Abstract
Christine Milligan’s There’s No Place like Home: Place and Care in an Ageing Society is an in-depth examination of key concerns about the nature and site of contemporary care and care-giving. As put forth in Chapter 1, the book employs a geographical analysis and contributes a better understanding of how the frail elderly and their informal carers experience shifting landscapes of care, an under-researched and inadequately conceptualized area of study. In doing so, it highlights how informal care-giving within domestic, community and residential care homes intersect to ‘create complex landscapes and organizational spatialities of care’ (p. 3).
At the onset of the second chapter, Milligan locates her work within a broader academic and sociopolitical setting by providing an overview of the growing debate around care and care-giving in contemporary western society. Political and ideological shifts in the meaning and place of care in the late 20th and early 21st century and their impact on contemporary care-giving for the frail elderly are afforded special emphasis. The section progresses with a critical review of some of the key theoretical frameworks that social scientists have used to examine shifting typologies and topologies of care, a virtual unpacking of the concept. In studying how care for older people is constructed and reconstructed, Milligan commendably draws attention to the multifaceted nature of ‘the landscape of care’ (p. 9). By this she hints at the increased porosity of the boundaries between the spheres of formal and informal care, and the importance of understanding ‘the emplaced nature of care and care practices’ (p. 6).
Chapter 3 sheds light on contemporary research and statistical data in neoliberal states in order to identify the agents (those who actually perform the informal care-giving role) and venues of informal care. In this section, Milligan correctly contends that the decision to care is affected or predicated upon a variety of factors. First, the choice to undertake the informal care-giving role is based on cultural factors such as kinship ties and the character of social mores motivating the potential carer. Second, notions of ‘proximity’ and ‘distance’ and economic considerations such as the ‘financial means of the cared-for and/or the wider family’, ‘the availability and cost of alternative sources of support’ and ‘the opportunity cost to the potential carer’ cannot be discounted (p. 27). Third, the conceptualization of informal care may be further informed by the changing nature of the family. Fourth, care-giving is inexorably tied to issues of class and gender since the promotion of policies crafted to reinforce familial responsibility is likely to manifest (and further ossify) the institutionalized bias against women and the working class. Yet among these factors the author convincingly points to the gendering of care as the most dominant. On the one hand, Milligan reveals that women are more likely to undertake care-giving responsibilities outside the household and bear the heaviest caring commitments. On the other, ‘women from lower socioeconomic groups and from ethnic minority backgrounds’ are marginalized the most when it comes to accessing care support (p. 41).
An apt segue into a more nuanced discussion of the nature of care and the extent of informal care-giving is afforded in Chapter 4. Like the previous section, it seeks to further demystify the notion of care and ageing in contemporary society. But it also departs from the former by delving more extensively into the plurality of systems of care and care providers. Essentially a charting of cultural differences across African, Asian, Latin American and Eastern European countries, this chapter maintains that the availability (and accessibility) of formal and informal care is strongly contingent upon varying social and political perceptions of rights and responsibilities in the realm of care-giving. In other words, the notion of ageing and the meaning and practice of informal care-giving are culturally determined and politically motivated. Needless to say, rights and responsibilities in relation to the care of older people vary and change over time as evidenced by the cross-national case studies the author utilized in this section.
Ensuing chapters show the changing landscape of contemporary care at work. In Chapter 5, for instance, Milligan observes that a virtual blurring of boundaries between ‘institution’ and ‘home’ is apparent owing to the relocation of care to the latter. How older people and their informal carers experience care-giving within this space or construct meanings about the ‘home’ amid the importation of clinical artefacts of care within it should therefore merit a critical gaze. Chapter 6, in turn, focuses on how the introduction of new care technologies as a means of supporting the needs of the frail elderly contributes to a reshaping of the nature, provider and site of care. In this section, Milligan enquires whether the use of new care technologies within the confines of the home promotes better living conditions for older people or engenders social isolation. Chapters 7 and 8 further demonstrate how porous the boundaries separating venues of care have become, a recurring theme in the book. The former examines how the community affects the availability and quality of care afforded the frail elderly within the domestic home while the latter is concerned with the impact of transitions in care on older people and their informal carers. Emotions as an integral and important part of the care-giving experience, a subject previously given little attention, constitutes the discussion in Chapter 9. As confirmed by the author, ‘The interrelationship between the physical and affective aspects of caring . . . is . . . important in helping us to understand how care manifests in different ways in different places’ (p. 119). In light of the realization of the complexity of the care-giving relationship presented in the previous sections, Chapter 10 attempts to uncover whether a blurring of boundaries across spaces within which care is undertaken is evident. An elucidation of the factors that provide an impetus for ‘the emergence of inclusionary and exclusionary spaces of care’ is also incorporated in the chapter (p. 133).
Milligan coherently sums up her key arguments in Chapter 11. On the whole, she argues that ‘care does not occur in discrete spaces, but stretches across and beyond the domestic home to include the community, public and private institutional settings’ (p. 8). As evidenced by case studies on frail elderly care, increased porosity between the worlds of formal and informal care is undeniable.
Scholars of care and care-giving will, without doubt, welcome the book. However, its main objective – in this case, to provide a better understanding of the dynamics of informal care-giving for the frail elderly within shifting landscapes of care – appears to be its main weakness. By mainly focusing on how care is experienced within and across homes, other landscapes of care are inevitably left unexplored. In particular, the urban–rural dimension of care and care-giving warrants further scrutiny. Transnational comparisons, while afforded attention in Chapter 4, should likewise be more detailed. As well, the issue of child-carers – a prevalent phenomenon particularly in developing countries – deserves attention as an area of study on contemporary care.
Nonetheless, these inadequacies do not erode the importance of the book. Milligan’s work is incontrovertibly a beneficial addition to the established scholarship on contemporary care and care-giving. It offers readers new insights into the experiences of the frail elderly and their carers by treating landscapes of care as fluid and shifting spaces, a contribution that merits commendation. Finally, it is a comprehensive and insightful reference for future scholarly pursuits in the field of ageing and care-giving.