Wspólnotowy Serwis Informacyjny Badan i Rozwoju - CORDIS

Book chapter: Soziale Ausgrenzung im Alter und häusliche Pflege

Within the book chapter the concept of social exclusion is discussed and transferred to the issue of care-dependency in old age and elderly care approaches. In a next step, on the basis of a literature review on the development of elderly care approaches in Europe and on the basis of an empirical study on the development in Germany, characteristics of elderly care approaches are assessed.

In the conceptual part the basic features of the concept of social exclusion, which have been developed within international comparative welfare state research, laid out and combined with findings of the research areas social-gerontology and elderly care. The multidimensionality of the concept of social exclusion requires a definition of a multidimensional ageing process, which reveals the different dimensions of ageing and the role of care-dependency. Processes of social exclusion are strongly related to different types of inequality putting women, members of the lower classes and migrants at a disadvantage. The discussed concepts and findings make demands on the further development of elderly care approaches. Basically, it needs a comprehensive and integrated care arrangement including both formal and informal care oriented towards different social groups in society and universal access to care services on the basis of social rights.

In the second part the analysis of the changes of elderly care approaches in Western Europe reveal an expansion and diversification of care facilities. Further, in particular in continental Europe new separate tax- or insurance based schemes have been introduced to cover the costs of elderly care. However, the benefits are often oriented towards basic nursing care and social needs are neglected. In addition, the expansion and diversification of services in accordance with efforts of privatisation enhance the fragmentation of services and thus impede the establishment of a comprehensive care arrangement. The analysis of the German situation showed a specific type of fragmentation in particular between basic nursing care delivered within the framework of the long-term care insurances and the social services at the local level. It is also characterised by a high level of social inequality with regard to the use of home-based care services, residential care and with regard to the situation of informal family carers. Informal family carers of lower socio-economic classes are only rarely supported by formal care services. In addition, women of the lower socio-economic classes are overrepresented in the use of residential care in nursing homes.

The chapter is published in a book, which is oriented towards researchers in applied social or health science, practitioners or social policy experts. Books of the series are widely used and discussed. The chapter can open up the debate for the new topic on social exclusionary processes in old age and adequate elderly care approaches. In particular, the emphasis on social care and the interplay of different dimensions contribute new perspectives to the debate.

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