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    Mind the Gap: The Dynamics and Work of Aging and Caring at Home

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    Author
    Penney, Lauren
    Issue Date
    2013
    Keywords
    audit culture
    health policy
    medical anthropology
    place
    Anthropology
    aging
    Advisor
    Nichter, Mimi
    
    Metadata
    Show full item record
    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    In the United States, a growing proportion of the population is aged 65 and older. Associated with this demographic transition is a rise in the number of people who are aging with chronic disease. While there is a cultural ideal for older adults to remain in the community and out of institutional settings ("aging in place"), there is little recognition of the work and experience of trying to accomplish this. In the following papers, I draw on 12 months of ethnographic research in the Southwest US to describe the work of "aging in place." As a starting point, I use Medicare-funded home health care (HHC), which stands at the crossroads of acute-based institutional care and custodial, long-term care. In the first paper, using definitions of place from cultural geography, I explore the work of aging from the perspective of chronically ill older adult HHC users. I illustrate how bodies, practices, and places shift as processes of disease and medicalization inscribe them with risk, and the ways in which people accept, resist, and negotiate these changes. The second paper extends the work on audit culture to describe how Medicare's audit system has structured the organization and practice of HHC, and how this has reinforced the commodification of patients. I note how HHC nurses can draw on personal and professional logics in their documentation practices as a means of resisting rationalizing forces and opening up eligibility for care. The third paper uses case studies to push the literature on family caregiver burden to include the fraught, yet highly meaning-filled experience of caregiving. The cases show the difficulties and ambivalence in providing care to a chronically ill family member. Throughout these articles, underlying the tensions, uncertainties, and gaps I explore questions about what type of care is needed, who is worthy of care, and how responsibilities are distributed. I focus on how people's worlds and work are structured by larger scale social, cultural, and economic forces, and attend to the ways in which they reproduce, contend, and negotiate these forces from their unique positions, in effort to protect what they value.
    Type
    text
    Electronic Dissertation
    Degree Name
    Ph.D.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Anthropology
    Degree Grantor
    University of Arizona
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