Stay with Me in the Night: Navigating Service Delivery and Safety in Elder Care during the Venezuelan Crisis

Background and Purpose: During disasters, social service and health organizations are often tasked with delivering care provision amid unstable and unsafe environments. This paper examines how two community health clinics modified practices to meet changing elder care needs and navigated competing safety risks during the evolving crisis in Venezuela. Since 2016, the oil-dependent country has faced some of the worst hyperinflation in global history, currently at over 18,000 percent. Severe shortages of food, water, and medicine have led to widespread hunger, malnutrition, destitution, and displacement. Economic and food insecurity have complicated spiraling community violence and crime, with homicide rates the highest in the world. While literature on natural and human disasters often reflects the disproportionate vulnerability and mortality of older persons, this study considers how practitioners strove to optimize elder care as they weighed the dynamic disjuncture between organizational objectives and environmental instability and insecurity.

Methods: Research draws on 24 months of ethnographic fieldwork on elder care in Venezuela, primarily 2014 to 2016. Clinical observation, participation in neighborhood life, and hundreds of interviews were conducted across multiple sites where older adult caregiving activities occurred, including two public community health clinics, neighborhood events, waiting in lines for government-regulated food rations, and home visits. Recorded interviews with 55 participants included urban and rural sub-groups, with split sampling between elderly Venezuelans living with and without a caregiver. Interviews incorporated gerontological caregiving assessment tools, such as strength-based assessment. Content analysis and narrative coding assisted in identifying analytics and themes in care needs and activities, life histories, and social support networks.

Results: This study finds that practitioners and elderly patients varied in strategies for adapting care practices to accommodate dynamic and unstable environmental pressures during profound crisis. Adapted practices include: 1a) providers’ reliance on medical technology shifted to reliance on clinical evidence and clinical expertise of senior physicians, and 1b) providers took on additional roles that had previously been filled by other personnel and ancillary services. Older adults adapted via 2) a form of self-triage through prioritizing and rationing the treatment of their medical conditions based on the availability of and ability to pay for medications.

Conclusions and Implications: Disasters often destabilize the environment in which organizations are accustomed to functioning, raising competing tensions between service delivery and safety. This research suggests that changing environmental pressures and reduced resources during disasters can result in the burden of modifications and risk assessment falling to individual practitioners and patients. Identifying strategies for adjusting elder care practices to changing care analytics, needs, and activities will assist social service and health care organizations during future natural and human disasters.