Navigating care in rural areas: Strategies employed by older adults with continuing care needs and their impact on social exclusion.

The literature recognizes the great diversity of care arrangements among rural-dwelling older people. However, little is known about the complex relationships between spatial, social and infrastructural characteristics of place and the strategies that older people develop to navigate care. Even less is known about how navigating care impacts social exclusion from the perspective of older adults themselves. To fill this gap, in this secondary analysis we draw on data from twenty-one in-depth interviews from two studies conducted in rural environments in Germany and Poland. We identify three main strategies of navigating care in the rural environment: adaptation to circumstances, making use of the environment, and shaping circumstances. We present details from four cases that exemplify how strategies are interconnected with characteristics of place. The relationships between place and navigating care in rural environments is discussed with reference to the overall level of social exclusion experienced by rural-dwelling older adults with continuing care needs.

[Benefits of supported holidays for the stabilization of domestic nursing arrangements]. / Potenziale betreuter Urlaube für die Stabilisierung häuslicher Pflegearrangements.

BACKGROUND: Situations where people with dementia are cared for at home are associated with a range of stresses and burdens for all involved, potentially endangering the entire arrangement. This article describes the results from the ESPRIT project (funded by the German Federal Ministry of Health from April 2016 to March 2018). The research investigated whether supported holidays for people receiving care and their carers (so-called tandems) positively influence the stability of home-based care arrangements. For this purpose, seven of the holidays organized and carried out by the Alzheimer's Society were evaluated. METHODS: A mixed-methods design was used to evaluate the effort required to organize the supported holidays and the effects on the participants. During five supported holidays these included participant observation and focus groups with accompanying carers. Questionnaires were distributed at 4 points during the subsequent 12 months to collect data from 59 tandems on the impact of 7 supported holidays and their effects on the care arrangement. In addition, the Alzheimer's Society branches documented their expenditure of work for preparation and postprocessing. RESULTS: The holidays improved the carers' everyday coping skills in different ways. Subsequently, the utilization of relieving professional assistance increased. Rest, competency gains and adjustments to the care mix contributed to stabilizing the home-based care arrangement by reducing workload and stress. Public funding for the organization of supported holidays (which is not currently available) would therefore appear to be justified.

[Assistance, nursing and participation in old age : Future of domestic care in cases of care dependency]. / Hilfe, Pflege und Partizipation im Alter : Zukunft der häuslichen Versorgung bei Pflegebedürftigkeit.

The future development of home care services for older people in need of care is associated with great challenges. This article begins with a brief summary of the most urgent care problems from the perspective of people requiring care and that of caring relatives. The problems exhibit social and spatial inequalities and are characterized by coordination problems within a fragmented organizational system. Calls for a viable "care mix" are nothing new but have recently gained considerable traction under the label of "caring communities". This model is prioritized by the German government and addressed in its Seventh Report on Older People (Altenbericht). It seeks to assign neighbors and unpaid volunteers a more central role in the provision of care and assistance. In relation to "caring communities" a differentiation between cure and care is also proposed. The article discusses this model and the assumptions about the potential of neighborhood and civic engagement upon which it is based, and analyzes its impact on the nursing profession. It concludes with a critical discussion of the model's prospects of contributing to a resolution of the outlined problems.