The Socialization of Dementia: How welfare state politics and cultural change impact living with dementia in community-based care arrangements

本研究项目使用民族志案例研究来分析福利国家的持续转型，关于痴呆症的文化观念和痴呆症的生活经验如何在德国背景下相互关联。在此过程中，该项目旨在审查当前的老年社会化形式及其相关的健康风险。由于痴呆症患者需要高水平的护理工作（护理、援助、情感支持），因此痴呆症患者的护理环境将是主要重点。更具体地说，分析将侧重于新形式的社区护理安排（例如，对痴呆症友好的社区），这种安排目前被宣传为解决一般老年人特别是痴呆症患者日益需要护理工作的一种解决办法。一方面，案例研究旨在阐明福利国家政治的转变（如政府权力下放、护理服务的货币化和市场化、个人及其环境中自我支持资源的激活）如何影响照顾痴呆症患者的日常实践。另一方面，本项目分析医疗化作为一种社会实践如何塑造痴呆症的意义以及护理工作的组织和实现。假设是，基于社区的护理安排是由不同的、部分矛盾的逻辑创造出来的：对痴呆症患者的护理工作面临着削减成本和提高效率的政治压力，而护理人员自己也赞同良好护理的道德规范，这将需要更多的劳动力和时间资源转移到实践中。在此背景下，该项目探讨了当前以社区为基础的护理安排形式是否以及在多大程度上为个人和集体机构开辟了新的可能性，以面对当代福利国家政治以及痴呆症的医疗化。通过进行经验民族志实地研究（结合参与者观察、重点半结构化访谈和文献分析），这是第一个在德国背景下系统探索当前护理部门的结构性自由化和经济化以及痴呆症认知的文化变化如何影响痴呆症患者在社区护理安排中的生活的研究。该项目位于福利国家研究、医学和护理社会学以及老龄化社会学的交叉点；它系统地利用了性别和残疾研究的理论和方法。

This research project uses ethnographic case studies to analyze how the ongoing transformation of the welfare state, the cultural ideas about dementia and the lived experience of dementia are interrelated in the German context. In doing so, the project aims to examine current forms of socialization of old age and its associated health risks. Due to the fact that living with dementia requires high levels of care work (nursing, assistance, emotional support), care settings for people with dementia will be the primary focus. More specifically, the analysis will focus on new forms of community-based care arrangements (e.g., dementia-friendly communities), which are currently advertised as a solution to the growing need for care work for the elderly in general and for those with dementia in particular. On the one hand, the case studies aim to clarify how the transformation of welfare state politics (e.g. decentralization of government, monetarization and marketization of care services, activation of self-support resources within individuals and their environments) influences the everyday practice of caring for those living with dementia. On the other hand, this project analyzes how medicalization as a social practice shapes both the meaning of dementia and the organization and realization of care work. The assumption is that community-based care arrangements are coined by heterogeneous, partially conflicting logics: Care work for people with dementia faces political pressures to cut costs and increase efficiency, while the caregivers themselves endorse an ethics of good care that would require more labour force and time resources to be transferred into practice. Against this background, the project explores if and to what extent current forms of community-based care arrangements open new possibilities for individual and collective agency in the face of contemporary welfare state politics as well as the medicalization of dementia. By conducting empirical-ethnographic field studies (combining participant observation, focused semi-structured interviews, and document analysis), this is the first study to systematically explore within the German context how the current structural liberalization and economization of the care sector as well as cultural changes in the perception of dementia affect living with dementia in community-based care arrangements. The project is situated in the intersection of welfare state studies, sociology of medicine and care, and the sociology of ageing; it makes systematic use of theories and methods from gender and disability studies.