Jansen, Erik (1); Pijpers, Roos (2); De Kam, George (3) (2017). '“I, as an independently living older person…” - A narrative study on older people’s capabilities in Integrated Service Areas in the Netherlands' Paper presented at the annual conference of the HDCA, Cape Town 2017.
In this paper, we apply the capability approach to understand the scope and limitations of efforts to support older people dwelling in integrated service areas (ISAs), as a widespread policy solution for organizing community care in the Netherlands. An ISA is a neighborhood or village in which housing, care and social policies are integrated and professionals from different sectors collaborate to offer various sources of support, often geographically bounded for availability within 400 meters of walking distance. ISAs form a specific operationalization of the concept of ageing-in-place as applied in several western-European societies to assist older people to remain resilient while facing increasing frailty and decreasing mobility, but also as a way to decrease the costs of care (Evans 2009). Research on the effect of this type of services integration on the wellbeing of dwellers is scarce. Therefore, the research question for this study reads: how do ISAs facilitate older people in living the life they have reason to value? Based on the capability approach as a lens to investigate ISAs, and a rationale for the connection between capabilities and community care organization we applied a narrative strategy to provide insight in (older people's) life-world perspectives. As part of a larger mixed-methods research project in which also a quantitative survey was performed (see De Kam et al. 2012; Pijpers, De Kam & Dorland, 2016), narratives of older people dwelling in ISAs were collected and analyzed, to learn what they value with respect to ageing-in-place.
In each of 12 ISAs across the country 36 older people were selected for narrative interviewing on daily life activities and experiences, in their current housing, welfare and care contexts. Thus, 432 narrative interviews with older adults were conducted all starting with the narrative generative question: "Considering your current life situation, can you take in mind a regular day and describe what you experience?" The interviews were transcribed verbatim, and segmented into substantively coherent fragments. Subsequently, these fragments were coded with a predefined system containing labels indicating the WHAT (substantive themes or topics), the WHO (the perspectives, actor-positioning or scene-setting) and the HOW (the tone or language used by the storyteller) of the stories, yielding a coded database of over 14,000 interview segments spread across the 12 ISA’s. Per ISA 3 or 4 thematic patters were identified as preliminary results, and these were presented and discussed with the respondents in a dialogue session by way of member-checking, occasionally resulting in adaptation before the themes were considered definitive.
Based on a narrative analysis of the interview segments, the research team identified 42 thematic patterns spread over the 12 ISAs. These 42 patterns were aggregated into a Manifesto of the Independently Living Older Person as a format deliberately selected to express the evocativeness of older adults’ stories. The narrative patterns as well as the Manifesto produced insight in both capabilities and functionings of the respondents, clearly referring to values such as autonomy, human dignity, and contributions to community care by older people themselves. In the presentation the Manifesto and ample example narratives will be shared to illustrate this.
The narrative findings evoke the image that the complex interventions developed in ISAs indeed expand older people’s capabilities, which greatly helps them to balance realistic and optimistic expectations for the future. These findings can be related to several specific capability-theoretical concepts. First, older people’s narratives refer to the notion of capability security (see Wolff & De-Shalit, 2007) in that care and support services are valued as countermeasures for future capability compromise even though this is not relevant to their current doings and beings. Second, effects of ageism and adaptive preferences (Elster, 1983) based on ageing necessitate processes of public deliberation and critical reasoning in enhancing realistic opportunities to shape older people's futures while they age in place. Third, integration of services at the community level reflects the notion of a collective capability for providing as well as receiving care. Finally, a tension is identified between individual freedoms to choose the life one has reason to value and the more paternalistic notion of community-care implicit in the ISA-concept, which underscores the need for ongoing and locally-embedded public dialogue on community-based provision of care and support.
Methodologically, we conclude that narratives as information base for capability assessment do justice to the complex, plural character and diversity of people’s lives by allowing respondents to substantiate and structure an integral account of what matters to them on the basis of their personal logic and conditions. Thus, it provides direct insight into people’s subjective aspect of opportunities to lead the lives they value.