Marking the Field of Engagement

Research in eldercare is diverse in character, theme and methodology. Eldercare is the object of several subdisciplines, such as nursing, gerontology, palliative care, ethics of care, welfare regime studies, healthcare and dementia, to name a few, and all of these comprise interests in the medical, historical, economic and social aspects of caring for elderly citizens. Reviewing this literature, I have focused on caregiving roles in eldercare in a Scandinavian context, and especially on the role of the relative.

This focus has two implications. First, I cannot start to do justice to huge parts of the many research fields participating in the eldercare literature, but only open up those areas specifically concerned with caregiving roles. The other implication is that I only include studies focused exclusively on Denmark or other Scandinavian countries or cross-continental comparative studies if these include Scandinavian countries. I have chosen the Scandinavian context because it is a central conclusion of care research that the welfare state systems and eldercare policies of Scandinavian countries are comparable and have more similarities with those of each other than of other countries.⁴² The Scandinavian countries are referred to in terms of ‘public service states’, ‘universal welfare regimes’ and ‘Nordic welfare models’. They are characterized by de-familiarized welfare services with a well-developed and publicly financed universal eldercare of good quality, one available to all according to needs more than personal finances; and by a low responsibility on the part of families and the market and a high responsibility on that of the state.⁴³

A current debate in the field of eldercare concerns whether a Nordic welfare model still exists across Scandinavia, or whether in recent times the countries’ social policies have developed in such disparate directions that they now set different conditions for eldercare.⁴⁴ Regardless of this debate, I use the Scandinavian context without further addressing the matter, as studies of

42 Anttonen & Sipilä 1996, Daly & Lewis 2000: 289; Daatland 2005; Esping-Andersen 1999, 2015; Kröger 2011; Martens 2018; Ringmose & Hansen 2005: 6; Rostgaard 2012; Rostgaard & Szebehely 2012: 101-102; Sand 2005: 197; Suanet et al.

2012: 492; Szebehely 2005: 13, 21; Trydegård 2005: 143.

43 Antonnen & Sipilä 1996; Esping-Andersen 1999, 2015; Esping- Andersen & Korpi 1986; Jensen 2008.

44 Andersen 2017; Häggström & Kihlgren 2007: 691; Hegli & Foss 2009: 23, 25; Kautto 1999; Kröger 2005: 253, 2011;

Martens 2018; Moberg 2017; Rauch 2007; Rostgaard 2012; Rostgaard & Szebehely 2012: 101; Sand 2005: 230; Suanet et al.

2012: 501-502; Szebehely 2005: 22, 47-48; Szebehely & Meager 2018; Szebehely & Trydegård 2012; Trydegård 2012;

Ullmanen & Szebehely 2015.

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eldercare in Scandinavia continue to use Scandinavia as a context and source of comparison⁴⁵ – with one exception, however. As scholars recognize, only a few studies identify and theorize relative roles in the eldercare setting.⁴⁶ To compensate for this shortage of Scandinavian studies, I have included studies from outside Scandinavia as well. As eldercare outside Scandinavia often differs significantly from Danish eldercare, most such studies though ultimately proved irrelevant to the thesis, for which reason I only include a few non-Scandinavian studies.

Although fields other than eldercare research also provide relevant insights into the relative in the eldercare setting, I have chosen to engage with only the field of eldercare. Still, two other fields – kinship studies and co-creation studies – deserve some mention as to why I have omitted them.

Kinship studies develop and debate the concept of kinship and how the understanding of what constitutes kinship varies between countries, cultures and times. Recent studies have shown that the notion of kinship is currently changing with sexual emancipation and the ensuing new rainbow family patterns. Likewise, the studies have pointed out how societal developments like globalization as well as financial, social and environmental crises have led to migration and large-scale refugee flows identifiable as families living apart, separated by national borders and even continents.⁴⁷ All in all, these developments open up the question of who the relative is to both theoretical debate and empirical inquiry in a way also relevant to the endeavour to understand the full-scale problematics and potentials of the concept of the relative in recent eldercare. However, in this thesis I have not examined this academic debate. This decision may represent a missed opportunity to fully comprehend the expectations posed to who can enter the role as a relative, such expectations being of significant relevance in the increasing number of cases where no blood relative lives nearby. The interest of this thesis is, however, broader in scope than the social dimension of who can be expected to play the role of the relative, as the thesis is equally concerned with what can be expected of the relative and when and with the uncertainty generated with such roles as to what to expect of the relative. Hence, whereas kinship studies make for a relevant discussion partner in regard to the social dimension of the

45 Daatland 1994, 2005: 53-54; Dahl 2000; Esping-Andersen 2015; Højlund 2009; Kröger 2005, 2011; Kuhnle 2019; la Cour

& Højlund 2019; Rostgaard 2002, 2012; Rostgaard & Bertelsen 2015; Rostgaard & Szebehely 2012: 102-105; Sand 2005;

Szebehely 2005: 30-49; Vabø 2012.

46 As pointed out by i.e. Davies & Nolan 2004; Herzberg &Ekman 2001: 615; Lindhardt et al. 2006; Sand 2005; Sandberg et al. 2002; Whitaker 2009.

47 See e.g. Franklin & Mackinnon 2002; Jallinoja & widmer; 2011; Pelets 1995; Riggs & Peel 2016.

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role of the relative, they do not offer a field within which to situate the entirety of my research interest, for which reason I have chosen the five points of engagement with eldercare research instead.

I also leave unexplored the possibility of situating the thesis in the research on co-production, co-creation and co-management in public service provision that emerged in the 1980s⁴⁸ and today constitutes a growing field of academic debate,⁴⁹ here referred to as co-creation literature.

This literature has shown co-creation to gain ground as a specific approach to service delivery, democracy and empowerment in various public service areas,⁵⁰ including studies of co-creation in the eldercare and healthcare settings.⁵¹ A central theme running through this literature is the attempt to define the co-producers and the ensuing debate about who they are. In the early days of the field, co-creators were defined as the clients or users of the co-created public service.⁵² Such definitions still prevail in recent academic literature, with the co-producers sometimes still identified as the clients, users and consumers,⁵³ but in recent debates the co-creator can also be seen as more broadly referred to as voluntary organizations, third-sector actors, stakeholders, and non-governmental partners.⁵⁴ Some scholars such as Pestoff (2012) have also pointed to how in enduring social services, such as eldercare, it is also relevant to consider family members and friends to the immediate beneficiaries of the services as co-creators of these services as well.⁵⁵ As I do not engage in a discussion with the co-creation literature, I have abstained from exploring the relative as such a distinct type of co-creator.

I have done so because I have found co-creation to be only a marginal theme in the empirical material of the thesis. In the initial interviews and observation studies performed at the outset of the PhD process, co-creation appeared as a central theme in the local councils and local eldercare institutions and organizations. However, in public eldercare policy in the form I have

48 Brudney & England 1983; Ostrom et al. 1978; Parks et al. 1981; Whitaker 1980.

49 Alford 2009; 2014; 2016; Alford & Freijser 2018; Bovaird 2007; Brandsen et al. 2012, 2018; Brandsen & Honningh 2018;

Brandsen & Pestoff 2006; Ostrom 1996; Pestof 2018; Pestoff et al. 2006; Verschuere et al. 2012; Waller 2017.

50 Alford 1998, 2009, 2014, 2016; Ansell & Gash 2007; Bovaird 2007; Brandsen et al. 2012; Brandsen & Pestoff 2006;

Bryson et al. 2017; Eijk & Steen 2016; Loeffler & Bovaird 2018; Pestoff 2009, 2018; Wamstad 2012.

51 For a review of scientific literature on co-production in healthcare see Palumbo 2016. See also Eijk & Steen 2016; Femke et. al. 2016; Freeman et al. 2016; Gábor 2018; Hawkins et al. 2017; Hemberg & Bergdahl 2020; Jaspers 2018; Kaehne et al.

2018; MacMullin & Needham 2018; Miles et al. 2018; Nederhand & van Meekerk 2018; Vennik et al. 2016; Vrangbæk et al.

2018; Væggemose et al. 2018; Willumsen et al. 2019.

52 Ostrom et al. 1978; Parks et al. 1981.

53 See i.e. Alford 1998; Alford 2014; Pestoff 2012; Wamstad 2012.

54 See i.e. Alford 1998; Alford 2014; Ansell & Gash 2007; Bovaird 2007; Brandsen & Pestoff 2006; Brandsen et al. 2012;

Pestoff et al. 2006; Van Eijk & Cascó 2018; Vrangbæk et al. 2018.

55 Hemberg & Bergdahl 2020; Mac Mullin & Needham 2018; Miles et al. 2018; Nederhand & van Meerkerk; Pestoff 2012:

21-22.

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constructed it as my point of observation based on documents from LGDK and the national government bodies of eldercare, co-creation has proved to be only scarcely addressed. Thus, the co-creation literature is a less well-suited academic field of engagement when one is studying eldercare policy in this way, as could be expected in view of my preliminary engagement with the eldercare communication of the two local councils of Hedensted and Skanderborg.

After having elaborated on and motivated my choice of overall areas of research in which I hope to situate the thesis, and especially of what debates I have refrained from probing, the next sections address the specific findings of and debates in eldercare research on which I hope to make a mark.