Our empirical research focussed on features of rural ageing. Ageing happens everywhere, be it in urban, suburban or rural areas. Nevertheless, in Flanders, we see an important overrepresentation of older people in non-urban areas (Schillebeeckx, Oosterlynck and De Decker, 2014). Aside from ‘the numbers’, other developments are relevant, since they are linked to the possibility of delivering formal and informal care. First, considering informal care, AiP is related to the assumption that rural villages possess a strong sense of community. Like societies as a whole, rural communities have changed. They are increasingly unlikely to contain autonomous villages with a wide variety of functions and services, such as work, schooling, culture and dense social networks (Lowe and Speakman, 2006; Keating, 2008; Krout and Hash, 2015; Commission for Rural Communities, 2012; Thissen, 2017). Either they have experienced deterioration, which is often the case for more remote areas, or they became mono-functional housing areas. The latter often occurred in villages of a high (perceived) environmental quality in the proximity of work-rich areas (often cities). But in both cases, the consequences for the elderly to age well in place seem to be the same. An important concern relates to the availability and possibility of informal care. AiP starts from the assumption that adult children and eventually other family members will take care of their parent(s), especially when a spouse/ partner has passed away. The problem is that many rural areas, as argued by Thissen (2015), experience a ‘dejuvenation’ since a decreasing proportion of adult children live near their elderly parents. They moved away because there is no work (push- factor) or they live in more vibrant work-rich (urban) environments (pull-factor). Therefore, adult children cannot automatically be considered as caregivers for their parents, at least not on an everyday basis (Vermeij, 2016 for The Netherlands). In addition to the role of the children, successful AiP ‘needs’ a socially cohesive environment. But here too, the story is similar. Vermeij (2016) points out how voluntary work is much less available in rural areas then in more populated areas. This follows from the fact that there are fewer people to do the voluntary work. But also in relative numbers, voluntary workers are – e.g. in the Netherlands - more scarce (Vermeij, 2016).

This brings us to formal care. At least in the case of Flanders, rural areas are not well equipped with home-care services or nursing homes that can cater for older adults with varying levels of care needs. Concerning institutionalised care, exceptions aside, two types are available: the nursing homes⁶ (for elderly people with high care needs) and service flats (rather expensive⁷ apartments where medical care is not included, but is organized by the same organisations that provide care for people in regular housing, people that 'age in place') (De Decker et al., 2018). Concerning home- care, there is a financial difference between rural and urban areas: it is more expensive to deliver care at home in sparsely populated areas compared to more densely populated areas (Commission for Rural Communities, 2012 for the UK; Sommer, 2017 for The Netherlands). People in rural areas (often) live in remote places, resulting in higher transport costs for care providers and their staff spending a larger proportion of their working time in their car.⁸ This, in combination with austerity policies and a pressing shortage of care providers, imposes the question whether the numerous rural elderly will receive adequate care. Obviously, this applies to all regions, but the situation is most precarious in remote areas.

There is also the feature of elementary services. This has (at least) two dimensions. One is the availability of services. Following the upscaling of commercial activities (Thissen, 2017), many services such as grocery stores, bakeries, (para)medical professions, are simply not available in many villages. The second dimension concerns social activity. Earlier we referred to research that indicates that people should be active to age well. They should be active volunteers in their community, go to social events, experience new things etc. But again, these opportunities are hardly available in remote areas. As a consequence, the elderly can either withdraw or hope to drive a car for as long as possible to be able to go to activities and services, and to meet family and friends.

Given the described limitations concerning care and housing: how do rural elderly experience informal care and to which extent are (1) family and (2) neighbours involved?

Figure 2 identifies rural areas in Flanders. We focused on two regions. They were selected on a pragmatic basis following contacts we already had from previous research or developed during the explorative phase of this research. Of course, both areas had to have an overrepresentation of elderly. Nevertheless, the two areas have their differences. The first is called ‘Westhoek’. It is located in the western part of the Flemish region. It is a very remote rural area, classified as ‘very rural’ in the Belfius typology (Gielens, 2018). Jobs and services (in its broadest sense) are limited. It is an area that has experienced a long-term and ongoing outflow of the highly educated due to the lack of jobs (brain drain). A general population shrink is expected in the near future. Our second research area (Kempen), although being a rural area, is more centrally located and ranks 3 to 4 on the rural-urban scale, 6 being the most urban (Gielens, 2018). The region is home to a diverse range of economic activities such as industrial activities along the Albertkanaal (a waterway connecting the cities of Antwerp, Genk, Hasselt and Liège), higher education institutions (polytechnics) and very specialized industries (nuclear sector; pharmaceuticals). A brain drain or a declining population is not an issue here. Hence, we expect to find some differences between the two regions when it comes to ageing well in place, not the least when it comes to the role of informal care by the (adult) children.

Figure 2
Selection of rural areas in Flanders, based on two different indicators (De Decker et al., 2018)
SumResearch

The two case study areas (Westhoek and Kempen) are indicated on the map. Since both areas have no clear boundaries, municipalities with a high share of people older than 60 are chosen within those areas. The appointment of rural municipalities is based on two sources (VRIND, 2014; PDPO III, 2015). This explains the colour differences.

We used a combination of primary data sources in our research. To start with, we talked to experts in the field of ageing and elderly care, including managers and employees of resting homes and local social services and representatives of umbrella organisations responsible for providing care and nursery services at home. In addition, we accompanied formal care takers and nurses during their daily tours. This allowed us to collect information about both the demand and the supply side of home-based care. However, the largest part of our research consisted of in-depth interviews with elderly people in each of the two study areas. The interviews were complemented with focus groups undertaken in nursing homes in each selected area and in a few new small-scale supported housing initiatives outside of the case study area (the municipality of Maldegem). In the focus groups, only inhabitants took part.

The interviews and focus groups in Westhoek took place between October and December 2015. To select respondents we contacted the municipalities, who provided us with a list of names and addresses of local residents aged 60+. Additionally, we also used a local elderly network, Nestor, to recruit participants. Older adults were initially contacted by telephone and if they agreed to participate in the research an interview followed in their home. 24 elderly people were interviewed in 21 interviews. The youngest participant was a man in his early sixties, the oldest was aged 93. Half of the respondents were in their 80s. 16 out of 24 respondents are women, which means women are overrepresented in the Westhoek group. Many had not worked outside the home (housewives) or had worked in low skilled or technical jobs⁹.

The interviews in Kempen were conducted in late 2016, between October and December. All potential participants were contacted through a list of 60-plussers provided by the municipalities. We interviewed 31 people of whom 17 were women and 14 were men. The youngest was aged 63, the oldest was 93. A majority (22) were in their 70s. Most of them had been employed in physically demanding or technical jobs¹⁰; some had worked in the education¹¹ or nuclear sectors. The general education level of Kempen participants was slightly higher than that of Westhoek participants.

Across both study areas only one participant did not own the house they lived in. The location of participants’ homes varied, including some in town centres, isolated dwellings and others were part of small groupings of houses.

The interviews were all structured around a topic list. Topics were based on a study of relevant literature (WHO, 2006; De Witte et al., 2012; Golant, 2015) and previous research undertaken by the authors (De Decker, 2013; Vandekerckhove et al., 2015). Working with pre-selected themes has the advantage that it structures the analysis. But because there are no predetermined questions, respondents get the freedom to narrate and to reflect on these themes but were also able to shine a light on new items.

During the interviews, respondents were asked to reflect on their housing and care situation. Findings from the Westhoek phase of the research highlighted the importance of care in the life of the Westhoek participants. This led to Kempen participants being asked to complete a diary listing their activities in a typical week. These schedules allowed us not only to estimate how active the elderly are, but also the level of social contact and interaction they had (who visits them? Who do they visit?) and levels of care they received (Who provides care? And when?).

Between 2011 and 2014, levels of informal care in Flanders decreased (Vanderleyden and Moons, 2015). The expectation is that for the ‘sandwich’ generation it will be even more problematic to offer informal care due to more complex family structures and an increasing pension age (Steyaert and Knaeps, 2016).

The Belgian Ageing Survey (BAS), a very large national survey, revealed that around half of Belgian 60-plussers can count on their (grand)children for help with, among other things, housekeeping. 52 % can count on a (grand)daughter; 45 % on a (grand)son. However, this national data suggests that approximately half of the elderly cannot count on informal assistance from a close relative. In one of our research areas, Westhoek¹², only 49 % of older adults receive assistance from the children, a lower proportion than the Flanders average of 61 % (Steunpunt Sociale Planning et al., 2015).

Our interviews revealed a lot of similarities and one major difference between the respondents in the two research areas regarding informal care from family members. In Kempen, a work-rich area with a high diversity of jobs, all of our elderly respondents had at least one child living within a radius of 20 km. Many of our respondents in Kempen had children living in the same village and some even in the same street. This was not the case in Westhoek where most children lived farther away. This follows from the fact that Westhoek is job-poor and has a long history of out-migration.

Beyond this difference, we see similar findings with respect to care provided by children. In both case study areas, the elderly can be divided into four different groups, based on the extent to which they rely on their children for help. The first group is the elderly who already need and receive care from their adult children (this dominates in Kempen but occurs also in Westhoek). In this group children pass by more than once a week and assist with a broad range of tasks including driving them to the supermarket or delivering groceries. Not surprisingly, the children that live close by provide most of the support. They also help with administrative and financial matters. If the respondents have several children, a division of labour seems to be in place. Experiences of this group are illustrated below in the extracts from two interviews conducted in Kempen:

1. R¹³: My daughter lives next door and we often go shopping. (75, Millegem - Kempen)

   I: Your children, do they help you?

   R: Yes. They have their own tasks, so they do what they have to do. Everything that concerns payments and money, is done by Margriet. For shopping I have Vera. And the other one for other things (93, Bel - Kempen).

A second group is still pretty mobile and self-sufficient and does not receive care from anybody. Members of this group often are care givers, helping their own children by taking care of the grandchildren. When asked what would happen if they needed care, they are not sure if they would ask for help. Several points are at stake. A first point concerns their own experience. Following the spirit of that time, numerous (female) respondents took care for their parents (or in-laws). Similar to findings from earlier research (De Decker, 2013), almost none of the respondents wanted to be looked after by their own children, as illustrated below:

1. R: I helped my father in law for 20 years. I said: I do not want to go and move in with my children (…). I said: none of my children is going to do that. And so it happened [she moved to a resting home] (83, Beveren - Westhoek).

   I: You lived here with your parents?

   R: Yes. It is now 20 years that my father died and 22 since my mother died. Between their pension date and their death, they were with me.

   I: You took care of them?

   R: More than that [starts crying].

   I: It was heavy?

   R: My mother stayed in a resting home for more than six years. I passed by two times a day. And my father was at home. And I have a disabled brother. (…) Back then it was like that (77, Krombeke - Westhoek).

Secondly, the zeitgeist has changed. This has two dimensions. One is that more children enter higher education or go to college. They no longer… work in the family business (often a farm or farming-related) as would have been common a generation ago. The second is that all children work (cf. the rise of dual-earner families) and have less free time to look after their parents. This societal change is illustrated below:

1. I: You don’t need it yet, but if necessary, can you count on your children?

   R: Hmm... the question is: do we want that? I’ve seen it with my parents. That was ok, but often… it created tensions. Also, we made the consideration that the children are pretty busy. (…) But, it is also the ‘zeitgeist’. You do not want to burden your children too much. Back then, it was different. When we got older, as a child, we helped our parents with their small farm with seven children. I started helping when I was 15. That was normal then. Now? We gave our children more chances, in order to do what they want. Go to college. Work. Being independent. I think the dependency has changed (70, Krombeke - Westhoek).

   R: We talked about that: what are we going to do? We have one son. He will not do that. He studied. These guys have another life now. We [women] were at home, we did not work. We stayed at home when the children came. This is not the case anymore. (71, Beveren - Westhoek).

A final point is that some do not want to be a burden to their children and make demands on the lives of their family members:

1. R1: Since a few years R2 [male partner] suffers from complications after an unsuccessful operation.

   R2: (…) Now I have a lame leg. And it becomes more and more difficult.

   I: Do you get help?

   R1: Yes.

   R2: From the children and the grandchildren.

   R1: But you try to limit that as much as possible. (…) We have 3 children. One [who lives next door] visits us now and then. He does some groceries if it’s necessary. The other…

   R2: … for paperwork. Money, bills…

   R1: And if I cannot do it, our son comes to mow the lawn. (…) If possible, since each has his own family and his house and his garden … (78 and 79, Bel - Kempen).

A third group is only found in Westhoek. It concerns respondents who do not have children or have no children living nearby. The first quote below is from a respondent with two children who do not live in the neighbourhood. Our respondent points to the fact that parents of big families have a structural advantage, while the respondent states to depend on volunteers to drive her around when she is not capable anymore. In the second quote the woman refers to a familiar process for the region: children go to the university and do not come back.

1. R: I [as a volunteer] have once driven someone to the dentist in Poperinge. It takes time then, to wait. Before we were paid to do that. Not anymore. But I still do it. (…) I hope they will do it for me too, later. You depend on it. A lot of families here have a lot of children. They have family around. Farmer families. If they have to go somewhere, there is always a son who can drive (between 60- 70, Gijverinkhove - Westhoek).

   I: Do you have other children?

   R: No, I have only one son. He works in The Netherlands. Went to school [university] in Leuven and then got a job in The Netherlands. (…) Have you been to the house across the street? She has a large family. A lot of visits. If you do not have family… (93, Beveren - Westhoek).

A fourth group consists of rather extreme cases and only corresponds to a handful of our participants. We nevertheless find it useful to highlight an example, because it indicates how far-reaching the combination of the unwillingness to move and the absence of (convincing) alternatives to care can be. In the quotation below the women says that her daughter had to come and live with her while her son-in- law had to go and live with his mother.

1. R: I have a daughter who lives with me. I cannot be alone anymore. She bought a house here in the village. She renovated it. If something happens to me, she would not stay, she would go home. But, the house here is way too large. Being alone here… No, it would not work.

   I: Her husband, does he also live here?

   R: No. He lives with his mother. She is 89. He has a brother and a sister and they arranged who should go (82, Watou - Westhoek).

In line with the above quotation the tour with nurses¹⁴ as well as regular media reports¹⁵ revealed dreary conditions. In this context, managers of care organisations we spoke to also stated they are thinking of setting up a 24h in-home care ('assistant') service to ensure care at all times.

The AiP and de-institutionalisation paradigm attributes a lot of caring potential to the neighbourhood, and depicts it as being a kind of socially warm and cohesive environment where it is assumed that people help each other. But is this (still) the case? For Flanders, quantitative data on informal neighbourhood care are scarce. Thissen and Vanderstraeten (2015) reveal that in non-urban areas only 34 % of neighbours visit each other on a regular basis. BAS indicates that in Flanders approximately 40 % of people older than 60 can count on support from their neighbours. In rural Westhoek this is approximately 45 % (Steunpunt Sociale Planning et al., 2015), which still means that more than half of the elderly cannot count on informal support by the neighbours.

Our interviews bring two nuances to the forefront. One indicates that rural areas are not the socially cohesive communities they are presumed to be; the other indicates that rural areas have changed and processes of social, economic and demographic change have led to a crumbling social cohesion. Different items are important here. What is very striking in both case study areas is that most elderly people tend to be rather reserved towards their neighbours. A majority indicated that they know each other, but hardly meet. They also say that they do not want to disturb their relationship with the neighbours. They do that by staying on their own turf and only assist each other with small chores. For example:

1. I: You know the neighbours?

   R: [surprised] Of course. We are good friends. If we wave, they wave back – even from far. We all talk to each other.

   I: Do you do things together?

   R: No, no. I never have someone in my home. I do not like that. I am not the kind of person who goes to a neighbour’s house and I do not let them in.

   I: Where do you talk then?

   R: [laughs] I do not have to talk to anyone.

   I: How do you know each other then? From the street?

   R: Of course. I would talk. Those are people from the past (80, Beveren - Westhoek).

   I: Do the neighbours help each other?

   R1: I do not know. The neighbour over there, if I need something he helps and I do the same for him. (…) But, drinking something together or frequently meeting? We don’t do that.

   R2: Everyone is on his own, that way it [good relationships with the neighbours] will last (70 and 71, Millegem - Kempen).

   R: We talk to the neighbours if we are outside, but we never frequented each other’s house. I have never been in the house of [neighbour across the street] (75 and 71, Bel - Kempen).

The interviews revealed several factors that hinder informal help from neighbours. The interviews included discussions with people who lived in isolated houses: such people simply do not have any neighbours. They are surrounded by fieldsand meadows, not by people. In the next quote, the participant’s nearest neighbour lives approximately 300 meters away. The respondent is aware of potential future problems.

1. I: Do you have neighbours?

   R: No. Well yes, the farm at the beginning of the street. And there. But that is further away. That might be, for later, a problem. (…) You can call them of course, but you cannot go outside and yell or wave. It can be a disadvantage to have no direct neighbours (between 60-65, Oostvleteren - Westhoek)

A second problem is related to the (former) professions of the respondents. A significant share worked in agriculture. Those who worked in other sectors feel excluded. A male interviewee told us that he goes to the village centre, talks to his neighbours, but he cannot understand them, since he knows nothing about animals or animal feed:

1. R: I go to the village center¹⁶. That’s where the villagers go. They are all farmers. And they talk about wheat or pigs. And I know nothing about that. So, I’m a stranger in my own region. I should take books with me to understand them (between 60-70, Gijverinkhove - Westhoek).

In line with the second problem, there also seems to be a division between the in- and outsiders, between those who grew up in the village – the ‘real’ villagers - and those who arrived later in life (see also Vandekerckhove et al., 2015). The last group feels that it is very difficult to get acquainted with neighbours and other local residents if you are not a ‘local’.

1. R1: Knowing people? Here? … as a stranger, that is very difficult. Once they trust you, they accept you… but it can take a long time. (…) It is an old-fashioned village mentality. You are a stranger.

   R2: Integrating here is not possible, even if you live here for 15 years. No way (both between 60-70, Gijverinkhove - Westhoek).R: Before, in [village X] everybody knew everybody. But today, you do not know your neighbours. I know the name of my immediate neighbours. But that’s it. They are immigrants. And a lot of them came later (73, Bel - Kempen).Importar imagen

   R: But the people who migrated here, you cannot expect that they help you (78, Bel - Kempen)

A fourth problem concerns interactions with younger generations in rural areas. On the one hand, respondents complain about the greying of their community and the lack of young people in the immediate environment, since this is associated with a loss of liveliness. On the other hand, they indicate that they have few interactions with younger neighbours. For example:

1. R: They are all young people. They are not interested in the village life. During the week they work, I don’t know where, and in the weekend they go, I don’t know where, shopping with the car or just go away. But they do not participate in the activities (68, Oostvleteren - Westhoek).

Lastly, some respondents consider the spatial order to be a hindrance. Living along a large and busy road, or in a residential area comprising large plots of land with detached dwellings, does not foster contact between neighbours:

1. R: I have strong ties with some neighbours. But those at the other end of the street, that is a few hundred meters. We never see them, with the exception of the yearly new year’s drink. It is the lay out and… you live 50 meters from one another. My next neighbour, that is already far away (70, Millegem - Kempen).

Our findings clearly nuance the romantic illusion of social cohesion often associated with living in rural areas, on the countryside and in village settings. However, our results do not in any way suggest that rural areas are dystopic places. Obvious informal help might not be dominant, but it still exists and is in some case absolutely necessary for AiP.