Elsevier

Journal of Rural Studies

Volume 82, February 2021, Pages 130-137
Journal of Rural Studies

Farm-based day care on the market: The case of dementia care services in Norway

https://doi.org/10.1016/j.jrurstud.2021.01.022Get rights and content

Highlights

  • In the market exchange of farm-based day care services, the municipality has relatively strong power compared to the farmer.

  • This asymmetrical power balance may hinder claims for economically and socially sustainable services.

  • A professional and predictable collaboration is important for farmers' perseverance as providers of care farming services.

Abstract

In line with the multifunctional agriculture discourse, care farming is highlighted by governments as a promising service—as an additional source of income for farmers and as a current alternative or supplement to ordinary public care services. Based on the rather modest number of care farming services and their often unstable existence, this paper examines critical aspects of the market relation between providers and buyers when it comes to ensuring sustainable and persistent farm-based day care services. Our analysis is based on interviews with farmers as providers of farm-based day care services for people with dementia living in their own homes and with representatives from the municipal health sector as buyers of these services. One of the findings is that the askew, yet harmony-characterised, power structure between the market actors makes professional ordering of care farming services critical to the providers’ endurance and wellbeing. The paper concludes that the market relation between providers and buyers could be strengthened, but vulnerabilities related to such a relationship are inevitable.

Introduction

Care farming is highlighted as a promising service in many Western countries, both as an additional source of income for farmers and as a supplement to traditional public care services (Haugan et al., 2006; Hassink et al., 2012). This kind of service is in line with the multifunctional agriculture discourse, which has been prevailing in the EU's (and, hence, individual countries') agricultural policy communication since the early 2000s (Erjavec and Erjavec, 2020). While agriculture was traditionally regarded as serving the common good through the production of food and fibre, during the last decades, a greater emphasis has been placed on the environmental and social benefits of this sector (Rønningen et al., 2012).

Numerous concepts have been used to describe care activities offered in farm locations: social farming (Di Iacovo and O'Connor, 2009); care farming (Hine et al., 2008); green care (Sempik and Bragg, 2013); and farming for health (Hassink and van Dijk, 2006). Notwithstanding the diversity of concepts, they share several central elements: The farm setting is used to engage in physical activities and tasks related to farm production of some kind, be they crops, horticulture or livestock, and the services promote mental and physical health for a variety of client groups (Hassink and van Dijk, 2006; Steigen et al., 2016) that are related to their social, physical, mental health or learning challenges. The services are regarded as appealing because of the green environment, the informal atmosphere and the opportunity to participate in diverse activities and be part of a community. In addition, where relevant, the farmers' personal involvement is seen as an advantage (Hassink et al., 2010).

Across Europe, care farming is also “framed” (i.e., communicated, organised and practiced) differently in different countries (Dessein et al., 2013). Alternatives to the multifunctional agriculture frame/discourse (identified in the Netherlands, Belgium, Norway) are the frame of public health (in Germany, Austria, UK), within which activities are primarily concerned with providing health restoration and protection; and the frame of social inclusion (in Ireland, Italy), focusing on the re-integration of socially excluded people in society through the contribution of on-farm labour (Dessein et al., 2013).

In Norway, the multifunctionality of agriculture is strongly embedded in public policy (Almås, 2004). For instance, the political authorities underline the high value of developing useful welfare services in the farm arenas (LMD-KRD 2012). Furthermore, in the Norwegian governmental so-called Dementia Plan 2015 (Norwegian Ministry of Health and Care Services 2015) and Dementia Plan 2020 (Norwegian Ministry of Health and Care Services 2020), the health authorities highlighted farm-based day care as a complementary service to meet the needs of this client group, together with instructions that every municipality from 2020 onwards is obliged to offer day activity services suitable for people with dementia living in their own homes.

It is, however, a challenge to establish a sector of sustainable, soundly-performing care farms. Over time, several Norwegian municipalities have gained experience with care activities offered in farm locations, but these are generally unstable in terms of durability, and the total number of providers accessible for a certain point in time is relatively small (Giskeødegård et al., 2016). In 2006, the number of providers of farm-based care services was lower in other European countries than in Norway (Hassink and van Dijk, 2006). However, a rise in the number of care farms has been documented over the last decade across the UK (Bragg and Atkins, 2016), the Netherlands (Garcia-Llorente et al., 2018) and Italy (Dell’ Olio et al., 2017). In the Netherlands, care farming is seen as a successful and innovative sector, but certain challenges threaten its sustainability, such as the organizational gap between agriculture and the health sector and the lack of sustainable financing structures (Blom and Hassink, 2008).

While much research has been conducted on farmers’ motivations and experiences as providers of farm-based care services (e.g., Johansen, 2014; Krom and Dessein, 2013), there has been less of a focus on the relationship between farmers as providers and the municipal health sector as a buyer, although such market-based relationships seem crucial to the establishment of sound and enduring services and farm businesses.

In this paper, we examine the market relations between these actors to see if the nature of this relationship explains the instability and the relatively low dimension of such services. We draw on qualitative data from Norway when examining the following research question: What are the most critical aspects of the market relation between providers and buyers when it comes to ensuring sustainable and persistent farm-based day care services?

Previous research has pointed to relevant aspects of the market relations involved in care farming. To attain a successful development of stable farm-based day care services for relevant user groups, effective and appropriate interaction and collaboration between involved actors are a prerequisite (Di Iacovo and O'Connor, 2009; Vik and Farstad, 2009). To ensure a tailored package of municipal care services for relevant user groups, it is important that the municipalities as buyers and farmers as providers keep each other informed and create a common understanding of the partners' responsibilities, duties, activities, needs and potential (Nowak et al., 2015). However, in a study by Vik and Farstad (2009), farmers as providers and the public sector as buyers were found to represent different “social worlds”, where an institutional framework and market devices capable of bringing key actors together are lacking. Hence, the ability of establishing a professional collaboration between the buyers and providers seems challenging. Hassink (2017) also identified bridging the gap between the agricultural and care sector as the main challenge to care farming providers.

Within the health and welfare sector, duty officers are accustomed to collaborating with individuals within agriculture (Kogstad et al., 2014). One challenge that has been identified is that the professional groups in the public health sector in Norway have been sceptical of services that are not fully based on professional expertise (Haugan et al., 2006). To some extent, this aligns with the findings of Krom and Dessin (2013) in their study of care farming in the Netherlands, in which the health sector regards care farms as only one among many informal care settings where clients can be placed, and responsibility for them lies primarily with the health sector and not the farmer. In a Norwegian study, Giskeødegård et al. (2016) found that staff in the health sector tends to regard farm-based care services as an add-on activity that users can choose in the menu of welfare and health activities, if interested, and not as an institutional and permanent part of the municipal health sector. This creates an unstable context for the farmers: if the municipality wants to terminate the contract in farm-based care due to a lack of interested users, it will be necessary to have strategies to ensure an alternative income.

In farm-based day care, farmers as providers must build alliances and negotiate with actors outside the agricultural sector, such as the municipality as a buyer of the services, and even adopt new modes of production and marketing. The market exchange relations related to ordinary farming, such as the sale of agricultural products, are different from those involved in care services. In a survey among farmers providing farm-based care in Norway, Ihlebæk et al. (2016) found that support from the health sector is important for the wellbeing for providers of care farming services. However, one-fourth (26%) answered that they did not have the possibility to receive professional help and advice from the health sector when needed. Such an initiative could involve suitable arenas where providers, users and their next of kin can meet and exchange experiences (Giskeødegård et al., 2016). In addition, Hassink et al. (2016) found that support from influential people in the care farmers’ network was crucial for pioneers to overcome resistance from powerful actors and gain access to care sector funds.

Collaborating with only one care institution (public sector within health and care) places care farming providers in a vulnerable situation, which could be an obstacle when running an effective care farm (Hassink et al., 2016). In a study of providers of farm-based care services for people with mental health or substance-abuse problems in Norway, the providers listed uncertainty arising from overly short contracts and complicated cooperation with the public health services as key challenges (Lund et al., 2015). Having no background in health care is regarded as the most severe challenge among innovators or pioneers of care farming (Hassink et al., 2012).

In this paper, we look more closely at the market relation between care farming providers and public buyers, using the following structure. First, we present the parts of Beckert's (2009) theoretical work on the sociology of markets which is relevant to our study. After describing our data and methodology, we provide a brief description of the Norwegian context for care farming together with key information about the farms and municipal administrations included in the study. We then continue with our analysis of the current market relations, structured around Beckert's theory on the three main problems of markets. Finally, we discuss the most critical aspects of the market relation between providers and buyers when it comes to ensuring sustainable and persistent farm-based day care services.

Section snippets

Markets theorised as arenas of social interaction

As a theoretical framework for a study of the market relations between farmers as providers of dementia care services and the municipality as a buyer, we use the theoretical work on markets by sociologist J. Beckert (2009). According to Beckert (2009), a first central element of markets is voluntary exchange of rights in goods and services. Second, the markets are characterised by competition, where at least three actors are involved: one actor confronting at least two other actors whose offers

Data and method

This study is part of a larger Norwegian research project on farm-based day care services for people with dementia. Our part of the project was designed to study farm-based day care services the market relation between providers and (public sector) buyers. There is a limited number of farms providing these kinds of services in Norway, about 32 (Ibsen et al., 2018). We carried out semi-structured face-to face interviews with eight farmers providing day care services for people with dementia

The Norwegian context for care farming

Farm-based day care has been offered in Norway since the early 2000s (Ibsen et al. 2018). The proportion of the operating farms providing care services has remained relatively between 2010 and 2018. In a representative survey carried out with Norwegian farmers, Logstein (2010) found that four percent of all farmers offer care farm services at their farm while in 2018, the number was three percent (Zahl-Thanem et al., 2018).

In Norway, care farming mainly takes place on family farms where the

Context information about the providers and buyers

The eight providers in this study are all pioneers in their municipality regarding the offering of farm-based day care for people with dementia. Their services were established between 2008 and 2012. All, apart from one, provide services to other target groups such as school children in parallel with the services for people with dementia, which are offered on different days. The dementia care services offered vary regarding in terms of the number of participants hosted and number of days per

Coordination problems in the market arena of farm-based dementia day care services

As outlined earlier, our analysis of the market relationships between care farming providers and the public health sector as a buyer is mainly based on Beckert's (2009) identification of three potential problems of coordination in the market arena. Hence, we examine if the value problem, the problem of competition and/or the problem of cooperation need to be addressed in order to ensure a well-functioning market of care farming services.

Discussion

In this study, the aim was to explore the critical aspects of the demander (buyer)-provider relationship when it comes to ensuring sustainable and persistent farm-based day care services. With help from Beckert's (2009) theoretical work on the sociology of markets, we have examined how three central market problems are raised and addressed in the case of farm-based day care services for people with dementia in Norway.

In the market relation between the municipalities and the providers, the

Conclusion

Although there is interest for farm-based day care services, both as a valuable supplement to regular public care services within the health sector and as an additional source of income within the agricultural sector, the scope and durability of such services are rather modest. This study has added increased understanding and knowledge on how to ensure a more stable and, hence, potentially larger service sector within this domain.

A key finding is that, even in cases where farmers have a

Author statement

Maja Farstad: Conceptualization, Methodology, Investigation, Writing – original draft, Validation, Brit Logstein: Methodology, Investigation, Writing – original draft, Project administration, Validation, Marit S. Haugen: Methodology, Investigation, Writing – review & editing, Deirdre O'Connor: Writing – review & editing

Funding

This work was financed by The Research Council of Norway [through the research programme BIONÆR, grant number 255033].

Declaration of competing interest

None.

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