Julia Twigg

Carework as a form of bodywork

The paper argues for the importance of recognising carework as a form of bodywork. It discusses why this central dimension has been neglected in accounts of carework, pointing to the ways in which community care has traditionally been analysed, the resistance of social gerontology to an overly bodily emphasis, and the conceptual dominance of the debate on care. Drawing on a study of the provision of help with bathing and washing for older people at home, it explores the body dimension of the activity, looking at how careworkers negotiate nakedness and touch, manage dirt and disgust, balance intimacy and distance. Finally, the paper draws together some of the key themes of this bodywork: its designation as ‘dirty work’, its hidden, silenced character, the low occupational esteem in which it is held and its gendered nature.

Clothing, age and the body: a critical review

Clothes are central to the ways older bodies are experienced, presented and understood within culture, so that dress forms a significant, though neglected, element in the constitution and experience of old age. Drawing on a range of secondary literature, this article traces how clothing intersects with three key debates in social gerontology, concerning the body, identity and agency. It examines the part played by clothing in the expression of social difference, and explores the role of age-ordering in determining the dress choices of older people, and its enforcement through moral discourses that discipline their bodies. Dress is, however, also an arena for the expression of identity and exercise of agency, and the article discusses how far older people are able to use clothing to resist or redefine the dominant meanings of age. Lastly the paper addresses questions of the changing cultural location of older people, and the role of consumer culture in the production of Third Age identities.

Models of Carers: How Do Social Care Agencies Conceptualise Their Relationship with Informal Carers ?

Carers occupy an ambiguous position within the social care system. Services are predominantly structured around the dependent rather than the carer, and this has important consequences for their delivery and evaluation. Many of the problems that arise in thinking about carer issues relate to confusion over the way the relationship between social care agencies and informal carers should be perceived. The paper outlines three models that provide frames of reference for this relationship: carers as resources; carers as co-workers; and carers as co-clients. The tensions between these are then used to explore the contradictions of policy in this field.

The spatial ordering of care: public and private in bathing support at home

Domiciliary care takes place in a special social space: that of the home. Focusing on the provision of bathing in the community, the article explores the spatial ordering of care at home, unpacking a series of interlocking contrasts between the public and the private, and their consequences for the power dynamics of care. These are explored in terms of the ideology of home; the spatial ordering of privacy within the home; and the treatment of the body. Carework trespasses on and re-orders these divisions. The article also explores the contrasting site of the day centre. Baths at day centres are private acts in public places, and in reversing the symbolism of home, they reveal some of the wider meanings of bathing.

Deconstructing the 'social bath': Help with bathing at home for older and disabled people

Assistance with bathing at home for older and disabled people has long been an area of service tension and ambiguity. Lying across the principal faultline of community care, that of the medical/social divide, it is at the heart of current debates over welfare provision. But exploring the meaning of the ‘social bath’, as it is termed in the field, also challenges some of the traditional ways in which community care has been described and analysed particularly within the discipline of social policy. Bathing involves the negotiation of intimacy and the management of the body, and as such entails aspects of being and of social exchange that have not traditionally been part of the standard, rather rationalistic and disembodied account of social policy. Part of the aim of the paper is to redress this omission. The article explores and deconstructs the three axes within which the ‘social bath’ is defined. The first is the boundary between the medical and the social; and the article outlines the complex and shifting ways, both institutional and ideological, in which this boundary is constructed. The second axis concerns the social meaning of the tasks themselves; and the paper explores recent historical and sociological literature concerning the body, washing, touching and nakedness. The third axis relates to the site where these practices take place: the home. The article explores the significance of home and the power that resides in private and domestic space as opposed to the public medical space of the ward or nursing home.

Dress, dementia and the embodiment of identity.

The article explores the significance of dress in the embodied experience of dementia, exploring questions of identity, memory and relationship. It suggests that clothing and dress are important in the analysis of the day-to-day experiences of people with dementia, giving access to dimensions of selfhood often ignored in over-cognitive accounts of being. As a result clothing and dress can be significant to the provision of person-centred dementia care. These arguments are explored through ideas of embodied identity, the materialisation of memories, and the maintenance, or otherwise, of appearance in care. The article forms part of the background to an ESRC-funded empirical study exploring the role of clothing and dress in the everyday lives of people with dementia, living at home or in care homes, and of their relatives.

The Body in Social Policy: Mapping a Territory

The paper explores the relevance of recent theorising around the body for the discipline of social policy. It aims to show how such work opens up new ways of thinking within the core areas of social policy as well as proposing new subjects for social policy consideration, arguing that the common image of the body as an absent presence that has been characteristic of sociological accounts in the recent past still applies in relation to social policy, but that considerable gains can be made from incorporating this new theorising and new subject matter into the scope of the subject. It explores this by means of six areas of relevance: health care, community care, disability, no-power consumption, as well as cross-cutting themes of age, ‘race’, gender, sexuality.

Architecture and health care: a place for sociology

Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.

Contrasting legal conceptions of family obligation and financial reciprocity in the support of older people: France and England

This paper explores the way family obligation and reciprocity are defined in law in France and England. Focusing on the areas of inheritance and financial support in relation to older people, it explores how these are contrasted and linked in the two societies. In France, families are legally obliged to support their kin through obligation alimentaire, but inheritance is secured by law within the family. In England by contrast there is no such legal obligation to support older relatives; nor is there any constraint on inheritance: testamentary freedom is the legal principle. The paper discusses the significance of these differences and assesses how far they are modified by the operation of the welfare state and by embedded assumptions about family relations. It sets the differences within the context of different discourses of law and social policy in the two countries.

Integrating Carers into the Service System: Six Strategic Responses

ABSTRACT This paper discusses the mechanisms whereby the needs and interests of carers might be integrated into the service delivery system. Over the last decade, informal care has emerged as a major subject for research and discussion, and much work has been undertaken exploring the experiences, burdens and needs of carers. Carers are increasingly recognised as central to community care, but little work has so far addressed the means whereby their needs and interests might be integrated within mainstream service provision. The mechanisms for achieving this are underdeveloped. This paper puts forward six possible strategic responses, and discusses the merits and demerits of each. The responses are: taking evaluation a step further; consumerism; case management; performance or service indicators; rights; and targets. The issues raised in the discussion