Social Relations, Long-Term Care, and Well-Being of Older Migrants in Luxembourg

Social Relations Within the Emotional Egocentric Networks

Studies have found that older people tend to have a more family-focused network, centered in their emotionally close relationships (Ajrouch et al., 2001). In our data, the spouse, children, grandchildren, and remaining siblings indeed occupy the inner circle, constituting the individuals who are the closest emotionally to our participants. Friends and other close relatives are in the second circle, while the third circle remained empty in all eight network maps. This choice may actually reveal an emotional selection effect (Fredrickson & Cartensen, 1990), in the sense that they prefer to have the third circle empty rather than filling it with peripheral relationships. Moreover, the first circle has the most entries, which means that the size of the network depends greatly on the number of offspring one has, since the range of contact with same-age peers tends to decline over time. An exemplary presentation of these aspects in the form of a network map is provided for Gioconda, one of our interviewees, in Figure 1.

While the children are mostly located in Luxembourg, friends, siblings, and other close relatives live predominantly in the home country, which represents an important feature in the lives of older dependent migrants. Although emotional bonds are maintained despite geographic distance and less personal frequent contact, advanced age and reduced mobility limit them to cultivating solely virtual relationships. Same-age peers are very significant for the well-being of older adults because they represent an important source of emotional support that children rarely can provide. “I don’t have confidence in anyone else,” says Gioconda about the intimate relationship she has with one of her Italian cousins.

However, it is not always easy to maintain long-distance relationships. Cândida, who lives in a care home subsidized by the National Solidarity Fund and receives some pocket money from her daughter, highlights the difficulty she faces to pay the telephone bills: “By phone I cannot talk much, it’s expensive,” she explains. Thus, she and her Portuguese friends have to talk briefly every 2 months only “to say hello and to ask how you are and how is your health.” The lack of infrastructure, resources, and cultural capital may clearly lead people to be less able to access new information and communication technology (ICT) than others (Wilding, 2006). Besides her friends, Cândida does not feel that she has someone left in her network who could be a shoulder to lean on in times of difficulty. About her daughter, she says:

Cândida’s statement shows that children may not be a source of emotional support because they may not understand the age challenges experienced by their aging parents. Moreover, older adults might prefer not to seek the emotional support of their children because they do not want to be a hindrance in their lives or want them to become distressed because of their daily problems, especially when they do not live in the same country, as the case of Amália, whose children are in Italy:

Baldock (2003) also found this attitude in her studies about transnational care among Dutch migrants and their parents left behind in the Netherlands: She reports that “migrants would hide from their parents that they were homesick, physically ill or depressed; parents would not tell their children about their health crises or about deaths in the family” (p. 53). In the case of Amália, who lives alone and has no family member in Luxembourg, the way in which she and her son deal with a difficult situation is to make jokes on the telephone. However, she warns that this type of banter represents a “terrible” way to mask the reality.

The fact that children are not able to or have elected not to provide emotional support does not mean, however, that they are absent in the support networks of older dependent migrants. Actually, most of the instrumental support is provided by professional caregivers in combination with the children, especially in case of widowhood. Mrs. Rossi’s sons take care of her medical appointments, Cândida’s daughter brings her the clean laundry, while Amália’s son sends her packages filled with groceries from Italy. Nevertheless, the intensity of this contact varies widely among our interview partners, depending on their children’s life situation, the quality of the parent-child relationship, the geographical proximity, and the way children perceive their family responsibilities in care relations.

Our data show that older dependent migrants do have close and supportive others, but that their social networks are relatively small and geographically dispersed between the home and the host countries. This means that face-to-face contact occurs primarily with children and grandchildren based in Luxembourg, which depends on the availability and the quality of the family ties; and that the location of the same-age peers in the home country represents a challenge to their social interaction and exchange of emotional support. In this sense, the daily contact with professional careworkers and with other dependent people in care facilities, especially to those who live alone, represent an important source of social relations and emotional support, a topic which we discuss next.

Social Relations with Professional Caregivers and Other Staff

The narration provided by Gioconda shows in detail the importance of the professional caregivers in her daily life. Gioconda lives alone, and she began receiving mobile-care services almost 20 years ago, after she became severely impaired. At this point she stopped seeing her daughter daily and receiving care from her. Since then, mobile caregivers have been providing care three times a day: shortly after she awakens, at lunchtime, and before she goes to bed at night. Gradually, they have become part of her family: “It’s true that I’m the customer, there’s always respect, I agree, but between us, after such a long time, we’ve become a family,” she says.

Gioconda has an active social network, receives practical help from her daughter, and emotional support by telephone from her cousin. However, she lacks face-to-face social interaction: She does not go out alone because she cannot walk, and she does not receive any other visitors besides her daughter. When she is asked about who visited her at home during the last few weeks, she replies: “The girls [from the mobile-care service].” To Gioconda, the professional caregivers have become not only part of the family, they are the only people with whom she shares aspects of her daily life.

As she says, professional caregivers are not only crucial because they provide hands-on care, but also because they give her the daily emotional support that her family can no longer provide: “I cannot talk to my family, I don’t have anyone left,” she declares. Gioconda emphasizes their centrality in her life by saying that they are her “strength,” the people who she can talk to, which she considers central for her well-being: “I have to talk with someone,” explains Gioconda about her need for social interaction and support. Amália, who, similar to Gioconda, also lives alone and cannot go outside without assistance, calls the female caregivers “mes filles” [my daughters], again indicating a family relationship. Sometimes she invites them to keep her company during lunch:

In this passage, Amália emphasizes that, although she insisted, she is aware that eating together with clients is something a caregiver should not do. The same happens to Gioconda. Even if she tries to have a close relation with them, this idea is not usually welcomed: “‘I want a family relationship,’ ‘But it’s not allowed,’ they say.” In their narratives, Gioconda and Amália address the general point of view that part of the professional role of the care-providers is that they should not become too close to their clients to avoid emotional dependency. However, to Gioconda and Amália, both living alone and deprived of other face-to-face social interactions, this daily contact with their caregivers represents an important source of well-being. This feature is interesting because besides possible gender differences, Mr. Sartori, who also receives LTC at home, does not even mention the importance of social interaction with his caregivers, probably because he lives with his wife, sees one of his sons almost every day, and together with the daily professional care, he also receives practical support from his family.

In fact, studies show that “where and with whom a person is living is an important condition with regard to social support and social relationships ... [since] it gives differential opportunities for social contact” (Fernández-Ballesteros, 2002, p. 647). Living alone, combined with the amount of time one spent alone, and low levels of social contact, may lead to feelings of loneliness. Indeed, social and family relationships seem to be crucial aspects in the definition of a “good quality of life” in old age (Victor, Scambler, Bond, & Bowling, 2000). Moreover, Makoni and Grainger (2002) argue that caregiving should be understood at least in two dimensions: the physical act of caring and helping someone (hands-on care) and the affective state of mind of a person with regard to another, which could be “paraphrased as a ‘concern’ and sometimes ‘love’” (p. 807). They suggest that communication should be perceived as an elemental part of caregiving, and that professional carers should receive training on the relevance of interaction to providing care (Antonucci, Okorodudu, & Akiyama, 2002). These “communication skills” are even more important in contexts of migration, where care-providers and care-recipients may not speak the same language.

The experiences of Gioconda and Cândida portray the language complexity in Luxembourg. The first complains about the fact that the caregiver, who should promote social activities, speaks only German. The latter laments that the meetings in her care home are often in Luxembourgish. Both would prefer to use French to better experience the care assistance they are receiving. In a country with three official languages (French, Luxembourgish, and German) and a large number of foreigners, that is, non-Luxembourgish passport holders (according to STATEC, on January 1, 2015, they made up nearly 46% of the total population), it is not always possible to have caregivers who speak the same language as the care-recipients (as the case of Gioconda) or to conduct the institutional meetings in French (as the case of Cândida), since older migrants still represent a minority inside the care homes (Ferring, Heinz, Peltier, & Thill, 2013).

However, this plurality of languages may also lead to an opposite situation. Because Luxembourg is characterized by the significant migration of careworkers who come mainly from the neighboring countries Germany, France, and Belgium, but also from Portugal, Italy, and other EU countries (Koch & Weisgerber, 2011), care-recipients also have the opportunity to meet caregivers and other staff (such as institutional drivers, cleaners, attendants, and cooking staff) who speak the same language, come from the same country of origin, or have the same national roots. Because of this heterogeneity of ethnic backgrounds, for example, Gioconda and Cândida also experience the opposite situation than the one just described above: Gioconda has an Italian caregiver whom she considers to be more pleasant than the noncompatriots because of the way he “explains things, how he speaks, [and] the jokes he makes.” Cândida, in turn, has a close relationship with a Portuguese staff member who works in the kitchen of the care home where she lives. She has become the only other person she speaks to besides the few contacts she has in her egocentric network. When Cândida is asked about who she talks about her daily life with, she says:

Benjamin, who attends a daycare center, explains the meaning of friendship by taking as an example not a relationship with a close friend, but rather with a former Portuguese assistant at the daycare center he attends. He says:

The descriptions of Gioconda, Cândida, and Benjamin show the importance of culture and language in providing care, which includes not only caregivers, but also other staff members involved in their care arrangement. As Stoller and Perzynski (2003) argue, ethnic traditions, eating ethnic foods, sharing memories, and the same ethnic background can foster closer relationships between care-recipients and careworkers, giving an individual the feeling of community or even kinship. It “facilitates the emergence of friendships in which members discover overlapping threads in their personal narratives” (Stoller & Perzynski, 2003, p. 379). Despite some challenging situations between caregivers and care-recipients, careworkers are highly evaluated by older dependent migrants, indicating that the personnel are mainly interacting effectively with them, an aspect that has also been found in other studies (Runci et al., 2014). In fact, as we are going to analyze next, this proximity can be crucial for coping with the difficulties faced in the social relations with other care-recipients.

Social Relations with Other Care Recipients

Older dependents who attend daycare centers or live in care homes have the opportunity of interacting with other care-recipients, thus expanding their social relations (see also Hubbard et al., 2003). However, the significance of this interplay is qualitatively different between the two groups. While the former can choose its periodicity, going back home at the end of the day, the latter have experienced a relocation, which also affects their daily life patterns, social networks, and support (Lee, Woo, & Mackenzie, 2002). Although care institutions accommodate many care-recipients who could potentially become a source of emotional support and positive social interaction, institutionalized social relations may be challenging, especially when involving migrants. Cândida, who is the only Portuguese migrant without dementia living in her care home, faces many difficulties in interacting with Luxembourgers in French, who make up the majority of the inhabitants.

Cândida highlights that language communication is the only aspect she would change in the care home where she lives, an action that would include the other residents but not the personnel, since the careworkers are generally open to communicate in French. Actually, most of her restrictions inside the care home, such as talking to others and participating in meetings, exist because of the language spoken by her roommates. On the one hand, most Italian and Portuguese migrants have only had a few years of schooling and tended to acquire only French, which is closer to their mother tongue (Dickes & Berzosa, 2010). On the other hand, although many Luxembourgers speak and understand French, they prefer to speak Luxembourgish, a situation that causes migrants like Cândida to remain apart.

Reviewing Cândida’s narrative makes it clear that contact with other care-recipients may not be easily established, although it constitutes an important aspect of her well-being. The mutual negative labeling of the “others” (she calls the Luxembourgish inhabitants “racists”), the presence in different locations (the majority group is occupying the lounge, while Cândida stays in her room or goes to the kitchen), and the language as a factor of impairment all play an important role in shaping her social relationships with other care-recipients. Mrs. Rossi experiences a similar situation in which despite actively seeking togetherness, she does not manage to interact with them:

Although relationships in LTC facilities are typically short-lived, devoid of intimacy, and therefore do not replace the contact with life-long friends or intimate relatives (Bear, 1990), research has shown that everyday social interactions are associated with well-being: “Of all the daily stressors that individuals experience, negative social interactions are the most frequently associated with poor well-being” (Antonucci et al., 2013, p. 89). Thus, extremely important to the social relations of older dependent migrants is not only the quantity, but also the quality of contact with other care-recipients. This should be promoted more systematically within institutional settings.

If we analyze the motivations underlying an individual’s choice of care homes and daycare centers, it becomes clear that the social relationship is the main aspect selected by older migrants in our data. Mrs. Maldini says that she decided to spend time at the center because her daughter works all day: “Thus, I prefer to come here because I’ve got companionship. At home, I’m alone ... It’s bad to be alone at home,” she declares. Benjamin, who lives with his wife, also decided to attend a center in order to interact with other people: “Because me, at home, I get nervous. And here ... here I’ve people I can talk to. My wife, at home, she cannot talk with me all the time! She’s always busy with housework.”

As we can see, “to have companionship,” “to have someone to talk to,” and “not to be alone” are important aspects in older people’s LTC arrangements. If some of them manage to achieve this aim, like Mrs. Maldini, who meets other Italians at the center, with whom she plays cards and talks about her life, others are quite isolated inside the care institutions. This was the case for both Cândida and Mrs. Rossi at a care home, but it is also the case for Conceição, who attends a daycare center. Conceição goes to the center from Monday to Saturday and always has the same routine: “I don’t do anything. Here I do nothing. Either I’m sitting here or I’m lying down in bed.” Seated alone on the corner, looking at the wall, she repeats from time to time: “There was a clock there; it isn’t there anymore, to see the hours ... At 5 o’clock I go back home. There’s still too much time left.” Since she does not speak Luxembourgish, Conceição only communicates with the careworkers, waiting each day until it is time to return home.