The caring community movement and public health end-of-life care has to maintain their critical potential against the commercialization and fragmentation of care (services), but also without "romanticizing" communities. Prospective caring community progresses need (I) an ecological health-promotion framework for action and (II) social learning processes along the existential experiences and the wisdom of community members, complementing each other. Organizing existential-political care dialogues can contribute to an ethic of caring in practice on a community level.
In accordance with the pluralisation of life plans in late modernity, the societal organisation of care at the end of life is diverse. Although the public discourse in western societies is dominated by questions about optimising specialised palliative care services, public health approaches, which take into account the social determinants and inequalities in end-of-life care, have gained in importance over the last decade. Conceptual aspects, dimensions of impact and benefit for the dying and their communities are well discussed in the public health end-of-life care research literature. Our research focuses on the preconditions of a supportive caring web in order to understand how communities can build on their social capital to deal with existential uncertainty. As part of a large-scale community research project, we carried out focus groups and interviews with community members. Through dispositive analysis, we generated a set of care-web 'ingredients', which constitute and foster a caring community. These 'ingredients' need to be cultivated through an ongoing process of co-creation. This requires: (i) a focus on relationships and social systems; (ii) the creation of reflective spaces; and (iii) the strengthening of social capital, and d) the addressing of inequalities in care.
Nursing homes are challenged by a significant change in the patient-structure. To care for dying elderly people means to enable them to live in dignity till the end. Helpful therefore is to implement Palliative Care into existing structures. This requires personal and organizational learning and development. The first step is to make central differences and contradictions visible und communicable. We describe three organizational types which leads into different core-processes. Organizational measures supporting the development of a palliative culture and indicators of successful implementation are presented.
This chapter briefly outlines the history, key concepts, and main practice methods from public health approaches to end-of-life care. Although linked to psychosocial care approaches, its main methods draw not from psychology or health services inspired approaches but rather from health promotion, community development, and civic engagement. Key methods covered include community volunteering, social networking, community engagement, and compassionate communities and cities. The aim of these kinds of approaches is to embed palliative care practice as a social and civic practice in all sectors of society and to ensure that palliative care as a policy is represented in all civic policies (e.g. schools, workplaces, faith groups, and cultural activities) and not solely in health care.
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