University of Amsterdam
Graduate School of Social Science
Master’s Medical Anthropology and Sociology Supervisor: Dr. Kristine Krause
Second Reader: Dr. Anja Hiddinga
Date and Place of Submission: Geneva, 14.08.2019 Word count: 22 026 words
German seniors’ ways of relating in a Polish care home
A study on the messiness of everyday life
Luise Schurian
luise.schurian@gmx.de
Student number: 12278580
Abstract
Due to a growing care-gap in Germany, and neoliberal trends in the domain of care, a small number of elderly Germans is moving to private care facilities in Poland. This research tries to account for these seniors’ daily life, situated in everyday practices. I narrate several situations in which German seniors relate positively or negatively towards their caretakers, other seniors, or the care home and depict how these particular ways of relating emerge. In many of these situations, seniors and caretakers have to deal with limitations in speaking and understanding. I portray relating as an inter-relational activity, emerging in particular situations out of specific relations between things, people, ideas, or objects. In scrutinizing German seniors’ ways of relating, I argue against a common narrative of the care home as a total institution. Furthermore, I call attention to the multiplicity and incoherence of everyday life.
Acknowledgements
In laying out and conducting my research and writing this thesis several people were involved whom I would like to thank here.
Firstly, I would like to thank the residents and staff of the two care homes I researched who were so friendly and open towards me. I am truly amazed to have met such helpful people who in no way hesitated to let me be part of their life, assisted me with translations, let me accompany them without communicating in words and still put so much effort in explaining to me their everyday practices. I am also thankful towards the owners of the care homes who immediately agreed for me to conduct a research in their places, provided me with free breakfast, dinner and lunch, and gave me the freedom to spend time in their care homes however I wanted.
Furthermore, I would like to thank Mariusz Sapieha. Without his help my research would not have been possible. He arranged two care homes for me to conduct research in, accompanied my visits there, assisted me in conducting research, helped me with insights about Poland and gave me feedback throughout my writing in progress.
I would also like to thank my supervisor, Kristine Krause, who inspired me to conduct this research in the first place, accompanied every part of it with helpful feedback and kept me motivated throughout writing.
Table of contents
Introduction 1
Theory and methodology 5
Theoretical concepts 5
The field 10
Methods 12
Ethics 13
Relating in practices of daily care 15
Tying the seniors 15
Interactions with people who do not speak 21
Language in care practices 28
Relating to people and place 36
Locking the doors 36
Translators, or the privilege of being a lipstick-lady 42
Speaking German in a Polish care home 48
1
Introduction
In the beginning of March 2019 I arrived in Pałac Pomarańczarnia1, a private care home
in Poland, close to the German border that, in addition to their Polish residents, also hosted several German seniors. I was prepared to spend three weeks in this care home, researching German seniors’ and caretakers’ everyday practices. Then I would move on to another care home, Spokojny Dom, also a private facility that hosted few German seniors, located in the North of Poland.
These private care homes are part of a wider phenomenon of elderly Germans migrating to Central Eastern Europe for care services. Germany, one of the countries with the oldest populations worldwide, is struggling to provide adequate care-services for its elderly citizens (Horn et al. 2016, 164). These difficulties are rooted in people’s increasing lifespan, changes in gendered divisions of labor (Buch 2015, 285) and are intensified through neoliberal trends in the domain of care (Ormond and Toyota 2017, 139-140). As a result, the number of people in need of care is rising, while respective staff availability is decreasing. Due to this growing care-gap, care-services are increasingly being ‘outsourced’. This outsourcing is stimulating two interrelated processes: care-workers migrating to Germany and older Germans in need of care moving to facilities abroad in countries such as Poland (Ormond and Toyota 2017, 134). Private care homes in former German territories within Poland are particularly common destinations for elderly people from Germany (Pflegeheime & Seniorenresidenzen im Ausland 2018) who can easily afford to pay for private Polish care homes with their pension and payments by the German long-term care insurance2 (Ormond and Toyota 2017, 141). Most of these private
1 Pałac Pomarańczarnia is a pseudonym. I altered care homes’ and informants’ names and irrelevant details about them to render them unrecognizable in my writing. Furthermore, in order to protect my informants, I made the information I collected confidential and stored it safely on a password-protected USB-stick. 2 German policies are aiming to support citizens to organize care privately, instead of providing places in care homes. This support is given through the long-term care insurance, called Pflegeversicherung. However, the money received from the Pflegeversicherung in many cases is not sufficient to pay for the high prices for private care homes in Germany (Ormond and Toyota 2017, 139-140).
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Polish care homes do not cater only to German clients, but also host a majority of Polish seniors3 (Schurian 2019, 2).
What sparked my interest in this transnational landscape of care between Poland and Germany were these private care homes, in which Polish and German seniors organized their day-to-day life together. I was particularly interested in the German seniors who, in addition to the transition to a care home that usually entails changes to practices and routines of everyday life (Hockey 2005, 217), had to construct their life in a foreign country. How did they manage to maintain continuity, I wondered, while being geographically separated from their former home and family, and in the midst of an environment that might seem foreign to them? In order to answer this question, I started to conduct a research in two Polish care homes that also hosted a few German seniors, which entailed my taking part in the daily life of caretakers and seniors over the course of six weeks.
Nonetheless, when I finally arrived for my research in Pałac Pomarańczarnia, conducting it seemed to be more challenging than I had imagined. I had planned to speak to the German seniors and their caretakers in my native language, German. I quickly learned, however, that most caretakers only knew few words in German, not enough to have a full conversation. They were friendly and welcoming and eager to take me along to see how their everyday work looked like. Nevertheless, talking was not really possible and the awkwardness of my position as an obvious outsider, a young German girl coming from a University abroad, was further emphasised by me not being able to have conversations with the Polish staff working in this care home. In addition, the German seniors were not very talkative, since most of them were in need of high levels of care. However, after one week of research, I came to notice that this particular position, in which I could not communicate in language, had certain advantages for my research. I
3 My research was part of a project at the University of Amsterdam with the title “Care outsourcing to Central Eastern Europe: Care migration of elderly to places where care is cheaper (CareOut)”, led by Dr. Kristine Krause. As part of this project, care homes in Poland hosting German residents were mapped, contacted and visited, intermediary agencies interviewed and information relevant to the topic gathered. Some of the information about care homes was collected in interviews which were conducted for this project.
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was now in a similar position as the subjects of my research - the German seniors in the care home who were also not able to speak or understand Polish, and whose everyday life was marked by similar struggles as the ones I had. Moreover, since I could neither focus on what caretakers and seniors were saying, nor rely on interviews or informal conversations, I became attentive towards micro-movements, interactions through touch and the few bits and pieces of German language that were spoken throughout everyday life. Thus, I started to employ a methodology in which I radically focused on practices in everyday life, which allowed me to foreground many aspects in a care home that otherwise would have stayed hidden and to occupy a position which served to better understand interactions in the lives of people who I, in the beginning of the research, perceived as silent.
While navigating through daily life in the care homes, my research question changed. Concepts of continuity did not seem sufficient anymore in describing the daily life of German seniors in an environment in which communicating through conversations seemed to only be a secondary practice. As I struggled to find ways of relating while being a German in a Polish care home, I also became attentive towards German seniors’ ways of relating in this place. In situations in which language was difficult, people seemed foreign and the environment strange, various ways of relating emerged. What crafts these ways of relating for German seniors? I asked myself. Thus, I came to research how ways of relating emerged for German seniors in a Polish care home.
In the following thesis, which is the result of six weeks of research on German seniors living in two Polish care homes, I am going to engage with this question and describe various interactions and situations in which ways of relating are enabled. However, this thesis is also shaped by my own coming to terms with the limitations in language I described above. It is written by a German in a Polish care home and many of the situations I am depicting are going to emphasize how German seniors go about their daily lives when language is difficult, or, how, when talking suddenly becomes possible, new ways of relating emerge. In order to explore these aspects of daily life of German seniors in a Polish care home, I am going to start this thesis with a theoretical discussion,
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which serves me to explain and justify my research question and to account for the theoretical concepts I am going to apply throughout my writing. Furthermore, in this part I am going to depict in detail the care homes I researched, my methodology and some of the ethical issues which accompanied my research. In my third part, relating in practices
of daily care, I aim to portray some of the practices in everyday care-encounters, which
enabled specific ways of relating for German seniors and caretakers. I am starting this part by attending to a practice which I perceived as problematic - tying seniors to their beds - and discuss different aspects of it. Then, I am moving on to describe how, against my own, family’s and outsider’s presumptions, caretakers managed to relate to seniors who did not speak. Finally, I am engaging with the usage of language in care, and depict what uttering specific words in a specific environment may evoke. In the fourth part,
relating to people and place, I am expanding my focus from direct care encounters to
other aspects of daily life in Pałac Pomarańczarnia and Spokojny Dom. By looking at how German seniors interacted with other seniors or specific materialities, I aim to scrutinize how they managed to relate to people, Poland, or the care home. Here, I am beginning by looking at the closed entrance doors of Spokojny Dom and how these closed doors can be restricting, but in some cases also enabling. Furthermore, I am engaging with seniors who acted as translators, facilitating relations between German and Polish seniors. Finally, I am scrutinizing how German seniors’ deal with not being understood while speaking German. By engaging with all these different aspects of German seniors’ life in a Polish care home, I aim to give a voice to people who often are perceived as silent. Moreover, I hope this research will shine a new light on life inside a care home which may be useful to develop better care.
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Theory and methodology
Theoretical concepts
“Every day at around 11 a.m. I accompany the caretakers on their tour through Pałac Pomarańczarnia to disperse drinks to the residents. Also, today we are pushing a silver cart through the hallway. On it, there are silver thermos flasks filled with tea, glass pitchers that contain juice, a small ceramic box with sugar and countless mugs and glasses in different forms, some with lids that make it possible to drink without spilling the content and some plastic syringes. Anna takes one of the cups and mixes juice and tea in it. Then we enter Jette’s room. Jette smiles at us. Anna hands her the tea-juice mixture, but Jette directly puts it on the nightstand next to her bed. Anna urges her to drink: Jette, du musst trinken!4 Jette does not
react. Anna sighs and runs back to the cart to take one of the syringes. She comes back into the room, takes off the lid of the plastic cup, dips the syringe inside and fills it with the mixture of tea and juice. She puts the syringe into Jette’s mouth and slowly injects the drink into her mouth. In the beginning Jette protests, she shakes her head and raises her hands, but then she swallows the drink. After the syringe is empty, Anna tries to dip it into the cup once more. Jette is faster. She grabs the cup and starts to drink herself. Anna smiles and says: Siehst du? Das ist gut.
Trinken ist wichtig.5 Then she opens the drawer of Jette’s nightstand, takes out a
piece of paper and a pen and notes down that Jette drank the required amount for the morning.”
Throughout my research, I observed countless situations in which caretakers urged residents to drink, often against their will. Caretakers were required to keep a close eye on the daily liquid intake of the seniors, since a lack of it would have consequences on their health. The seniors, however, often refused to drink for various reasons. Some told
4 Since a large part of my thesis is about words and language, I chose to include expressions in their original language. The English translations for these expressions will be given in the footnotes.
Jette, you have to drink!
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me they did not want to drink at that particular moment, others explained to me that they did not want to go to the toilet that often. None of these concerns were of relevance for the caretakers. They followed the regulations of the care home, which determined the daily amount of liquid intake for every resident and that each intake had to be monitored closely. These regulations for drinks were just one of many that structured residents’ everyday living - what to eat and when, how often seniors had to be washed, what they should wear and even when they were supposed to sleep. This was all determined by the care home. While describing daily life within such an institution, I could have easily highlighted these aspects of loss of autonomy and pictured the care home as a place of control and restrictions. An institution that assumes a powerful role in deciding upon residents’ possibilities, monitoring them closely, keeping them alive and healthy, and - through this - taking control over their lives. In such common narratives, care homes are often described as total institutions, places which determine every part of their residents lives and in which individuality vanishes (Goffman 1961, 6). In the course of my research, I did come upon such conceptions, sometimes even mirrored in residents’ perceptions of everyday life in the Polish care home. Thus, I am partly going to engage with them while also scrutinizing the powerful discourses in which care homes, and in this case Polish care homes, are conceptualized in a certain way and have an effect on the everyday lives of individual seniors living in such institutions. However, a sole emphasis on different forms of control in these care homes paves the way to explore relations in care exclusively as relations of power. Authors drawing on the work of Michel Foucault have pointed out that care workers’ (Constable 2019, 2), or patients’ (Yates-Doerr 2012, 140) actions then become reduced to either being determined by all-pervading power structures, or to resisting them. While I believe that discourses of care homes as a place of control shape various aspects of daily life within this places, and relations of power determine daily life to a certain extent, other aspects of seniors’ life do not to align with the view depicted above. Daily life in a care home is not coherent and describing how a single discourse shapes German seniors’ understanding of it does not seem sufficient to understand how German seniors construct their life in the foreign environment of a Polish care home. Referring to the various relations that structure their daily life within this place solely in terms of power leaves no space for seniors experiencing anything outside the realm of
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power, such as tenderness, or caressing. In the following chapters, I aim to argue that, while caretakers taking control of residents’ lives and the seniors simultaneously losing their autonomy is one story, daily life in a care home is far more complex. In doing this, I take inspiration from material semiotics, an approach which takes, among others, Foucault’s concept of discourse as a starting point, but evolves to account for the multiple and non-coherent realities of daily life (Law 2009, 149).
Foucauldian approaches are mostly concerned with normalizing discourses that shape the conditions of knowledge and are manifested in specific settings, objects, techniques and buildings which can be studied (Moser 2005, 671). In material semiotics the writer expands his research of fields in which possibilities for knowledge are materialized to other modes of ordering, as opposed to just a singular, coherent discourse, and furthermore puts large emphasis on their multiplicity in changing relations and settings. Nevertheless, material semiotics still borrows from Foucault, as John Law emphasises by calling these modes of ordering mini-discourses (2009, 149). However, while many writers who are inspired by the work of Foucault trace how people’s lives are ordered coherently through the power of one singular discourse, in material semiotics “the
argument is that in practice people slip and move between multiple modes of ordering that coexist, are partially related in complex ways and even folded into each other (Ingunn
Moser 2005, 667-668).” Writers utilising the material semiotics approach suggest to move the field of inquiry to everyday life, where these multiple modes of ordering are articulated, instead of studying “above and about it” as one would do in a Foucauldian fashion (671). In order to achieve a thorough understanding of ordering practices in daily life, the researcher then must limit her or his field of interest - in order to study how people and things6 relate to each other in practice as micro-societies, which are small scale and local
(Pols 2015, 82). In studying the various ways of relating of German seniors in two care homes in Poland, I am inspired by Jeannette Pols’ mode of ordering, described in her writings on empirical ethics of care. While arguing against an ethics of care as a set of rules that is defined outside of care practices (82), she looks into how in everyday
6 The term things in my writing refers not only to material objects, but to all the practices, objects, actors, words, concepts, etc. which are part of the local setting which form the micro-society (Pols 2015, 82).
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attempts to deliver good care, different notions of what is good to do are embedded (83). She explains that, in order to find out more about good care, one has to scrutinize everyday practices, which foreground some things and neglect others, thereby making explicit the goodness that people strive for in their actions (85-86). For instance, Anna’s and Jette’s interaction, illustrated in the beginning of this chapter, reveals that Anna aims to keep Jette hydrated. After Jette refuses to drink, Anna uses a syringe to inject the liquid into Jette’s mouth and writes down the amount that Jette drank, so that other caretakers will know exactly how much she drank and therefore act accordingly. Anna’s actions in relation to Jette, the syringe, the fluid, and the pen and paper she uses to note down the amount that she drank, embed a particular notion of what is good to do here. By looking into what people strive for in daily practices, Pols then takes over goods as an organizing principle in her writing (86-87). In portraying specific details of daily life in Pałac Pomarańczarnia and Spokojny Dom, I aim to make use of Pols’ mode of ordering to explore things that are foregrounded by carers and residents to bring something about that they perceive as good. Mobilizing Pols’ argument allows me to deviate from a single story of loss of autonomy and control of the total institution and therefore account more for relations between people and things that emerge through practices of prioritising things that are believed to be good. Although Pols’ method and concept serve me well to depict some elements of German seniors’ life in the care homes I researched, other aspects I found relevant and which I wish to include in this thesis, again, do not seem to fit into Pol’s mode of ordering. I explained in the beginning of this chapter that the concept of the total institution does not capture German seniors’ relations outside of regulatory power-led activities. Similarly, Pols’ empirical ethics of care does not account for things that are happening next to people’s foregrounding practices. Alongside residents’ everyday strivings and caretakers’ efforts to deliver good care, things are neglected, or even harmed, as we can see in the vignette in the beginning - where Anna overrules Jette’s concerns by forcing her to drink with the syringe. What people foreground in their actions does not always align and sometimes there are tensions in what is good to do (Pols 2015, 87). Furthermore, some of the things that are neglected simply do not embed any notion of goodness and others are solely effects of the practices of people attempting
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to do good. While focusing only on what is foregrounded in order to achieve something that is good, such aspects of daily life vanish in writing.
In this thesis I aim to shine light on how German seniors construct their lives in the foreign environment of a Polish care home. In order to do so, I wish to tell stories of everyday life situations in these care homes and depict daily life as it is: messy and various, situated in moments of pleasure, discomfort, feelings of loneliness and powerlessness, but also in respectful and tender interactions. In some of the situations depicted here, I aim to trace the relations of power, in others the relations that reveal the
good that people strive for. However, in doing so, I will try to be attentive towards and
point to what falls behind and what is neglected. Therefore, as an organizing principle, a framework that structures my writing, I choose to take a step back and take as inspiration an element which I have underlined in both my discussions of empirical ethics of care and different forms of control. Both of these approaches are based on a notion that various kinds of relations determine who we are in specific situations (Pols 2015, 82-83; Foucault 1982, 777-778). While Foucauldian approaches describe such relations in terms of power (Yates Doerr 2012, 137-138), and Pols’ empirical ethics of care attends to the relations that are foregrounded to attain something believed to be good (Pols 2015, 85-86), I aim to focus on relations that are formative for German seniors’ various ways of relating in a Polish care home. In order to account for these ways of relating, I am putting the German seniors in the centre of my writing, as to attend to all kinds of relations around them - relations to residents and caretakers, relations to objects, to language, and ideas. Through these relations, then, multiple ways of relating emerge that do not have to align, and can even stand in tension to each other. As a result, relating becomes what Pols terms an inter-relational achievement, being dependent on relations between people, things and concepts (Pols 2015, 82). In order to leave space to the messiness of daily life in the care home, I am not specifying yet what these ways of relating are - or lay out completely in what terms I am going to attend to them - but rather leave this question to be answered in the course of my writing. I believe that my focus on relating allows me to account for many aspects of situations in daily life, in which German seniors experience pleasure, enjoy themselves, engage with other seniors and caretakers, struggle to
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communicate and find other means to do so. In short, how they construct their lives within a Polish care home.
In order to describe the ways of relating of German seniors in everyday life in a Polish care home, I am making use of various concepts, most of them introduced by authors’ writing in line with the material semiotics approach. Besides being inspired by Jeannette Pols’ empirical ethics of care, I am also making use of her concept of enacting
appreciations as a way to better understand people who do not express themselves with
words. Pols claims that, even if people do not speak, they often reveal in practice whether they appreciate a situation or not. She describes how, in care-encounters, caretakers understand and align their actions to those appreciations in line with the material environment. Thus, people who do not speak are able to enact their appreciations and can, in this way, also be included in research (Pols 2005, 214-215). Furthermore, my discussion of the usage of words in practices of everyday care leans on Annemarie Mol’s analysis of the Dutch word ‘lekker’ (2014, 110), as well as Sander’s and Pomerantz writing on language and social interaction (2018, 106), who claim that language is not an isolated entity, but rather an act that occurs in a specific situation in relation to specific people and things and also accompanies other practices. What words come to evoke is then always dependent on the circumstances in which they are uttered.
The field
This thesis is based on six weeks of qualitative research in two private care homes in Poland, conducted from the beginning of March until the end of April. Both care homes were located in former German areas of the country7 and hosted a small number of
German residents, in addition to their Polish clients. In contrast to care homes in Germany, which are not affordable for many seniors (Ormond and Toyota 2017, 139-140), the Polish care homes I researched could easily be paid for with a German pension and the payments of the long-term care insurance, both of which can also be received
7 After 1945, several areas in the Eastern part of Germany changed their state affiliation and became part of Poland (Hahn and Hahn 2011, 11).
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abroad8 (141). However, for Polish pensioners these care homes were rather expensive.
As a result, they were only accessible for elderly Poles that had wealthy families, many of them working abroad.
Pałac Pomarańczarnia, the first site of my research, was located in a rural area close to the German border, and hosted around 80 seniors. Among them, five came from Germany9. Pałac Pomarańczarnia accepted seniors in every condition, resulting in a
majority of seniors in the care home being in need of high levels of care. In regards to these high demands for care, the care home was seriously understaffed, sometimes only three or four caretakers were available. Furthermore, I learned that salaries paid to the caretakers were rather low, barely reaching the minimum wage. Many of the caretakers had working experience in Germany, resulting in them knowing a few words in German. Due to the seniors spending a lot of time in their rooms, residents’ days in this care home were heavily structured by activities like eating, washing, changing diapers or clothes - routines and everyday tasks that ensure physical and psychological well-being, so-called
activities of daily living (ADL) (Driessen 2019, 9).
Spokojny Dom, the second care home I visited, was located in a district town in the North of Poland. This place was much smaller than Pałac Pomarańczarnia, hosting around 40 seniors, among them four that came from Germany. Many of the seniors living in Spokojny Dom were only in need of basic levels of care. Thus, in comparison to seniors in Pałac Pomarańczarnia, they spent their days more independently, often moving through the care home and socialising in the common room. While the salaries of caretakers here were higher than in Pałac Pomarańczarnia, this care home employed little personnel as well. On most days, there were two or three caretakers present. In this place, none of the caretakers spoke German.
8 According to one of the agencies who organizes German seniors’ stay in Poland, not the full amount of the Pflegeversicherung can be received abroad. Together with the pension, the amount, however, is still enough to pay for private care homes in Poland.
9 Many of the seniors had various connections to Germany and Poland and it was difficult to determine who was German and who was not. Thus, I am basing this number on the seniors that moved from Germany to Poland after having lived in Germany for a large part of their lives.
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Methods
As mentioned earlier, my research has been informed by authors writing in line with the material semiotics approach. By directing my interest towards what is done in daily life in a care home, this approach also affected my research methodology, which largely consisted of participant observations in daily life within the care home. This methodology was not only inspired by a theoretical approach, but also by the characteristics of the field itself. Since many of my informants did not talk, and others did not speak a language I could understand, I learned most about them and their lives in the care home by being attentive towards what they were doing on an everyday basis.
I spent around five days per week, and six hours per day in each care home. I took part in various activities in order to look at daily life within the care home from different perspectives. I shadowed care-workers and joined in their care work while they performed daily tasks. Moreover, I spent a lot of time with the German seniors to find out what their day looks like, and in what ways their daily living activities structured their day. I hung out in different rooms, e.g. the common room, dining room, residents’ rooms, visitor’s room and rehabilitation room/bureau, an activity that helped me observe a variety of practices that differed in each location. Furthermore, I employed the method of guided walks (Ross et al. 2009, 608-610), asking seniors to show and explain to me their different activities and places. Due to the personnel speaking only little German - and many of the seniors not being able to answer questions - I was only able to conduct a few interviews myself. However, asking questions in the form of an interview did not prove useful, and so I relied rather on observations, informal conversations and following seniors during their daily routines.
Since my research was attached to a larger project, I was able to receive help from Mariusz Sapieha, who was working for this project, spoke Polish and was familiar with the objectives of my research. For one week, he accompanied me during my research activities in Pałac Pomarańczarnia. He conducted several interviews and translated for me, but mostly moved through the care home independently, employing participant observation himself. In order to direct his observations into a direction that was useful for
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me, I gave him tasks to find out about specific practices, and the verbal interactions that accompanied those practices. Such tasks included finding out about words that caretakers spoke to the residents while feeding or washing them, how caretakers spoke about the German residents during their breaks, or what Polish residents said about the German seniors in the common room. After each day of fieldwork, we discussed our findings with an emphasis on these tasks and recorded these discussions.
For data analysis, I used Atlas.ti, a qualitative data analysis software. This software served me in organizing my descriptions, interviews and notes, and was helpful in looking for themes in the data, which then helped uncover how these themes related to each other.
Ethics
While I believe my research to be crucial in contributing towards a better understanding of old age as it is situated in practices of daily life, my choice of methodology and the particularities of my field required me to deal with various ethical issues. Taking part in everyday life of German seniors, but also accompanying caretakers during care work led to a strong involvement from my side in both care practices, and everyday struggles of German seniors. As a result, I was complicit in many situations during my research. Some of these situations I perceived as ethically problematic. Inspired by George Marcus’ discussion of complicity as a commonality between researcher and informant in relation to an ambiguous outside world, which allows the researcher to analyse what he might perceive as ethically questionable (Marcus 1997, 100), I did not directly intervene in such situations, but rather closely scrutinized them in my writing. Nevertheless, I discussed my observations of these happenings with the care home while emphasising that I am in no position to judge.
In both care homes, I gained access through the owners of the care homes. I also explained my research to the head of care, who then informed the staff. Nevertheless, I
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tried to explain the objects of my research to each member of the staff individually10, who
all gave their consent to participate in my research. However, since most of the residents did not speak coherently or not at all, I could not ask them for consent to participate in my research verbally. Inspired by Pol’s concept of enacting appreciations, outlined above, by observing what people did, I learned about non-verbal clues that helped me understand whether seniors in the care homes appreciated my presence and could participate in my research (Pols 2005, 211-212). These clues also helped me to assess when people were in a state of well-being and when they were not. I only approached seniors who I thought felt comfortable in my presence. Whenever a seniors showed sign of ill-being, I tried to get help from one of the caretakers to dissolve the research situation. While taking part in the daily life of the care home, I constantly tried to clarify my position as a researcher, as long as it did not disturb care routines. In Pałac Pomarańczarnia this was easy, since my outlook distinguished me from the caretakers and seniors. In Spokojny Dom, where the head of care equipped me with a shirt that resembled the caretaker’s uniform, I had to look for other strategies. In this situation, I explained my position whenever I started a conversation and used my notebook and pen to show that I am there as an observant.
In laying out my research, I was attentive towards the ethical guidelines of the Amsterdam Institute for Social Science Research11. I obtained ethical approval to conduct
this research through my research proposal, which was evaluated by my supervisor, Dr. Kristine Krause, and the fieldwork coordinators of the Medical Anthropology and Sociology Master’s program of the University of Amsterdam, Dr. Rene Gerrets and Dr. Anja Hiddinga.
10 In Pałac Pomarańczarnia I got help from Mariusz Sapieha and the head of care to explain my research. In Spokojny Dom I asked one of the seniors to translate for me.
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Relating in practices of daily care
Tying the seniors
“Martin is finished with his shower. He is in a good mood, smiling at me and Anna and talking a lot in a mumbling, not-understandable manner. He is sitting in the ‘shower-wheelchair’ with a hole in the middle, already wearing the upper part of his pyjamas. Anna slowly pushes the wheelchair towards his bed. As soon Martin sees the bed, his mood worsens significantly. His hands hold on tightly to the armrest of his wheelchair and he stammers: “Nicht die Handschellen.12” His voice
is whiny, he is begging now. “Bitte nicht die Handschellen.13” Anna ignores his
appeal. She grabs him underneath his armpits and heaves him on the bed. She takes his pyjama pants from the nightstand and, one leg after another, puts them on. Martin’s body is following her movements, she makes him stretch his legs and turn, so that she can pull up the pants. On both sides of Martin’s bed are two small leather straps that can be opened and closed with a silver buckle. Anna opens the buckles. Martin watches her and his whole body tenses. Then Anna takes his wrists, first the left one, then the right one, and, slowly and carefully, wraps the straps around them. She closes the buckle and puts her fingers in between Martin’s wrist and the strap to check whether it is not too tight. Martin is not protesting. His tensed body is now sunk into the bed. He silently stares towards the ceiling. It is the only position that he can lie in now, since the leather straps force his hands to be on both sides of the bed.”
My initial idea in researching elderly Germans in Polish nursing homes - and also the reason why I came to Pałac Pomarańczarnia - was to tell stories about the positive aspects of daily life within these care homes. I wanted to challenge hurtful ideas about care homes as places of cognitive decline and social death, places in which personhood vanishes and people are no longer treated as individuals (Higgs and Gilleard 2014, 10).
12 Not the handcuffs.
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However, while I witnessed many moments in which caretakers and other residents enabled German seniors to relate positively, there were other moments I perceived as problematic. Sometimes the actions of carers were intrusive and caused seniors to express discomfort. As an observer who sometimes participated in the care work as well, I took part in these situations and, by not intervening, became complicit in seniors experiencing distress. Such moments were challenging for me, being there made me feel uneasy and doing nothing felt wrong. Nonetheless, there were various reasons for me not to intervene, and I tried to be considerate towards other factors that contributed towards the tying of seniors instead. My attitude was informed by Jeannette Pol’s writing about empirical ethics of care, in which she explains what is good to do in care should not be defined beforehand. What can be understood as good care becomes clear within care-practices that can then be compared to each other. “Each practice embeds a different
notion of what is good to do,” she explains, to then go on: “An empirical ethics description of a care practice reports on the ‘goods’ that patients strive for, the values and norms they in- or explicitly shape, and the ‘bads’ they want to avoid” (Pols 2015, 82-83). Me, as an
observer trying to understand daily life within a care home, could not intervene into care practices on the basis of my own understanding of good and bad. In doing so, I would have put my own values before the caretakers - while being an outsider that did not know as much about daily life in the care home as the caretakers or seniors did. Thus, I am going to start this thesis by describing a practice that might seem bad or unethical to an outsider by looking at the way caretakers want to bring something about that is good within in this practice. Nonetheless, I am also going to reflect on the seniors’ discomfort, while trying to bring the contradicting values underlying the tying of seniors to the fore.
I met Martin for the first time on a tour through Pałac Pomarańczarnia, during which Magda introduced me to all the German seniors who were living in the care home. Before entering his room, Magda stopped me and warned me: “Martin ist gefährlich.14” Back then
I did not know what she meant. The senior that I met seemed calm and nice and we had a short, friendly talk before Magda and I went further. In the course of my fieldwork, however, caretakers warned me whenever I was about to engage with Martin. He
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sometimes hits caretakers, they told me, and whenever I was about to bring a plate, a cup, or any other material thing in his room, they advised me to hold onto it very tight, because Martin might knock it out of my hand. Thus, caretakers understood Martin as someone who might harm himself and others. This is also shown in the following vignette:
“In some cases, Martin is not aware that he is in a care home. Also, right now he does not seem to understand where he is. He is lying in his bed and Magda is about to change his diaper. At first, when Magda is opening the diaper, Martin seems to be disoriented, but curious. He asks calmly: “Was machst du da? Was
passiert hier?15” Then Magda removes the diaper, grabs a washcloth and starts to
clean the more intimate areas of his body. Martin seems to be overwhelmed and screams: “Da nicht! Geh da nicht hin!16” He tries to sit up and hit Magda. Magda
puts the wash cloth aside and walks around the bed, until she faces Martin’s upper body. Without saying a word, she takes Martin’s arms, one after the other, and uses the leather straps to attach his wrists to the bed. Then she goes on to continue washing Martin’s buttocks. Martin calms down, but he is still uncomfortable. “Bitte
nicht,17” he pleads now.”
Martin was physically strong and he disliked care practices that could be intrusive. While opposing such a practice, he tries to hit Magda and, because he was very strong, he would have been able to cause severe physical harm to her. Magda wants Martin to have a fresh diaper and to remove feces from his intimate areas. In order to achieve this, she needs a peaceful atmosphere in which she can attend to Martin’s care needs. To prevent Martin from hitting her, Magda restricts his abilities to move freely. The good Magda is striving for, here, is to clean Martin, and the bad she wants to avoid is his being unhygienic. In order to achieve this good, she needs to tie Martin to prevent him from causing physical harm to her. While Magda might feel bad about her tying, she would feel worse about him lying in his feces, she explained me once. Magda also has physical
15 What are you doing there? What is happening here? 16 Not there! Do not go there!
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strength - in her standing position, she might even be stronger than Martin. She is able to hold onto his arms and to put them in the leather straps. However, by tying Martin, Magda overrules his appreciations. She decides upon his possibilities and leaves no space for him to express his discontent. While striving for good care and preventing Martin from causing harm, Magda now creates a situation in which Martin relates negatively to her.
While Magda’s actions are intrusive and might seem violent, there is more to this story. I learned that caretakers in Pałac Pomarańczarnia were under a lot of time pressure. Pałac Pomarańczarnia hosted around 80 seniors and most of them were in need of high levels of care. Caretakers had to assist them with all aspects of their daily activities - they had to help them get out of their bed, dress them, feed them, wash them, change diapers and put them back into their beds in the evening. In regard to these duties, Pałac Pomarańczarnia was seriously understaffed. During their 12-hour-shifts, care workers ran from one senior to another, trying to attend to them as much as possible, often working without a break. Apart from the challenging nature of care work itself, time pressure and staff shortage contributed to care workers not being able to spend a lot of time with individual seniors. During these stressful shifts, care workers did not only have many tasks to fulfill, they were also responsible for the residents’ safety. In talks with Martin’s family, caretakers had learned that Martin was at risk of harming himself. Martin had lived in a German care home before coming to Pałac Pomarańczarnia. In this care home, doors could not be locked and seniors were not tied to their beds. Martin often escaped from the German care home, which left his family worried about his safety. Moreover, he hurt himself by trying to get out of his bed. His family was relieved that in Pałac Pomarańczarnia freedom of movement could be restricted. The front door could be locked, the rooms closed and seniors could be tied to their beds to prevent them from running away, hurting themselves and showing aggression towards carer. Martin’s family wanted him to be tied to his bed. For caretakers and Martin’s family, tying was supposed to bring him safety. Especially in regards to the large workload and little time the caretakers could invest in each resident, restricting Martin’s freedom seemed to be the only option to prevent him from being harmed.
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However, while the caretakers’ duty was to ensure Martin’s safety, and they wanted to avoid him being physically harmed, Martin himself was not comfortable being tied. When I was alone with Martin, he continuously asked me to open the silver buckle, so that he may move around freely. He explicitly expressed discomfort whenever carers would start to attach the leather straps around his wrists. This is also shown in the vignette at the beginning of this chapter. As soon as Martin notices that he is going to be tied, he tries to oppose it. He grabs onto his wheelchair, pleading for Anna not to use the handcuffs. Without listening to Martin, Anna overrules his wishes. While Anna starts to put the leather straps around his wrists, Martin’s body tenses, showing once more that he is not comfortable with what is happening. In Anna’s actions the intrusive character of this practice is revealed and it becomes clear that there is a tension between Anna’s practices, directed at Martin being safe and Martin’s preferences.
Apart from creating discomfort and negative ways of relating to caretakers, I believe that the practice of tying furthermore limited seniors’ abilities to relate to other seniors or the care home. I often visited Martin in his room while he was tied to his bed. Whenever I started a conversation about something positive, for instance that the cake served during Podwieczorek18 was tasty, or pointing to the sun shining into his room, he
would answer: “Aber ich bin hier festgebunden,19” indicating that being tied deprived him
from enjoying good food and from experiencing the nice weather. By not being able to move, Martin perceived most situations as negative. Furthermore, the limitations on his movements restricted him from engaging in things he might enjoy, like closely watching what is happening in front of his window or feeling the sun on his skin. Martin spent his days tied to his bed, rather isolated, and not being able to leave. Martin did not watch TV or play board games in the common room, he did not engage in walks in the park. He rarely interacted with other residents at all. The view from his bed was constrained: through the window on the other side of the room, he could have a look on the muddy road in front of the care home. Sometimes he was able to spot a passing bus. Otherwise,
18 Podwieczorek in Polish describes a small meal between lunch and dinner. 19 But I am tied here.
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there was his roommate, who spent most of his time in the common room and his hospital-like room with bare walls and little personal items. Being tied was a bad experience for Martin, it made him relate negatively to the things he knew and severely restrained his access to positive aspects of life in the care home, resulting in a lack of relating.
Anthropological fieldwork, as George Marcus pointed out, entails the researcher being involved in changing situations in a complex field, which then again is situated in a broader context. He calls this involvement complicity (Marcus 1997, 100). While, as a researcher, complicity accompanied my every move in Pałac Pomarańczarnia and Spokojny Dom, being complicit in situations in which residents related negatively to caretakers, and observing seniors everyday life being characterized by restrictions, proved to be very challenging to me. As a German who researched German seniors in Poland, I could very much relate to my field and the subjects of my fieldwork, and the actions and situations I observed and took part in were not alien to me. Although I perceived practices such as tying as ethically problematic, I did not intervene. It was important for me to scrutinize such practices closely before condemning them on the basis of my own assumptions. As a tool, then, to closer inspect the tying of the seniors, I employed Pols’ empirical ethics of care. Within the practice of tying the seniors, I found various goods and values, but also bads that had to be avoided. Caretakers’ motivation in tying the seniors was not to harm the people in their care. Their actions were directed at giving good care to the residents. They wished for them to have a clean diaper and no feces on their bodies. They wanted the seniors to eat and drink, and to avoid them to go hungry or to be dehydrated. They aimed for seniors to be safe, to not harm themselves or others, or go missing. However, the stressful conditions of their jobs made it difficult for caretakers to achieve such goals without tying the seniors. At the same time, the values of good care, which caretakers strived for in their actions, were not shared by the residents. Tying made them experience discomfort and relate negatively to care workers. Furthermore, tying restricted their movements to such an extent that they were deprived of relations with other residents and other positive aspects of daily life in the care home and thus, lead to non-relating.
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Interactions with people who do not speak
In the last chapter, I focused on one German senior’s experience with the practice of tying, and how this practice let him to relate negatively. This chapter deals with German seniors who, in the beginning of my research, I believed to be unable of relating at all: seniors who did not express themselves in words. In conducting research, I was inspired by the sociologist Stefan Hirschauer. While emphasizing the importance of descriptions in social science research, he argues to shift attention towards the silent, the voiceless, and the mute. Social practices cannot be found in language alone, he explains, and researchers should focus their descriptions on what is not yet in words (Hirschauer 2006, 438-439). Especially in the case of Pałac Pomarańczarnia, this approach proved to be very helpful. There was not much told in words: German residents’ lives in this home were rather silent, and by focusing solely on what was spoken I would have captured very little of the many encounters and situations that made up daily life. Some seniors could not speak, others chose not to and many of the residents were not understood. As a result, back-and-forth conversations between seniors and caretakers were rare and even rarer between seniors and seniors. Spoken communication, in many cases, was limited to single words that accompanied practices. Many seniors’ everyday life, I learned, could not be grasped by analysing back-and-forth conversations, but rather in practices and encounters in a specific setting. Residents’ days in the home were structured by activities of daily living. Almost all of the seniors required help from caretakers to perform these activities. Inspired by writers like Jeannette Pols (2005, 210) and Annemarie Mol (2008, 9), I understand these routine care encounters as situations during which various ways of relating emerge in interactions with the social and material environment. By depicting how caretakers enacted seniors in everyday care situations as people with preferences, I am mobilizing their argument to attend to the most dependent residents in the care home - residents that did not express themselves in words. In the beginning of my fieldwork, I did not know how to include them in my research. Influenced by what other residents and Dawid, the owner of Pałac Pomarańczarnia, had told me, I understood them as mute, motionless and not being able to express themselves in any way. However, inspired by Mol and Pols, I became attentive towards micro-movements and touch in everyday care situations. By observing these practices and speaking with caretakers, I quickly learned
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that people who do not speak are interacting in many ways with their carers. I understood how carers came to know silent residents as people with preferences and by enacting their appreciations how different ways of relating emerged in everyday care situations.
Let me begin by telling how I got to know Wiola, one of the residents in Pałac Pomarańczarnia, who did not speak. Before I met Wiola for the first time, Dawid had already told me that she was the most dependent resident in the care home. In Germany, she had suffered from an aneurysm and had fallen into a coma afterwards. After she awoke from the coma, her daughter had arranged for her to stay in Pałac Pomarańczarnia. Now, Dawid had explained to me, she was not in a coma anymore, but she was still unconscious. Wiola did not speak and did not move a lot, either. Throughout her day, caretakers washed her, changed her clothes, fed her through a tube and corrected her position in the bed. At first, when I accompanied caretakers into her room, I was prejudiced by the owner describing her state as similar to a coma, and understood such care-encounters as one-sided. Caretakers did not talk while performing their tasks, and Wiola barely moved. However, the more I became attentive towards detail, I learned that caretakers and Wiola were interacting. Caretaker’s actions revealed that they knew her as someone who notices touch and who likes certain things. Furthermore, Wiola herself, despite not moving arms and legs, reacted to the caretakers’ actions, and in this way also interacted with them. This becomes apparent in the following vignette in which Magda and I were checking up on her:
“Magda and I visit Wiola. She lies almost motionless on her bed. On the bedside table is a basket filled with cosmetics. There are flowers on the windowsill, and a large picture of holy Mary, printed in gold and red. Wiola’s hair is shaved and her painted-on eyebrows and eyelid lines seem to be permanent, they stand out in her otherwise pale face. Since our last visit in the morning, Wiola sunk down in her bed. Magda quickly walk towards her bed and pulls away her blanket, exposing her in her girlish nightgown. As soon as her blanket is gone, Wiola’s eyelids start to flutter. Magda looks at Wiola’s face and notices her eyelids, opening and closing very fast. Magda lets go of the blanket and slowly walks around the bed to Wiola’s
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left side. With her right hand she strokes Wiola’s short hair and shoulder, while glancing towards her face. Wiola’s eyes now stay open and her pupils move into Magda’s direction. Magda seems to have waited for Wiola’s glance, since she now looks away from Wiola’s face and starts to approach her. She turns her full body towards Wiola and grabs her underneath her armpit to pull her up until Wiola lies straight. She also corrects Wiola’s clothing, her girlish nightgown has shifted, exposing her underpants. Then Magda pulls the blanket a bit higher, so that it covers most of Wiola’s body. The whole time, Wiola’s pupils follow her movements. As we are about to leave, Maria returns to Wiola’s bed and presses her left hand. Then we move on. ”
In this case, Magda’s and Wiola’s interactions reveal that, contrary to my first impressions, Wiola was not unconscious and Magda understood her as someone who is aware, able to react and to have preferences. Firstly, Magda recognizes Wiola as someone who senses her and is able to respond, becoming apparent in the way she approaches Wiola after taking away her blanket. Wiola’s eyelids flutter, which Magda seems to read as a sign of distress. She seems to understand that Wiola is able to perceive the blanket being removed and to react on it by moving her eyes fast. This is shown in Magda coming close to Wiola and touching her carefully after noticing Wiola’s eye-movements. Caretakers were unsure whether Wiola could hear or understand them when they were talking. Thus, instead of speaking, Magda uses touch to calm down Wiola, making explicit that she sees Wiola as someone who notices touch in the first place. Wiola reacts to Magda’s touching - her pupils move into Magda’s direction, indicating that she is aware of her being there. Only after Wiola stops moving her eyelids and glancing at Magda, Magda continues with her task: correcting Wiola’s position and clothing. Therefore, after sensing Wiola’s distress, Magda calms her down and makes her aware of her presence. Before continuing with care-activities that could be perceived as intruding, Magda is waiting for Wiola’s reaction. These actions convey that Magda does not see Wiola as unconscious. She seems to understand that Wiola can notice touch and through this her presence as well. Furthermore, Magda is aware that Wiola can express herself by moving her eyelids and her eyes. She links Wiola fluttering her eyelids to her being in discomfort and interprets
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Wiola’s pupil’s moving into her direction as a sign of approval to start with the care work. Magda does not just act on a motionless body, as I thought in the beginning of my research - she interacts with Wiola. Moreover, Magda’s actions reveal that she understands Wiola as someone who likes and dislikes certain things. She assumes that Wiola does not like to be approached without a warning, and that she likes to be touched gently. By acting in this way, Magda shows that she sees Wiola as someone who appreciates some things and does not appreciate other's, and that, by moving her eyes, is also able to express these appreciations. Furthermore, by being attentive towards Wiola’s reactions, Magda relates to Wiola and in turn, by performing care work in a way that Wiola seems to appreciate, enables Wiola to relate towards her.
The situation that has been described and analysed here contrasts with what I heard first about Wiola - her being unconscious, her being motionless, and her being not able to express herself. The way caretakers attend to Wiola reveals that she is perceived as someone who senses people and things touching her, who likes and dislikes certain things and is able to express discomfort and appreciations. By describing Magda approaching Wiola as someone who has preferences, I am linking my writing to Jeannette Pols, who, in her work, talks about enacting appreciations. She explains how rather silent residents of care homes can be given the possibility to enact appreciations - in other words, to convey in their actions what they do like and do not like (Pols 2005, 211). As explained above, caretakers certainly understood Wiola as someone who is able to appreciate or not appreciate, and enabled her to enact these appreciations by moving her eyes. In this way, they interacted with Wiola as a conscious being and established possibilities for her to relate positively. This was not only true for Wiola - other residents were able to enact their appreciations as well, even though they were not communicating with spoken words.
Martha was also one of the silent residents. Before coming to Pałac Pomarańczarnia, she had lived in Hamburg all her life. Shortly after her husband had died, she started showing signs of dementia. Her daughter and her partner, a full-time working couple, did not have the time and resources to care for Martha at home,
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especially because Martha’s condition soon required her to be under constant supervision. Having heard about care homes in Poland on TV, they arranged for her to stay in Pałac Pomarańczarnia. During an interview with me, the couple continuously emphasised that it did not matter where Martha lived, since she did not perceive anything that was happening around her. “Her mind is empty,” her daughter told me while explaining why they stopped visiting regularly. I believe, however, that the caretakers’ actions that are described in the following passage show that Martha was not only able to perceive what is going on around her, but also to communicate her preferences to her environment.
While Martha could not get up on her own, she was able to move in her bed and, provided that food and drink were directly in front of her and in the right container, eat and drink on her own. Often, when there was not enough staff to help her into her wheelchair, she ate in her bed. This is also the case in the following vignette, where Katarzyna and I are coming to her room to bring her something to eat:
“It is time for Podwieczorek. Katarzyna and I are entering Martha’s room. Katarzyna is holding a small ceramic bowl with yoghurt and a plastic mug with a special lid that allows to drink without tea being spilled. It is filled with a red mixture of tea and juice. Martha is lying in her bed, awake. Half of her body is covered with a blanket and behind her is a large pillow, supporting her to sit up. Directly in front of her, attached to her bed, is a movable tray. As soon as she notices us, she starts to smile. When Katarzyna places the ceramic bowl on the tray, she stops smiling and quickly moves her hand to push the tray away. Katarzyna shrugs her shoulders and places a spoon next to the bowl. ‘Spaeter, ja!20’, she tells to Martha
in a commanding voice. She hands the plastic mug to Martha and Martha grabs it with both of her hands. With some effort she moves the mug up to her mouth, takes a sip and, again, refuses. She puts the mug on the tray, next to the yoghurt and, once more, pushes the tray a little further away from her. Katarzyna takes the plastic mug back to the cart, opens it and fills one spoonful of sugar inside. She
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stirs, then closes it again and hands it back to Martha. ‘Trinken!21’ Martha takes a
sip and smiles again. She keeps the mug in her hands, then takes sip after sip. Katarzyna watches her drink half of the cup, then she says: ‘Okay’ and puts her hand on Martha’s.’”
Here, Martha is making Katarzyna understand that she does not want to eat by moving the tray away from her and by resigning from her smile. She does not need to talk, her gestures and mimics are enough. Her movements are immediately understood by Katarzyna. She accepts Martha’s wish to eat later. Furthermore, the material environment has been adapted to her needs: the movable tray makes it possible for Martha to reach for the food on her own, so she may eat whenever she wants. However, when Martha refuses to drink as well, Katarzyna doesn’t agree. Every resident has to drink a certain amount every day, Martha too. But instead of forcing her, Katarzyna tries to change her mind. Martha has lived in the care home for a long time already and based on countless care encounters, Katarzyna knows that she likes to drink her tea very sweet. By putting an extra-spoon of sugar into her drink, she uses her knowledge of Martha’s habits to change her mind. Because the social and material environment allows her to, Martha’s can express her appreciations and they are acted upon. “Patients enacting appreciations are part of a material and social situation in which their appreciations are located and by which they are co-produced,” Pols writes. She continues, “in these local co-productions, the appreciation of patients become understandable not primarily by talking, but by describing practices (Pols 2005, 215).” Various interactions and materialities make up this situation, in which Katarzyna is serving Martha Podwieczorek.
Wiola and Martha both do not speak and do not move very much either. They both spend most of their days in their beds. While, at first, interactions with people in such a situation might seem one-sided and communication impossible, foregrounding micro-movements and detail during everyday care encounters enabled me to view residents the same way as their carers did. Caretakers, as I described before, interacted with people who others believe to be impossible to understand on a daily basis. Through touch,
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waiting, materialities, speaking and other practices, they managed to relate to the seniors and, in turn, enabled seniors to relate to them. Relating, then, enabled seniors to react to caretakers’ actions, by moving eyes and pupils, frowning, or pushing away a container with tea. Thus, caretakers and silent seniors interacted. In these interactions, caretakers conveyed that they perceived so-called silent residents as people who appreciate some things and not others. Even though neither Wiola nor Martha could have a long conversation about how they would like to be cared for, caretakers understood them through their actions, based on a knowledge about their preferences and their habits. They knew about Wiola’s eye-movement and that Martha preferred to drink her tea with a lot of sugar in it. By putting into words what caretakers do in everyday care situations, and describing different ways in which they relate to their clients and through that open up possibilities for interactions I hope I could shine a different light on residents that were perceived as silent.
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Language in care practices
Even though the situations described above do not include a back-and-forth spoken conversation, and interactions with German seniors can not only be described by what was spoken in the care homes, words are still uttered. While serving Podwieczorek to Martha, Kartarzyna says “Spaeter, ja!” in order to signal that Martha can eat later. She urges Martha to drink with the imperative “Trinken!” and after Martha drank enough, Katarzyna stops her by saying: “Okay." Katarzyna does not only speak to Martha, she speaks to her in German, a language she herself does not know very well. Of course, care work is not based on speaking the same language - or speaking at all. Care-work is being done. Nevertheless, excluding words from analysing care practices does not do justice to the situation. Care work consists of a variety of practices, and the words spoken cannot be separated from the setting - the same way the setting cannot be separated from the words. As Annemarie Mol explained in her discussion of the Dutch word lekker, words do not just describe a “reality out there” - they “may also participate in a reality here
and now” (Mol 2014, 95). In changing situations, words can refer to, evoke, and create
links between various meanings or happenings (97). This is also foregrounded in a body of work on language and social interaction research (LSI). “Communicating a message is
just one possible purpose for saying something, one possible action that gets done”
(Pomerantz et al. 2018, 106), Sanders explains. Thus, it is of relevance to focus on what people are doing while they are talking. Speaking is a situated practice, and saying something can be differently motivated. Only by describing situations in which the use of language is entwined within a practice, it is possible to find out more about what occurs when words are spoken, and thus understand more about why they were told and what they evoke (Pomerantz et al. 2018, 106). By looking at what happens while certain expressions in a specific language are told during everyday care practices, I aim to find more about how language in care does not just transmit a message, but also allows residents to relate positively to caretakers. In the following, I am going to engage with words spoken in Polish and German. Since I do not speak Polish, I asked caretakers after care encounters to spell out expressions I noticed, meaning that the words written down here could deviate from what was actually spoken. I chose to include Polish expressions in this text to emphasize that the caretaker here spoke in a language that the German
