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Moral Conflicts in Familial Dementia Care Involving Migrant Live-In Carers in Germany and Israel: A Comparative Empirical-Ethical Exploration and Analysis (MoDeCare)

Prof. Dr. Mark Schweda
Head of Division

Dr. Merle Weßel
PostDoc

+49 (0)441 798 - 4304

Contact Person

Anna-Eva Nebowsky 
Research Assistant

­­­­­+49 (0)441 798-2812

Postal Address

Carl von Ossietzky University of Oldenburg
Faculty VI - Medicine and Health Services
Department of Health Services Research
Medical Ethics Division
Ammerländer Heerstr. 114-118
26129 Oldenburg

Visiting Adress

Campus Haarentor, Building V04 (1-106)
Ammerländer Heerstraße 140 
26129 Oldenburg

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Moral Conflicts in Familial Dementia Care Involving Migrant Live-In Carers in Germany and Israel: A Comparative Empirical-Ethical Exploration and Analysis (MoDeCare)

Project Description

Due to demographic change, the proportion of older people in society is growing and the number of dementia cases continues to increase. However, the correspondingly high need for care cannot be fully met by specialised staff and the care of people with dementia often cannot be managed by relatives alone. One answer to this gap in home care is caregivers who live for a limited period of time in the household of the person to be cared for - so-called live-in carer - who come to Germany mainly from Eastern Europe. Israeli care arrangements are also entered into with people from Eastern Europe, but also with people of Southeast Asian origin.

Families in Germany who choose this form of home care are usually left to organise it on their own. There is a lack of counselling services and binding information, and the arrangements are almost always situated in a legal grey area. In contrast, in Israel, residential care arrangements are regulated by law through binding regulations.

The social and legal aspects of home care for older people through live-in carer are comparatively well researched in both, Israel and Germany. However, the focus has so far been on the perspective of the live-in carer. The living and working conditions of the carer as well as labour law problem areas are discussed. In contrast, research has offered little insight into the views, motives and patterns of interpretation in the micro-setting of the triad - relatives, live-in carer and person with dementia. A systematic ethical analysis of moral conflicts in the triad in interaction with the underlying framework conditions and cultural implications, as well as a comparison between Germany and Israel, is largely missing.

By investigating on different levels, the international research team pursues the research question: What moral conflicts arise in the micro setting of the triad consisting of the caregiver, the dementia patient and their relatives in both countries? Here, asymmetric power relations within the triad itself on the micro level, unclear responsibilities in the cooperation with care agencies on the structural level and the different legal frameworks and social negotiations of a new concept of global care work on the macro level, are important aspects.

The aim is to explore moral conflicts in live-in arrangements and to formulate recommendations for policy makers and people involved in the organisation of these arrangements to improve the care of people with dementia.

Methodological Approach

The research project adopts an exploratory qualitative approach.

Guided qualitative group and individual interviews with all participants of the care arrangement will be conducted in Israel as well as in Germany. Additionally, experts with different backgrounds, e.g. from politics, labour law, and care agencies and organisations will be interviewed. The interviews will then be analysed with a care and family ethical framework.

Furthermore, a document analysis will follow to present and compare current legal regulations, debates and approaches.

Funding

The project is supported with funds provided by the VolkswagenStiftung.

Project Team

Dr. Merle Weßel (Ethics in Medicine, Carl von Ossietzky University Oldenburg) (PI)

Dr. Milena von Kutzleben (Organisational Health Services Research, Carl von Ossietzky University Oldenburg)

Prof. Dr. Mark Schweda (Ethics in Medicine, Carl von Ossietzky University Oldenburg)

Prof. Liat Ayalon (Bar Ilan University)

Responsible research assistant (please contact if you have any questions about the project):

Anna-Eva Nebowsky (Ethics in Medicine, Carl von Ossietzky University Oldenburg)

Study Participation

To conduct the study, we are looking for care arrangements in which a person with dementia is cared for by a live-in carer. We would like to conduct individual or group interviews with you about your current care arrangements. If you are interested in participating in the study, please contact: Anna-Eva Nebowsky (E-mail: , phone: +49 (0)441 798 - 2812) for more information.

Publications

Gerhards, S.; von Kutzleben, M.; Schweda, M. (2022) Moralische Probleme der Versorgung von Menschen mit Demenz durch osteuropäische Live-in-Hilfen: eine ethische Analyse der Erwartungen von Angehörigen in Onlineforen. Ethik in der Medizin. doi.org/10.1007/s00481-022-00708-8

(Changed: 30 Sep 2022)