lnnovating eldercare. Exploring older adults' peer-to-peer practices in the outskirts of public care

Abstract

The focus of this thesis is everyday care between older adults and their peers who are not family. Public eldercare is also discussed. At first glance, these two issues may seem quite different. Nevertheless, trends in eldercare, including the entry of innovations, together with ageing policy and a strong belief in technology, has brought everyday care between older adults and their peers and public eldercare closer to each other. Thereby, providing new challenges for researchers and practitioners. The aim of this thesis is to explore care between older adults and their peers and to provide both descriptive and conceptual understandings of this phenomenon. Furthermore, the aim is to reason about utilising this type of peer-based care through innovations involving public care. The theoretical orientation of the thesis is influenced by the idea of ‘care practices’ and by practice theory, and thus a practice-oriented perspective on care is adopted. This perspective puts the routine everyday world at the centre of analysis and emphasises action rather than individuals, thereby enabling the consideration of things and materiality in care. For the aims of this thesis, several types of empirical data materials and methods have been used. The data material includes 30 individual interviews with older adults, a survey study comprising the responses from 10 044 older adults and ethnographic observations of an innovation initiative aiming to utilise peer-to-peer based care. These materials have been analysed using constructivist grounded theory and mixed methods. The findings demonstrate that care between older adults and their peers may involve a range of practices and activities. These activities could range from letting another person come knock on one’s door in the middle of the night to fetching the neighbour’s robotic lawnmower when outside its working area. This peer-based care could be characterized by reciprocity as well as being one-way-oriented. Two common forms of peer-based care activity among the participants were social activities and practical or instrumental help. The findings suggest that engagement in these two forms of care possibly links to a lower degree of social isolation among older adults. Additionally, these activities were linked to both sex and age. The findings show that when an innovation involving public care aimed to co-produce peer-based care tensions emerged concerning the logic of this peer-based care and institutionalized logics. These tensions complicated the utilisation of peer-based. The findings also show that some older adults engaged in a variety of peer-based care during the midst of the COVID-19 pandemic in Sweden. Thereby both enabling others to maintain their daily routines and maintaining their own care routines in sometimes innovative ways. The findings from the four papers are integrated to form the concept of ‘peer-to-peer care practices’. To cultivate peer-to-peer care practices through innovations involving public care, the findings suggest that there is a need to (1) take care as the starting point as opposed to the promises of technology, (2) consider who engages in peer-to-peer care practices, (3) consider the creative solutions that those who engage in peer-based care come up with, (4) refrain from assuming shared experiences among older adults, and (5) seek compromises not consensus between different logics.