Questions about who should provide care for older people provoke lively debates not only in Western countries but across many regions world-wide. From retirement migrants from the United States of America (USA) seeking better (cheaper) health care in Ecuador, to Surinamese returnees from the Netherlands seeking a ‘gentler’ way of life in their homeland, ageing and care present new challenges for individuals, families, service providers and policy makers. This is, however, not to suggest that older people are passive recipients of care. As active agents, they often make pragmatic decisions based on resources, relationships and needs. For example, middle-class families in Tanzania can draw upon a range of resources both locally and across the diaspora to access diverse forms of care and support. Upon retirement, former gastarbeiter österreich, actively negotiate with partners and children about whether to remain in Vienna or return back home to Turkey. Some choose to split their time between the two locations. Tibetan refugees living in long-term settlement camps in India may decide to stay put, in close proximity to caring relationships with friends and neighbours, rather than join their children in long-distance migration.
Older people make decisions based on the available knowledge and resources. However, sometimes these decisions are shaped by dreams and aspirations which are not borne out in reality. For older Nepali-Bhutanese refugees reunited with their families in the USA, the reality of ageing in the USA may be very different from what was hoped and anticipated. Loneliness, isolation and unfamiliarity with a new language and customs may cause a deep sense of alienation for older people. Indeed, even relocating within a country, in the case of rural Tuareg elders who join their children in cities across Mali and Niger, may cause a loss of status and authority.
These are some of the rich ethnographic case studies discussed in this excellent and highly engaging new collection edited by Azra Hromadžić and Monika Palmberger. The scene-setting introduction, by the editors, eight chapters and an epilogue by Sarah Lamb, all speak to each other and engage with shared cross-cutting themes which add to the overall coherence of the collection. Rather than taking for granted the availability of caring relationships, the contributors critically interrogate how discourses, narratives and assumptions about care are negotiated and experienced in changing contexts. Going beyond a simple dichotomy of ‘warm’ (familial) versus ‘cold’ (institutional) care, the rich ethnographies reveal the complex and dynamic practices of care within and across borders. As Sarah Lamb, in her epilogue, reminds us: ‘We are witnessing the confluence to two extraordinary phenomena: population ageing and population mobility … These inter-related processes necessitate new ways of thinking about eldercare’ (p. 171).
The neoliberal strategies of commercialising care make ‘state of the art’ care available to those who can afford it, while simultaneously reducing state provision of care and, as a result, increasing the pressures on families, especially women. Lamb explores the impact on women of the ‘sandwich generation’, those of working age who find themselves squeezed between the needs of ageing parents and the care needs of their own dependent children. The impact of reduced state provision is vividly demonstrated in the case of the Balkans where health and care services have drastically reduced since the fall of communism, leaving a vacuum in provision especially for older people who have been displaced and traumatised by war. Drawing on Joan Tronto's argument that care is a ‘tool for critical policy analysis’ (p. 114), this collection offers new insights from a diverse range of case studies. Spreading across Africa, Asia, Europe and North, as well as South, America, the rich ethnographies bring to live stories of elder-care across distance. As well as early career researchers undertaking new, innovative research, the contributors also include established scholars who have been working in the field for many decades and who can draw on a wealth of longitudinal data. For example, Susan Rasmussen's work over many decades with the nomadic Tuareg peoples in Africa and Ann Miles’ work on Ecuador both show significant change over time as apparently ‘traditional’ ways of life in small local communities are impacted by wider global, geo-social forces. The associated impact on relationships and care are especially apparent for older people.
The rich ethnographies in this collection clearly demonstrate how care and ageing are mediated not only by distance but also by socio-economic class in its complex and dynamic intersections with gender, ethnicity, citizenship and, in particular, immigration regimes. Nowhere is this more forcefully apparent than in the case of ageing refugees in resettlement camps whose lives are seemingly ‘on hold’ while they await immigration decisions that will shape their future wellbeing and access to care.
