Social milieu and the need for nursing care - A practical example of the effects of (not only) social-economic differences

Josefine Heusinger, Institut fuer Gerontologische Forschung e. V.

The effects of differences between social milieus are amplified when nursing care is needed. This becomes particularly obvious when social and cultural capital are taken into account alongside economic resources. We interviewed people who needed nursing care whilst living at home, their domestic carers and, where appropriate, professional nursing staff. The interviews were conducted twice two years apart, and interviewees were selected from eight social milieus (using classifications drawn up by the German SINUS Institute [1992] following Pierre Bourdieu) in eastern and western Germany. The main questions were about the conditions under which elderly people who need care are able to participate in decisions that affect them, and consequently their pos-sibilities for self-determination. It became evident that the different social milieus have different weaknesses and with respect to the chances care recipients have of making their own decisions. These differences stem from the milieu-specific responses of care recipients and their families to the need for care, and these in turn reflect different expectations of care and attitudes towards the appropriate use of resources. In the working class milieus, for example, the main aim of the families is to save money by doing as much of the practical work as possible themselves. The social networks they are able to draw on are more helpful than in the other social milieus. The social networks in the con-servative upper class milieu in western Germany are quite extensive, but there it is not com-mon to exchange practical help, which instead is usually done by paid carers and domestic workers. This means that in the conservative upper class milieu in western Germany it is lack of money that endangers the self-determination of elderly care recipients, while elderly care recipients in working class milieus lose the ability to make their own decisions when they are taken out of their helping social network, for example if they have to move into accommoda-tion that is specially adapted to their needs.