The vicious circle of familism in housing and care during Covid-19 in Greece.

Dr Myrto Dagkouli Kyriakoglou is currently a post-doctoral researcher interested in the relation between housing practices, welfare state and the notion of family. Her PhD in Urban Studies at the Gran Sasso Science Institute, focused on the interconnections of family housing support with gender, sexual orientation, ethnicity and austerity in Athens, Greece during 2017. During my post-doc in the Institute for Urban Research at Malmö University I plan to explore the impact of family housing strategies on short-term rental activity in “post-crisis” Greece and Sweden as well as the gender dimension. Because of the emergence of Covid-19 related crisis I am currently investigating its impact on housing and family as well as related coping practices in Greece.

The vicious circle of familism in housing and care during Covid-19 in Greece.

COVID-19 impacts all aspects of family life and inter-generational relationships, through housing and informal systems of social care in Greece. In the centre of the political discourse is home and its association with care.

‘Stay safe’ is the wish among people both in personal and work-related communication as well as the “order” from the state officials all around the world in countries that have been affected by Covid-19. This injunction is often paired with ‘stay home’. Even in the case of states with the luck of adequate healthcare without extremes of healthcare inequality, people are strongly encouraged to stay safe at home and within their own means as long as possible. ‘Self-care’ is highlighted as a one-way street both from the government and from the people who realize that the healthcare system cannot support them efficiently. 

Care provision in Greece is mainly self-regulated by the family and the kinship network. Home was in the centre of official and informal campaigns that recommended strongly or ordered people to ‘stay home’ in order to stay safe. For achieving that according to officials’ recommendations worldwide (WHO, 2020), one should have a safe home with high hygienic standards and care support. These parameters: home and care are inevitable connected with family and especially women in the Greek situation.

The importance of the social institution of family in Southern Europe has deep historical roots (Ferrera 2010). The Greek state was always inactive in this field, promoting home-ownership and framing housing as a self-regulated need supported by favourable taxation. Housing fortunes are dependent on family welfare and people enjoy the housing solutions that each family could offer. Family members employ specific housing strategies to strengthen family welfare by collectivising problems and means, providing care services and maintaining a residential, financial and/or sentimental proximity to family members. This scheme of kinship’s proximity and reciprocal support provides security and financial relief to family members (Mantouvalou & Mavridou, 1993). The close proximity of extended family homes has always been a favoured pattern, as it facilitated intra-family care services (Allen et al., 2004; Maloutas, 2008). Familistic housing strategies include the late emancipation from the parental home, intergenerational co-residence, and residential spatial proximity to members of the same extended family.

Extended intergenerational cohabitation in Greece is a culturally accepted practice as 55% of people aged between 25-34 live with their parents (Eurostat, 2018). Extended stays or returns to the parental home can be explained by the poor performance of the labour market, the absence of welfare support for housing, the limited availability of high quality and affordable rented housing and the cultural norm of relying on the family (Serracant, 2015; Minquez, 2016). Considering the above, many Greeks are supported by a ‘cushion’ of intergenerational solidarity and family welfare (Serracant, 2015) resembling a ‘substitute for the limitations of state intervention’ (Martin, 1996, 31). 

Proximity of family and kinship households is also a practice that is connected with the activities of family welfare. One particular concept that involves housing provision and proximity is the ‘family polykatoikia (apartment building)’. It regards a detached house that is owned by a family and is extended in order to accommodate other family members, especially the oldest and youngest (Mantouvalou & Mavridou, 1993). Parents invest in this scheme (of the family polykatoikia) in order to produce more houses in their plot. They do this by adding extra floors, thus creating a construction that is many storeys high. Inside these buildings, family members live almost exclusively, meaning that a stranger may be faced with mistrust and hostility. The vicinity of family households also produces an area of support in terms of family welfare, with child or elderly care and general repairs taking place here (Allen et al., 2004).

The main care-provider in the family is the woman with her unpaid work and dedication to kin’s needs. The reciprocity of support across generations inside the ‘welfare society’ (i.e. families, extended relatives and neighbours) is assisted by women’s devotion to and work done for their families (Martin, 1996). The work conducted by women includes informal healthcare services; caring for the frail, the elderly and the young; helping with housework; shopping; and providing companionship (Vaiou, 1996) activities that were brought to the spotlight during the new crisis but still without recognising the ‘Carer’.

Family welfare is both the weapon and the weakness of people in Greece against the new Covid-19 related crisis. It is a system that contains its own inequalities but when resources and capacities permit, this institution guarantees housing and care support for its members in need but on the other hand it does not allow the necessary distance between people in risk. Informal carers can, of course, be virus carriers. The way this supportive network is structured with co-dependency and proximity does not allow for people, that have to, to isolate. In the absence of housing and care provision by the welfare state, its self-regulation is a one-way that may lead to a dead-end as its structure may damage the whole effort.

Indicatively, old or people at risk live in the same house or in the same family polykatoikia with people that are still working, kids that are going to school or active in external activities (when possible within the related measures) and may bring home the virus. On the other hand, those who at risk do not suffer from loneliness as they are experiencing this tough period together with their loved ones even though they may be the ones to risk their wellbeing because of this proximity.

Even vulnerable people that do not live in proximity with their kinship network are assisted mainly by their relatives. This situation may be safer for them even if they feel lonelier. However, a support network that it is not comprised of or supported by professionals in healthcare may sometimes inadvertently put the supported person at risk. The main carers – usually the female members of the kin – are typically over-burdened by care activities that are now more demanding both inside their household but also at dependent family households. This puts family and especially women under a lot of pressure in a period with significant stress and insecurity.

Family housing and care strategies that involve cohabitation or proximity often lead to a lack of privacy and isolation. Privacy is a luxury that ‘in each civilization, as it advanced, those who could afford it chose the luxury of a withdrawing place’ (Schwartz, 1968, 743). According to this, people in Greece today do not have this luxury as housing is supported by strategies that sustain and strengthen the institution of family and its members’ interdependence. Nowadays isolation is not only a luxury but a necessity for certain population groups, ironically they are also the ones that are the most dependent on care services that are granted by the family and this seems like a vicious circle.

This new crisis is piled on top of the previous global financial crisis that stagnated the country economically and socially, shrinking the family’s resources and capacities to offer support to its members. However, the state still relies on these informal institution and functions in order to avoid the cost of welfare. For more than a decade, economic stagnation is threatening the strongest pillar of Greece’s familistic society – the main welfare provider, the family (Moreno & Mari- Klose, 2013) –removing any cost obligation from both employers and the state (Papadopoulos & Roumpakis, 2013). The future forecast is extremely worrying for Greece as it is going to be the most affected EU country financially with a downturn of around 9,7% and unemployment rising to 20% in 2020. Even during the previous period family absorbed the turbulence created by the crisis by offering housing and care solutions to its members but its deficits were coming into stagnation. For how long can family and especially women bare this heavy burden of care and housing provision and how safe is that in the new circumstances? As long as state exploits the self-regulation of the crises’ problems, there is no exit from the vicious circle but a rapid spiral path to family exhaustion. 

Author contact details:
Dr Myrto Dagkouli Kyriakoglou, Postdoctoral Researcher
Project CRUSH in Institute for Urban Research
Department of Urban Studies
Malmö University

References 

Allen, J., Barlow, J., Leal, J., Maloutas, T., & Padovani, L. (2004). Housing and Welfare in Southern Europe. Oxford: Blackwell Publishing/RICS Foundation. ISBN: 978-1-405-10307-7

EUROSTAT (2018) Bye bye parents: when do young Europeans flee the nest? https://ec.europa.eu/eurostat/web/products-eurostat-news/-/EDN-20180515-1

Ferrera, M. (2010). The South European Countries. In F. G. Castel, S. Leibfried, J. Lewis, & C. Pierson (Eds), The Oxford Handbook of the Welfare State (pp. 616-629). Oxford: Oxford University Press. https://doi.org/10.1111/1478-9302.12016_65

Mantouvalou, M.; Mauridou, M. (1993). Illegal building: one way to dead end. Bulletin of Architect's Society, 7, Period B. Retrieved from: https://docplayer.gr/31082424-Aythaireti-omisi-monodrouos-se-adiexodo-maria-mantoyvaloy-maria-mayridoy.html (in Greek).

Maloutas, T. (2008). Housing models and family strategies in Greece. In Carlos, M. (ed.), The Challenge of Social Policy Reform in the 21st Century: Towards Integrated Systems of Social Protection. Athens: Kritiki Publishing. Retrieved from: https://www.academia.edu/21281309/_2008_Housing_models_and_family_strategies_in_Greece_in_The_challenge_of_social_policy_reform_in_the_XXI_century_Towards_integrated_systems_of_social_protection_I.Sideris 

Martin, C. (1996). Social Welfare and the Family in Southern Europe. South European Society and Politics, 1(3), 23-41. https://doi.org/10.1080/13608749638539481

Mínguez, A. M. (2016). Economic crisis and the new housing transitions of young people in Spain. International Journal of Housing Policy, 16(2), 165-183. https://doi.org/10.1080/14616718.2015.1130604

Moreno, L. &; Marí-Klose, P. (2013). Youth, family change and welfare arrangements: is the South still so different?. European societies 15(4), 493-513. https://doi.org/10.1080/14616696.2013.836400

Papadopoulos, T. & Roumpakis, A. (2013). Familistic welfare capitalism in crisis: social reproduction and anti-social policy in Greece. Journal of International and Comparative Social Policy, 29(3), 204-224. https://doi.org/10.1080/21699763.2013.863736

Schwartz, B. (1968). The social psychology of privacy. American Journal of Sociology, 73(6), 741-752. https://doi.org/10.1086/224567

Serracant, P. (2015). The Impact of the Economic Crisis on Youth Trajectories A Case Study from Southern Europe. Young, 23(1), 39-58. https://doi.org/10.1177/1103308814557398

Vaiou, D. (1996). Women’s work and everyday life in Southern Europe in the context of European Integration. In J. Monk; M. D. García-Ramon (Eds.), Women of the European Union. The Politics of Work and Daily Life (pp. 61-73). London: Routledge. https://doi.org/10.4324/9780203430361

WHO (World Health Organization) (2020) Coronavirus disease (COVID-19) advice for the public. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public [last accessed: 15/05/2020]

Care leavers’ narratives of their past and future selves

Ahead of their CRFR seminar on 13 October and National Care Leavers Week 2015 (22-31 October), Lisa Whittaker (University of Glasgow) and Emma Davidson (University of Edinburgh) reflect on their research project Young People and their Future Selves.

This project arose after a chance meeting at the Journal of Youth Studies conference in Glasgow 2013. Lisa was working for a Scottish youth charity (who we will call the Green Project) and Emma had recently finished her PhD. Lisa had always felt that the video diaries filmed by young people at the end of the Green Project’s residential programme were a potentially fascinating resource. In these videos young people reflect on, and talk to, their ‘future self’. We were fortunate to be awarded funding from The University of Edinburgh’s Challenge Investment Fund for a pilot study to analyse a sample of video diaries combined with interviews with young people who had recorded them. We hoped this would give us an insight into the social worlds of vulnerable young people that research often overlooks.

Over the past 18 months we have interviewed 20 young people, some had not grown up in care but most of our sample had. Young people had different motivations for participating. Many wanted to give ‘something back’ following a positive experience at the Green Project but several were still experiencing challenges in their lives and saw the interview as an opportunity to re-engage with support. The interviews themselves were powerful and often very emotional. While we did hear positive stories about care, unfortunately many more were negative.

Our findings highlight the importance of relationships for young people in care, specifically the role of care, love and consistent unconditional support within professional/corporate relationships. Many of the relationships young people experienced were shaped by bureaucratic boundaries and regulations. There were many examples of positive, supportive professional relationships ending abruptly and without warning, and young people’s own ‘natural’ transitions into adulthood often did not match those impressed upon them by the care system. Young care leavers articulated goals and aspirations in their video diaries and interviews, but all too often structural processes denied them the opportunities to realise their aspirations and were left in precarious situations.

Our findings add further evidence to the research and debate about young people’s experiences of care. In particular we see parallels with IRISS’s exciting project Relationships Matter, the work of CELCIS and Who Cares? Scotland. We have shared our findings at several national and international conferences and will shortly submit several papers to leading journals. However, we would like to look beyond measuring success on the completion of academic outcomes. By working collaboratively with practitioners we can share information, clarify our understandings and inform their practice. Following the CRFR seminar, we have more knowledge exchange activities planned (including a podcast for IRISS:FM) which we hope will help build a network between the University, practitioners, policy-makers and young people.

Please note: our CRFR seminar is now fully booked. If you are interested in finding out more we would really like to hear from you. Please contact Emma Davidson e.c.davidson@ed.ac.uk and Lisa Whittaker lisa.whittaker@glasgow.ac.uk and follow us on twitter via @lisawhittaker02 @emz_davidson

Quality of life and dementia

CRFR associate researcher, Jane Robertson, reflects on how research is helping to change ideas about quality of life for people with dementia

Quality-of-life and dementia. Are these mutually exclusive terms? Certainly, loss and dread are commonly associated with dementia if we rely purely on media images of the condition. Losing the person as they succumb to a debilitating and dreadful disease is a view frequently portrayed when dementia is represented in newspaper and television reports. Indeed, there is much that is frightening and distressing about dementia, particularly as the condition develops and a person becomes progressively disorientated and communication becomes increasingly challenging. 

However, a sustained emphasis on ‘losing the person’ to a disease that eats away at their personhood negates the potential for people with dementia to continue to enjoy life. Significantly, it also makes it harder for people with dementia to be valued by others as having a meaningful life, if that life is continually represented in a one-dimensional and negative manner.

In the academic world, quality-of-life for people with dementia has traditionally relied upon observation and asking other people about what the person is experiencing (proxy reporting). Frequently, this perspective confirms a fairly poor picture of life with dementia. 

On the other hand, when the person is asked directly about their life, which has been the case in more recent research, more positive interpretations can be found. Their quality-of-life is not all bad. Like most people, it has its good and its bad aspects. This different perspective is often countered with the assumption that, if a person with dementia reports their quality-of-life in positive terms, this is due to a lack of awareness as a result of their condition. This stance therefore undermines the capacity, firstly, for people with dementia to reflect accurately upon their lives and, secondly, for people with dementia to be able to enjoy aspects of their life like anyone else.

Significantly, in-depth qualitative studies have demonstrated that people with dementia can reflect meaningfully on their lives even when they have significant cognitive impairment. Research has reported the potential for quality-of-life to be good if a person is valued by other people and if they are supported to continue to make a meaningful contribution in family and community life. 

Conversely, quality-of-life is often reported to be poor when the person believes they no longer have any social standing, particularly if they believe that others view them as being diminished in relation to their self and social identity. The importance, therefore, of presenting a more balanced perspective on life with dementia cannot be understated: if quality-of-life is closely associated with how others perceive and respond to a person, then understanding the positive aspects of life with dementia, as well as the challenges, is vital to ensure a society that treats people with dementia as having worth and value. Being able to find meaning within and from life are inseparable.

Dr Jane Robertson is a researcher at the University of Stirling with an interest in ageing, dementia and quality-of-life. She is an associate researcher with  the Centre for Research on Families and Relationships. Read more about her research examining narrative perspectives on quality-of-life among people with dementia here:  http://dem.sagepub.com/content/early/2013/03/15/1471301213479357

Challenge on Dementia

Co-Director, Heather Wilkinson, has had her collaborative research project, Healthbridge, included as a case study in the Prime Minister's Challenge on Dementia.

According to a recent Alzheimer’s Society’s report, three-quarters of people in the UK feel that society is not geared up to deal with dementia. It also found that three in five (61 per cent) people diagnosed with dementia are left feeling lonely, four in five (77 per cent) feel anxious or depressed and nearly half (44 per cent) have lost friends.

The PM has announced his commitment to make the UK a world-leader in dementia research and care, saying that not enough is known about the disease and has set out how the UK Government will lead on research in this area.

Healthbridge is an evaluation of the English Dementia Strategy. The strategy stresses the importance of promoting the quality of life and well-being of those living with dementia and their carers. As part of the implementation of the Strategy, dementia advisers and peer support networks were established in 40 demonstrator sites across England. These have developed a range of different methods and approaches for enhancing the well-being and increasing the resilience of those living with the disease. The Healthbridge evaluation aims to:

• describe the range of dementia adviser and peer support organisational models developed; and their evolution, management and governance.
• evaluate the impact of the new service models in terms of:
• the well-being of patients and carers
• their contribution to the objective of the Strategy
• the integration, sustainability and transferability of the organisational models involved
• examine in depth the patient/carer experience of the new service models, in respect of increasing accessibility, improving involvement and information, enhancing support for making choices, and increasing independence.

The study began on 1 April 2010 and is due to complete in September 2012. Interim findings indicate:

• strengthened partnership working;
• increased awareness of dementia on the part of providers;
• support provided being seen to fill a 'gap' in existing provision;
• a perceived reduction in carer stress;
• appreciation from other providers of the value of the new services;
• a reduction in demand for statutory services; and
• a network built on commonality of experience.

Led by University of Edinburgh the Healthbridge team have been brought together from Edinburgh University and Glamorgan University. 

Health Secretary Andrew Lansley said:

“Dementia is one of the biggest challenges we face as a society and we are determined to transform the quality of dementia care for patients and their families. In England today there are an estimated 670,000 people living with dementia, a number that is increasing with one in three people set to develop dementia in the future.

“That is why the Challenge sets out the Government’s ambition to increase diagnosis rates, to raise awareness and understanding and to strengthen substantially our research efforts so we can help those living with dementia have a better quality of life.”

New Publication: Providing Good Care at Night for Older People

Providing Good Care at Night for Older People
Practical Approaches for Use in Nursing and Care Homes
Diana Kerr and Heather Wilkinson

The experiences and needs of residents and patients in nursing and care homes are very different at night, and this is particularly true for those with dementia. Yet nursing and care homes are not always inspected with the same rigour at night as they are during the day, and night staff do not always receive the same levels of training, resources and supervision as day staff.
This book provides night staff, their managers and anyone else with an interest in care homes during the night with the information, knowledge and practical skills they need to deliver positive and appropriate care at night. The authors look at all of the issues that are particularly pertinent in caring for older people at night, including nutrition and hydration, continence, challenging behaviour, medication, night time checking, pain management and end of life care. They also look at the impact that working at night has on care staff, and offer practical suggestions to help them to safeguard their own health. The final chapter provides a set of night time care guidelines for inspectors that can also be used by managers to evaluate night time practices in their homes.
This book is essential reading for night staff and their managers and employers, as well as inspectors of services, policy makers, and anyone else with an interest in the provision of care for older people.
To order go to http://www.jkp.com/catalogue/book/9781849050647