health Care Professionals (HCPs) Family Care Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

5 Search Summary Database: factiva Global News Database Key words (in German, French, Italian): Search template: Date: all Dates Source: Group CH / not CH Region: All Regions Language: All Languages Elder care AND foreign country Nursing Home AND foreign country Nursing Home AND Eastern Europe Nursing Home AND Hungary Nursing Home AND Thailand Nursing Home AND Asia Dementia AND foreign country Dementia AND Thailand Dementia AND Eastern Europe Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

6 Elder care abroad Timeframe of the emergence of the subject France 8 3 Germany Switzerland Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

7 Subtopics of the elder care abroad discourse strand (1) Structural analysis 1. (Health) Care setting in comparison to Switzerland Higher patient-staff-ratio More individual care Quality of care 2. Cost savings in comparison to Switzerland Care services are cheaper due to lower labor costs 3. Swiss welfare state lower social security expenditures Foreign nursing homes for Swiss citizens as a future strategy? 4. Relatives / Family members High responsibility corresponding with high burden Ambiguous role of (distant) family caregivers Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

8 Subtopics of the elder care abroad discourse strand (2) Structural analysis 5. Language Ambiguous relevance of language 6. Distance as a big challenge / risk Strategies to overcome distance 7. Familiarity / Foreignness Specific strategies to overcome foreignness / create familiarity: food, sounds, rituals, symbols 8. Expert voices striking often experts are quoted representing diverse fields of knowledge Often in contrast to the voices of the family care givers or the care receivers Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

9 Discourse strand elder care in Thailand Paradise for the Elderly in Thailand Five times more Swiss retirees in the land of smiles than ten years ago: nursing homes are booming not only sex tourism. (Blick, 3 April 2016) Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

10 Discourse strand elder care in Eastern Europe Eastern European nursing homes promote their services in Switzerland Foreigners want to get our elderly Blick am Abend, Author: Guido Felder Eastern European nursing homes discover business with the Swiss. They want to take care of elderly in need of care to a fraction of the costs applicable in Switzerland. Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

11 Rather two different discourse strands? Thailand Metaphors: resort, paradise, palm trees, lands of smile, exotic, holiday, (...) To enjoy one s remaining years Sunny side of ageing Active role of relatives Emigration as a decision of the relatives Relation care receiver / caregiver: close, family like, touchy Devoted Thai women as quality criteria for good elder care German language skills not important Eastern Europe Metaphors: rather not dominant To spend one s remaining years Cost-saving side of ageing Active role of agencies Emigration as a decision of the person in need of care Professional relation care receiver / caregiver Professionalism as basic quality criteria German language skills important Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

12 Subtopics that are conspicuous by their absence Local consequences of the phenomenon concerning Health care sector (internal brain drain / access to health care services) Labor market structures Village structure (Thai context) New axis of inequality Ecology and environment Further dynamics of globalization Power asymmetries / dependencies Violence Sexuality and sexual needs Spirituality and religion Dying and death Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

13 Summary and conclusion High variety of subtopics and dense entanglement with other discourse strands. But: The phenomenon is dominantly discussed in context of health care expenditures, quality of care, and the role of the family caregivers Modality of arguments is limited A boom? Mostly the same references to service providers abroad Lot of blind spots remain. In contrast to the discussion of 24h-care and circular migration, the living and working conditions of the caregivers are rather absent. Vulnerabilities are suspected for the migrating care-receiver. Intermediary services of agencies are hardly mentioned Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

14 Verlag Die Gesundheitswelt der Zukunft denken Thank you!

15 Contact & further information Karin van Holten Careum Research, Kalaidos University of Applied Sciences, Department of Health Science Pestalozzistrasse 3 CH-8032 Zurich Christine Bally-Zenger Institute of Biomedical Ethics and History of Medicine, University of Zurich Winterthurerstrasse 30 CH-8006 Zurich Karin.vanholten@careum.ch Christine.bally-zenger@uzh.ch Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,

16 Bibliography Jäger, M. & Jäger, S. (2007): Deutungskämpfe. Theorie und Praxis kritischer Diskursanalyse. Wiesbaden: VS Verlag. Jäger, S. (1997): Bemerkungen zur Durchführung von Diskursanalysen. Vortrag auf der Tagung "Das große Wuchern des Diskurses. Der Diskurs als unberechenbares Ereignis", 3./4. Juli 1997, Universität GH Paderborn. Download: Jäger, S. (2010): Der öffentliche Diskurs über die Benachteiligung von Jungen. Eine kursorische Diskursanalyse unter Berücksichtigung biopolitischer Aspekte. In: Cillia de, R., Gruber, H., Krzyzanowski, M. & Menz (Ed.): Diskurs Politik Identität. Stauffenberg Festschriften. Jäger, S. (2012): Kritische Diskursanalyse. Eine Einführung (6. vollständig überarbeitete Auflage). Münster: Unrast. Jäger, S. & Maier, F. (2016): Analysing discourses and dispositivs: a Foucauldian approach to theory and methodology. In: Wodak, R. & Meyer, M. (Ed.): Methods of critical discourse studies. 3rd. Edition. London: Sage. p Karin van Holten & Christine Bally - 14th IMISCOE Conference, Rotterdam, June 28 30,