Scandinavian welfare research has paid more and more attention to the
role played by women in building institutions for children, the sick
and the elderly. The new institutions were generally called ”homes”
and it was precisely this linkage between women and homes that may
have led to clear perceptions of what the new ”homes” were like. Concepts
like motherliness, homeliness and intimacy are presented as important
characteristics, despite (or because of ) the lack of empirical
evidence. Historical research has shown that the home was highly idealised
around the turn of the last century, but this idealisation was prescriptive
and did not necessarily reflect real homes. The aim of this
article is to argue that an institution, or any social system, cannot be
perceived in isolation from the particular parties that created them –
or from the place where they were created. Only then is it possible to
say something about which or whose concept of a home was (attempted)
realised. A phenomenological perspective on the home will
often take as its starting point people’s need for identity, intimacy, security
and meaningfulness. From a sociological point of view, the aspects
that phenomenology pinpoints as important are created through
time-consuming work and relevant categories can be connected with
how the work is organised. ”A home” can be a lot of things, so the
analysis must draw on both material, structural and symbolic aspects.
An increasing number of individuals with complex health care needs now receive life-long and lifeprolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation.
Using qualitative research methods, a Grounded Theory influenced approach was used to explore the
families’ experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults) were recruited for 10 in-depth interviews.
The core category, “fighting the system,” became the central theme as family members were asked to
describe their experiences. In addition, we identified three subcategories, “lack of competence and continuity”, “being indispensable” and “worth fighting for”. This study revealed no major differences in the families’ experiences
that were dependent on whether the ventilator-dependent individual was a child or an adult.
These findings show that there is a large gap between family members’ expectations and what the
community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide
in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.