The CSW and ‘Help at Home’

180 for the elderly. She had not heard of the project but had seen the informational letter from the CSW on the cupboard. Goca explained: ‘The gerontodomaćica is not a domestic worker, but the ‘right hand’ of the older person.’ The social grandchild thought it was a good initiative and it was agreed that the carer should come on Tuesdays and Thursdays (D, 10.8.2009).

As this excerpt from my field diary shows, some social work professionals and social grandchildren experienced the posited elder care crisis as an accurate depiction and collaborated in devising state care arrangements in order to alleviate the situation in their social environment.

181 her colleagues to socialise (družiti se) over a cup of coffee Turkish style (domaću kafu), explained the rationale of the ‘coffee-socialising’ as follows:

It is probably a fact that this economic crisis has alienated us from each other a bit, but also the way we live has influenced how we start to behave differently and have other kind of relationships [odnose]. For those good family relationships we simply have to thank our parents […]. Today it is a question whether that solidarity exists at all, the way it existed then. […] Here it was a time-honoured custom, let’s say in the morning because my mother [b. 1944] started to work late, that you drank coffee, at one neighbour, a second, a third and a fourth. They were more friends [oni su se više družili] than today, and that habituation is what we don’t have. That was for me really, you know, good that way, because it allowed people to discharge some inner problems, to exchange experiences and decisions, and to more easily come out on top of a problem of a tougher kind, when it appeared (tI, Zorana, 23.5.2012).

Referencing an imagined better past that she linked – through her mother’s neighbourly coffee rounds – to socialism, Zorana today assembled the staff of the CSW into the coffee group in the little office she shared with Goca. As I learned, special pedagogue Goca was paid by the municipality to lead the urban and rural elder care programmes which Zorana had initiated.

Zorana’s life experience influenced her interests in developing this new service. She had been born and bred in Creek Town, where she raised two sons as a single parent. When her children were big enough to leave for university, she increasingly cared for her mother, who had dementia. Her parents had belonged to “the middle class,” she said, in the sense that the family went to the seaside every year when she was a child and her mother only started working when Zorana was 17 years old (and her brother 15). Their father worked as a supervisor at a big retail and wholesale trade company. When Zorana studied social work in the Higher Education College in Belgrade between 1983-5, her parents rented a single room for her, a luxury many of her fellow students from the dormitories could not afford. Her father’s firm also paid her stipend (a practice discontinued when her brother studied agronomy four years later).

In 1986 Zorana returned to Creek Town and began to work for the youth job exchange (omladinska). One of her first jobs was a four month contract with the CSW, and it ignited her interest in care for the elderly:

[M]y work was an investigation of the citizens above age 35 to find out if they were interested in placement in an institution of social protection, more precisely a gerontological centre that was planned in Creek Town. However it was not built, and the situation has stayed like that until today. From the questionnaire we could see that the older people were not interested, but the younger ones had already thought about that option and were interested. Many people decide today for such an accommodation. Those prejudices of the type ‘Why go there if I have children?’, ‘Why if I have a house?’, today the mind-set is different and the people understand now that this doesn’t mean something worse for them, but something better. […] We didn’t make it to the rural area, a couple of villages were finished and then the survey was interrupted because there was no more money […]

(tI, Zorana, 23.5.2012).

182 After that short stint at the CSW, Zorana worked for almost sixteen years in several positions in the trading company where her father was employed. After a while she began to work there in social work professions, as a human resources officer (kadrovski referent) and as a social worker. In February 2004 Zorana replaced a social worker in the CSW who moved to another municipality. She thought that the amount of work had increased since 2004, because there was a rising rate of “depression” in the population today (which she linked to changes in economic and social structures, as indicated in her explanation of the coffee-ritual above). Depression brought with it all kinds of diseases, Zorana thought. With the former Director of the CSW (until 2008) she had hoped to counter such depression by recreating supportive social relations, e.g. for those elderly “that were not for accommodation in an institution” through a care at home programme.

In contrast to her survey in 1987, Zorana undertook no “real study” to prepare the project in 2007. Instead, the social workers asked their users whether they were interested in participating.

While special pedagogue Goca ran the project, Zorana attended an in-service further training course (open only for social workers) in Ćuprija on “gerontologija and care (briga) for the elders.” This course lasted for two years and was financed by the Norwegian government.

Zorana met professionals from different towns and institutions (CSWs, polyclinics, and hospices) in Serbia, Bosnia and Herzegovina, Montenegro, and Norway, and travelled for seven days to Norway so see “orientationally” how colleagues worked there and “what Norway can offer its citizens.” Zorana thought these experiences enhanced the quality of her work, e.g. her sensitivity in supporting the users’ decision making processes. So what may these Scandinavian inspirations have looked like?

Scandinavian elective affinities

Norwegian social policy advisors have supported the establishment of home care projects in Serbia since the mid-2000s. They generated organizational and professional structures, and also new welfare discourses and models that entered professional self-understanding. Although British social policy was equally “translated” into Serbian practices, most social workers aimed for the “Scandinavian model.” After self-managed socialism with its vision of universal state obligation for modernisation and welfare, citizens expected the state to be involved in their lives to a high degree compared to liberal states where more people preferred non-involvement.

Therefore the social democracy of Scandinavian countries like Norway, where local politicians accepted the “deeply moral task” to primarily “secure the welfare of everyone” (Vike 2002, 62), appealed to the social workers’ own values and ambitions.

183 It is fascinating to observe overlaps between post-Yugoslav and Scandinavian care practices.

First, both in Scandinavia and in former Yugoslavia, high value was attached to state involvement in social security, while a sharp boundary was drawn between a supposedly impersonal state bureaucracy and the emotional intimacy of the home. An ethnography of Danish child care homes, for instance, revealed that these were modelled on the “hom[el]iness”

of private homes (Hojlund 2011). Second, in Swedish home care for the elderly, like in Serbia, space-times ‘surfaced’ through careful relational moves (Lutz 2013). In Lutz’ ethnography, the Swedish care receivers were often very elderly, frail people who were visited daily by an array of caregivers. Time compartmentalisation inspired by New Public Management was the norm, but it was partly circumvented by the caregivers, who negotiated care arrangements that incorporated the rhythms of the caregivers, the care receivers, and the service managers. A

“careful surfacing” was observed when care givers discussed their day’s work schedule over their morning coffee, while the folders with the work schedules remained unopened. One carer explained:

We have a schedule, but generally we don’t use it. We know all the clients. We tend to reach an agreement between ourselves. Also, we don’t make the same rounds every time.

We switch villages every other Sunday and on main holidays so we can know everything.

We have so many clients now. We try to vary ourselves. Otherwise, we have no real perspective” (Lutz 2013, 87–8).

Lutz’s ethnography led him to argue that “good senior home care involves not only knowledge and experience but also flexible practices or possibilities for tinkering that far exceed the objective-subjective divide on which NPM strategies depend” (Lutz 2013, 88). This account of the position of care givers (and social workers) in Scandinavia shows an emphasis on flexible, humanist time and tinkering with schedules similar to that of their counterparts in Creek Town.

Pitching the programme

Creek Town did not pioneer senior Care at Home in the region – the CSW in neighbouring River City began such a project in 2006, but it did not support Creek Town in establishing one of its own. While both CSWs operated in the same interface types II and III vis-á-vis other local state institutions, there were significant differences in the welfare state Relation that they each developed. The CSW in River City was “specific,” rather self-contained and difficult to work with (tI, social worker of Polyclinic River City, 10.2.2010). In contrast, the CSW in Creek Town, maybe because it was smaller and had less political weight, nurtured good contacts with the Municipal authorities that “simply have that feeling of solidarity and responsibility to the inhabitants” (tI, Zorana, 23.2.2012). As the single institution of Social Work in the

184 Municipality, the CSW also cooperated with other local state institutions, although things were seen as far from ideal:

[W]e cooperate with kindergartens, schools, polyclinic, and hospital. We try to maintain every type of cooperation. How far we are able to do so is an open question. It has not been raised to the level on which it should be. We have cooperation also with the court and the police, but it is not raised to the level [...]. Formerly we had more influence concerning employment, because we could propose why someone could have preference [in employment] [...] from a person with the same educational profile [...]. [I]n reality family circumstances are one of the causes why somebody should have preference [...]. I think after all we should be heard a bit, because we would automatically participate in the quality of life, contributing to the better functioning of the city (tI, Zorana, 23.5.2012)

Zorana did not beat around the bush with her critical view of what she saw as apparently socially irresponsible employment decisions and their consequences for the quality of life in Creek Town. Already in 2003 her colleagues had argued in the annual CSW report to the MWSP and to the Municipality: “We have to state that in the last couple of years there has been the tendency of a continuous growth of the number of unemployed people, which is especially pronounced in the last two years” (CSW 2003, 2). In the programme of work for 2008 the alarmism was only thinly veiled:

It can be realistically anticipated that the social set of problems next year will manifest itself as the consequence of a growing mutual dependence and disturbance of interpersonal relations. The social work services will, in the coming year, proportionally adjust from the predominantly material sphere (which realistically will grow linearly) to the psychosocial sphere, with regards to mental problems, conflicts and disturbances of balance […] (CSW 2008b, 3).

Here the social workers connected the “mental problems, conflicts and disturbances of balance”

to the growing tasks in the “psychosocial sphere” that a new “Help at Home for the Elderly”

service could tackle (CSW, 2008b, 3). If ageing as crisis discourse was merely alluded to, the 2009 Public Works application for a “Home Elder Care in the Village” project by special pedagogue Goca argued more bluntly:

[N]ot only the number of old people is a problem, but the number of single households, with disturbed health status, without kin help, in social isolation and impossibility to satisfy their basic existential needs; and along with this the low quality of life (CSW 2008c, 3).

Goca framed the separation from kin as a key issue in problematic elderly situations. Playing on the imaginary kin-state division, where kinship was seen as a good realm in which the state should be rather absent, she suggested that local state relations should (especially) act as a substitute for absent kin. In practice, however, most of the elderly who were included in the care arrangements had kin. What both the CSW programme for 2008 and the rural project application of 2009 had in common was that a stark problem formulation was used as a tactic to lobby for funding. In the CSW’s programme plan for 2008, the supervisor directly addressed the municipality with the “hope that the [elder care] projects that were in an experimental phase

185 will find the understanding on the part of the local self-government. And that they will, accordingly, be included in the budget for the next period” (CSW 2008b, 4).

This lobbying proved successful when in March 2008 the municipality pledged to take over the annual expenses of 1.8 million dinar (then € 18,000) for the urban elder care service after the Public Work funds were exhausted (CSW 2008c). The CSW also “won” every year a Public Works grant for the similarly sized village project through the summer. The CSW’s hopes to

“budget” the rural project permanently, however, were curtailed by municipal spending cuts from 2009. In the next subsection I turn to the organisational features of the (urban) service.

Organising ‘Help at Home’

In order to stretch the meagre funds, the initial ten carers started to work without any job training. Obviously it was expected that the women somehow “naturally” knew how to deal with the exigencies of their new profession.¹⁸¹ The carers, who were colloquially called

“gerontodomaćice” (geriatric-domestics), visited five or six households two to three times a week for two hours. The weekly workload was calculated at 30 hours, and they received 25 per cent below the legally guaranteed minimum wage of € 150 for forty hours of work per week.

Contracts were renewed every month, and so the expenses for holidays were also scrapped. On the up side, social insurance contributions were paid. Meetings between Goca and the carers were planned monthly, although in practice they were more irregular. At these meetings, carers voiced problems or exchanged users. This is why in 2011 one carer whom I accompanied had worked with 20 households, while Ljilja always stuck to “her” seniors and had had ten households in all by 2012 (three users died). After some years, the carers in the two teams also began to exchange their experiences in joint team meetings.

The insecure, underpaid and non-professionalised working conditions upset the urban care workers. By 2011, their number reduced to seven (some moved away or found better paid employment). Given the stable budget, salaries could be raised by a third (which compensated

181 In contrast to their urban colleagues, the carers for the village received at least a pro-forma training, as I observed on 1 August 2009. I arrived at 11 am at the training workshop held in the CSW. Ten trainees had already waited an hour for the trainer, who finally arrived 11.15 am. He was a social worker from the CSW in Jagodina, and ran a social work NGO on the side. There had been some problems on the road, he explained his delay. The training then lasted for ca 2.5 hours. Basically the women followed a power point presentation on problems and solutions in elder care. One crammed slide, for instance, described the needs and difficulties of seniors as: “social security; economic independence; existential needs; safe living space […] concordant with the physiological needs of the old person, reduced possibility to move, enfeebled sense of hearing, sight et al.; need to belong – qualitative relations and contacts with the family that cares about it. […]; what other kind of needs do we have?” At 2 pm the workshop ended with a multiple choice test. Goca was unhappy to put it mildly, because the training was booked from 9 am to 3 pm. She thought the man had drunk the previous night, and that was why he came late and lacked concentration (D, 1.8.2009).

186 for inflation). Yet the number of seniors remained constant at 50, so that carers now catered for seven or eight each (D, Zorana, 6.9.2011). This reduced the time available for each household, but unlike in the managed care time analysed by Lutz, the spatio-temporal adjustments of the carers were basically left to their own discretion. Though the gerontodomaćice handed in rough monthly schedules that they wrote themselves, the implementation was hardly ever checked.

Indeed, several of the seniors cared for by Ljilja had not seen a social worker until 2012.

Despite these problems, the senior care service was able to kill several birds with one stone.

The CSW proved agentic in its fight against the impoverishment of the population. Their users

“in the files” received an additional form of support, which cost less than putting them in a care institution. Furthermore, the CSW created insured (though underpaid and deregulated) jobs, which reduced unemployment and helped the carers to earn a living and a future pension.

Ironically the last point was the main argument to convince the reluctant old people to try and use the service:

When we introduced Help at Home [...] it was rather difficult at the start to do the things that we had planned. The number of users was much smaller, some participated only out of hardship [...]. They saw this as something imposed on them and not a need, and that was how they experienced the people who came to them. They simply thought they were doing a favour to somebody, that it is not as good for them as it was presented. They thought because of them somebody gets paid and then like, alright, then let’s do them the favour (tI, Zorana, 23.5.2012).

That it took a while until the care relationship became satisfactory for both sides was connected to three factors: the newness of state senior care in central Serbia, its ambiguity with relation to the family ethos of care, and the popular discourse on state help which supposedly was only received by the most needy, the greedy, or the well connected. But over time the elder people began to feel that the service also meant something positive for them.

We will see now how intimate, reciprocal relationships developed in the ensuing long-term care practices on the example of care giver Ljilja’s relations with Maja and Veljo, and Marija.