Nebowsky, Anna-Eva and Ulitsa, Natalie and Kutzleben, Milena von and Ayalon, Liat and Schweda, Mark (2026) Moral conflicts in familial dementia care involving migrant live-in carers in Germany and Israel: A comparative empirical-ethical exploration and analysis (MoDeCare). Project report. Monografie. Selbstverlag. (Unpublished)

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Abstract

The MoDeCare-project (Moral Conflicts in Familial Dementia Care Involving Migrant Live-in Carers in Germany and Israel) aimed to advance our understanding of the ethical challenges of home-based dementia care arrangements that rely on migrant live-in caregivers. In response to a growing reliance on this form of care in ageing societies, the project addressed a key gap in the literature, namely the lack of systematic empirical-ethical analysis of moral conflicts arising within these arrangements. The project adopted a comparative and interdisciplinary approach, combining qualitative social research with ethical analysis across two national contexts, Germany and Israel. It was among the first to provide empirically grounded insights into all three perspectives involved at the micro-level (people with dementia, family members, live-in carers) within a cross-national comparative framework, and to conduct ethical analyses informed by these findings. The focus was on the triadic care arrangement involving persons with dementia, migrant live-in caregivers (live-in carers), and family members. MoDeCare conceptualized care as an interdependent relational system, shaped by everyday interactions as well as broader institutional and structural conditions. Empirical data were collected through qualitative interviews with multiple stakeholders, including experts in dementia care or/and migrant caregiving (n=24, in Germany 10; in Israel 14), family members of persons with dementia (n=29, in Germany 12; in Israel 17), migrant live-in carers (n=31, in Germany 10; in Israel 21), and persons with dementia (n=7, in Germany 3; in Israel 4), and were complemented by ethical analysis drawing on care ethics and family ethics. A central scientific contribution of the project was the development of a conceptual framework for analyzing moral conflicts in migrant live-in dementia care. The framework distinguishes between conflicts involving moral norms and values and situates them across micro (interpersonal), meso (organizational), and macro (structural) levels. This allows for a systematic understanding of how ethical tensions arise within caregiving relationships and how they are shaped by institutional arrangements such as migration regimes, labor markets, and long-term care systems. Empirically, the project generated new insights into the multidimensional vulnerabilities of all actors within the caregiving triad. The findings demonstrate that vulnerabilities are deeply entangled, with the needs and constraints of one actor affecting the others. In addition, the project examined everyday caregiving practices, particularly the management of behavioral and psychological symptoms of dementia, highlighting the central role of experiential knowledge, as well as the importance of communication and cooperation between family members and caregivers. At the systemic level, the project identified significant organizational and structural challenges associated with migrant live-in care. The comparative analysis showed that while both Germany and Israel rely heavily on migrant caregivers, differences in legal frameworks, welfare systems, and labor market conditions shape how care is organized and experienced. The project also examined how crisis situations, specifically the Israel–Hamas war, intensify moral tensions within caregiving arrangements. Migrant live-in carers in Israel faced acute dilemmas between personal safety and caregiving responsibilities, highlighting the structural invisibility of this workforce in emergency contexts. Complementary findings demonstrated that older care recipients themselves exhibit agency and resilience, challenging assumptions that portray them solely as passive recipients of care. Through its interdisciplinary and comparative design, the MoDeCare project contributes to advancing knowledge in gerontology, migration studies, and care ethics. It provides an empirically grounded and theoretically informed account of moral conflicts in migrant live-in dementia care and offers a foundation for policy-relevant ethical reflection on the future organization of long-term care in ageing societies.

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Das MoDeCare-Projekt widmete sich der Erforschung der ethischen Herausforderungen häuslicher Demenzversorgung mit Hilfe migrantischer Live-in-Betreuungshilfen in Deutschland und Israel. Ziel war es, die moralischen Konflikte in den Triaden aus Live-in Hilfe, Person mit Demenz und Familienmitgliedern systematisch zu erfassen und durch eine Kombination aus qualitativer Forschung und ethischer Analyse zu verstehen. Das Projekt entwickelte ein konzeptionelles Rahmenwerk, das moralische Konflikte auf Mikro-, Meso- und Makro-Ebene zu analysieren hilft und dabei zwischen Konflikten von Normen, Werten oder einer Kombination aus beidem unterscheidet. Empirische Untersuchungen zeigten, dass alle Beteiligten der Versorgungstriade multidimensionale Vulnerabilitäten aufweisen, die eng miteinander verflochten sind und sich gegenseitig beeinflussen, wobei Unterschiede zwischen den nationalen Kontexten die Rolle von Wohlfahrts- und Pflegesystemen verdeutlichen. Darüber hinaus wurden die alltäglichen Sorgepraktiken und der Umgang mit den Verhaltens- und psychologischen Symptomen von Menschen mit Demenz untersucht, wobei insbesondere die Erfahrung, Kommunikation und Kooperation zwischen Familien und Live-in Hilfen als entscheidend hervorgehoben wurden. Das Projekt beleuchtete auch die organisatorischen und strukturellen Herausforderungen, denen Familien bei der Koordination von Live-in Betreuung gegenüberstehen, sowie die Belastungen in Krisensituationen, wie beispielsweise während des Israel-Gaza Kriegs seit 2023, die moralische Dilemmata zwischen eigener Sicherheit und Sorgeverantwortung verschärften. Gleichzeitig zeigte sich, dass die Personen mit Demenz in dem Setting aktiv Verantwortung übernehmen, Resilienz an den Tag legen und die Sorgebeziehung mitgestalten. Insgesamt liefert MoDeCare ein umfassendes Bild der ethischen, relationalen und strukturellen Dimensionen migrantischer Live-in-Betreuung und zeigt sowohl gemeinsame Muster als auch kontextspezifische Unterschiede zwischen Deutschland und Israel auf. Die Ergebnisse tragen zur wissenschaftlichen Diskussion in Medizinethik, Care Ethik, Gerontologie, Psychologie und Migrationsforschung bei, bieten empirisch fundierte Grundlagen für politische Empfehlungen und bilden die Basis für Folgeprojekte wie TriaDe.

Item Type:	Monograph (Art der Monografie: Project Report)
Uncontrolled Keywords:	Migrant Live-in Care, Live-in Care Arrangements, Dementia Care, Home Care, Vulnerability, Moral Conflicts, Care Ethics, International Comparison, Germany, Israel
Subjects:	Technology, medicine, applied sciences > Medicine and health
Divisions:	Faculty of Medicine and Health Sciences > Department of Public Health and Medical Education
Date Deposited:	12 Oct 2026 08:42
Last Modified:	26 Oct 2026 14:03
URI:	https://oops.uni-oldenburg.de/id/eprint/7529
URN:	urn:nbn:de:gbv:715-oops-76109
DOI:
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