‘Giving and giving back’ at the end-of-life: Reciprocal investments between caregivers and residents in the Swiss nursing home context

Abstract

The present article is based on an ethnographic research project exploring the constitution and reproduction of exchange relationships between residents and caregivers in Swiss nursing homes and elaborating on their significance within end-of-life trajectories. The results show that despite scarce personnel, time and cost resources in old-age long-term care, exchange relationships in the sense of non-liquidating transactions are of major significance both in daily interactions and in the context of acute dying in the nursing home. Residents as well as caregivers invest in relationships that build on an informal ‘giving and giving back’. Invested goods or services are manifold and often immaterial, both on the caregivers’ and on the residents’ side. The main informal investments are: 1) permitting affection and emotional involvement 2) sharing personal information, and 3) offering extra-time. The paper demonstrates how actors exchange these goods to establish an informal dimension in their care relationships and how this dimension may influence end-of-life practices in the nursing home. Focusing on informal parts in exchange relationships allows considering care relationships from a theoretical perspective that has gained little attention so far, both in anthropological exchange theory and in disciplines concerned with care relationships.