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

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 elaborates on their significance within end-of-life trajectories. The results show that despite limited personnel, and time and cost constraints in old-age long-term care homes, exchange relationships are significant both in daily interactions and in the context of acute dying. Residents as well as caregivers invest in relationships that build on an
informal ‘giving and giving back’. Invested goods or services in this exchange are manifold and often immaterial. The main informal investments are: 1) permitting affection and emotional involvement 2) sharing personal information, and 3) offering extra-time. Scant research exists on the reciprocal exchange in care relationships from a theoretical perspective, a gap this study sought to fill. This paper employs anthropological exchange theory to demonstrate how the exchange of these immaterial goods establishes an informal
dimension of care that may influence end-of-life practices in the nursing home.