Ageing and Gerontology

We are the UK’s leading publisher of books on Ageing and Gerontology and our titles fill a clear gap in the current literature. The list interrogates the challenges of an ageing population, push forward knowledge and reframe perspectives.

Central to this are the international and comparative works in the Ageing in a Global Context series, published in association with the British Society of Gerontology, and the Longitudinal and Lifecourse Studies journal.

Ageing and Gerontology

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This chapter demonstrates how ailment mobilises concrete, embodied and emotional responses in immediate social encounters and care work, along with discussing the gendered, racialised and classed divisions of care labour that extend to a global scale. The relatedness and variance inherent in ailment – and care as a key response to it – mean that there is a large degree of unpredictability in the chain reactions that ailment creates. Moreover, as responses to ailment may include neglect, violence and humiliation, a variety of ethical and political identities and structures can ensue. Societal structures and the organisation of care work specifically affect and ail those who have less power, influence and money: typically, working-class women, racialised minorities and international migrants. The varying responses to ailment in the world may be imagined as an emergent and constantly changing network of relatedness and affects that organise societies. Within these local and global networks, those caring for others are also affected by their care relationships and may suffer various kinds of distress, which are discussed in terms of caregiver ailment. Political and institutional actors who ignore the relationality of care and often disregard the needs of the caregiver play a major role in engendering and perpetuating caregiver ailment.

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This chapter introduces the concept of ailment, which is about generalised care needs, including the need for self-care. Ailment does not indicate an immediate dependency on others. Rather, it is a human condition and force that mobilises emotions, actions and relations. Responses to ailment extend from concrete encounters between human beings in the immediate environment to political and institutional responses in societies across the world. The political relatedness that ailment enacts in the world and the different kinds of social orders that emerge through different personal and collective responses to the needs of ailing subjects are discussed.

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This chapter concludes the book by focusing on today’s circumstances, with ailing bodies having become sources of profit making and the ailments of their caregivers largely unacknowledged or misrecognised. It is time to change how humans are perceived. The notion of homo aegrotus – the ailing human – recognises ailment as a permanent and all-encompassing feature of societies. It generates a variety of responses and creates webs of connections between individuals, families, communities, regions and countries. When approaching the field of care with the concept of ailment, a new political regime becomes imaginable. The new political regime derives from ailment in its two senses: the existential state of human ailing, and the affective or responsive state of being bothered by it. The ailing earth is also implicated here, emphasising human interdependency with biodiversity and ecosystems and thus opening possibilities for research into and the development of sustainable, caring policies. From this perspective, large portions of modern societies appear to be built around ailment.

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A New Approach to Care

Deficiencies in old age care are some of the most pressing human rights concerns in mature welfare states.

This book radically challenges the ethics of viewing care as a tradeable commodity and introduces a novel framework for understanding and analysing social care through the concept of ailment. Providing examples from the British and Finnish welfare states, it demonstrates how ailment shapes societies from the micro to the macro level. Addressing the marketisation and financialisation of care, the authors bring to light increasing inequalities in care.

This book argues that ailment is part of human life and society, and therefore the politics of care should begin with a politics of ailment.

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This chapter examines how the marketisation and financialisation of care are transforming and challenging the social and care policies developed during the heyday of the welfare state. Marketisation and financialisation significantly affect these politics of ailment by introducing the mechanisms of profit making, competition and choice as solutions to human ailment and by replacing the ailing subject with a market actor as the target of social policies. Nevertheless, ailment continues to be a mobilising force that simultaneously generates both social and care relations and market and financial activities. The problem with these trends and the neoliberal vision on which they rely is that the logic of the market is different from – and largely incompatible with – responses to ailment that are based on a logic of care. While businesses perceive ailment as producing unlimited market opportunities, they fail as to the more profound recognition of ailment as an existential human condition warranting ethically sound responses such as affordable care.

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This chapter’s sections – ‘Sanctioning the ailing’, ‘Protecting the ailing workforce’, ‘Acknowledging ailment’ and ‘Failing the ailing’ – trace how ailment as a social force has historically manifested itself in social and care policies in western societies. In pre-modern Europe, workhouses and other disciplinary institutions were used to control and sanction ailing individuals. Later, social policies began to recognise the need to protect the ailing workforce to secure the demands of an industrialising world. After the Second World War, social and care policies began addressing ailment throughout the life course, and collective and public responses to the needs of ailing individuals expanded to several areas of life as part of the modern welfare state. The transformation of the welfare state and the austerity politics of recent decades have undermined the acknowledgement of ailment in social and care policies. Through this exploration, it is demonstrated how ailment creates various relations and responses and how these responses combine elements of care, control and profit making to different degrees, depending on the historical, political and social context.

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The framing of old age has long been regarded as being relatively unproblematic, given that old age and decline appear inextricably linked. This connection helps to explain why concerns of the latter part of the lifecourse are regarded as the province of health and social policy. Old age was a period marked out by ‘agedness’, something constituted by both physical need and social dependency (Pickard, 2013). Even the most noticeable marker of old age, the state retirement pension, was a product of the widespread recognition that older workers (in the first instance men) needed a substitute income to compensate them for their inability to work, given the physical limitations accompanying ageing (Scheubel, 2013). Similarly, the health problems of the older population were assumed to be intractable chronic conditions that led to institutionalisation of one kind or another (Trattner, 2007; Levene, 2009). The modern welfare state categorically saw older people as a residualised group incapacitated by their social dependency and individual passivity (Carey, 2016).

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In many European countries a climate of austerity and cuts to health and social care budgets, alongside issues of population ageing, are creating particular challenges in the provision of services for older people in the community (Lymbery and Postle, 2015; Donnelley, Begley and O’Brien, 2018). The introduction of neoliberalism into many European welfare states since the late 1990s has also meant challenges in terms of the reorganisation of social work policy and practice (Milner, Myers and O’Byrne, 2020). Budget cuts have taken place and standardisation has become commonplace, which has impacted on changing legislative and policy drivers for gerontological social work (Ray, Bernard and Phillips, 2018). Social workers have a key role to play in ensuring the participation of all older people in assessments, care planning and decision making in ways that uphold human rights, autonomy and self-determination. The application of a critical gerontological lens is particularly important in a context of neoliberalism and scarce resources, where social workers are increasingly reliant on informal caregivers, mainly family members, to provide care and support to older people, creating challenges and ethical dilemmas in practice situations.

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