Balancing Physical and Mental Care for Older People in the Bulgarian Town Vidin
Economic decline and out-migration have made Vidin one of the most rapidly aging cities in Bulgaria. Older people struggle with isolation, illness, and poverty. The role of care workers is invaluable, as they are often their only social contact.
Vidin is a city in north-western Bulgaria, located on the southern bank of the Danube River with a population of 45,583 people as of 2021. It is one of the most rapidly aging cities in the country, characterized by a highly unfavorable demographic profile. The city’s population reached its highest point during the late communist era but has experienced a significant decline since then. The economic transition and ensuing difficulties prompted many residents, particularly younger individuals, to migrate either abroad or to Bulgaria’s capital city, Sofia, in pursuit of better job opportunities. As these younger people left, the proportion of elderly residents rose, leading to a higher dependency ratio and increased pressure on social services.
Our research team spent two days in the city, conducting focus group and biographical interviews. Our aim was to compare the findings from Vidin with those of similar fieldwork conducted in Burgas, a larger city on the Black Sea coast with a population of 210,813 people. The total number of interviews conducted in Vidin is thirteen – nine individual biographical interviews, two face-to-face interviews/focus groups and two short interviews with a questionnaire. The interviews in Vidin involved three social workers and the director of the social patronage service, along with three service users interviewed in their homes.
Street scene in Vidin
Copyright: Erik Cleves Kristensen, Vidin street (27450825045), CC BY 2.0
Vidin – A place of socio-economic challenges
The historical context of Vidin’s post-communist transition is crucial to understand its current socio-economic landscape. The period following the fall of communism in Bulgaria was marked by significant disruption. Vidin, like many other regions in the country, faced severe economic challenges. During the communist period, the city’s economy was heavily reliant on state-owned industrial enterprises. These enterprises were a source of employment and economic stability, operating under the centralized planning of the communist government. However, with the transition to a market economy, many of these state-owned enterprises could not compete in the new economic environment and were either closed or significantly downsized. One of the biggest examples of this is the Zagorka tobacco factory of Mihail Dimitrov and sons. This industrial collapse led to high unemployment rates, further compounded by the absence of new industries to absorb the displaced workforce. Consequently, economic hardship became widespread, prompting many residents to migrate to larger cities or even abroad in search of better opportunities. This migration trend exacerbated the population decline and left behind an aging population increasingly reliant on social services. Furthermore, pensions are so low that they are insufficient for subsistence, thus further toughening the life of the older part of the population.
Social patronage and the dual role of care workers
Social patronage in Vidin represents a specialized social institution aimed at providing vital social services within the community. It is run by the municipality and the subscription fee consists of 60% of the client’s income. These services include the preparation and delivery of food to homes, assistance with household chores, and buying medication if the person needing them is unable to do so. The service is available only to pensioners although not all eligible people use it. The problem for those who would benefit from such service but do not qualify remains unsolved. The service extends beyond mere delivery of warm meals or assistance with tasks like paying bills and purchasing medication. For many older people, having someone visit once a day for these deliveries is often their only form of personal social interaction. We already know the danger loneliness and isolation bring to the mental health of the older part of the population, so the importance of this interaction cannot be overstated, as it helps with those feelings and improves the lives of the service users. One social worker shared:
“It is a great pleasure to work with them – they always welcome us with great excitement, the candy is always prepared, they welcome us like guests and share their pains with us.”
This quote shows the dual role that social workers play, not only as service providers but also as companions and anchors.
As a result, informal connections between social workers and service users develop. The former hear and sympathize with the life stories of many older people who have led challenging lives. As they often become the sole confidants for them, the emotional labor required by social workers is another critical aspect to consider. This relationship can be fulfilling yet emotionally draining, as social workers become deeply involved in the lives and struggles of their clients. They witness firsthand the challenges faced by the older people, including their fears, hopes, and the harsh realities of their daily lives. One social worker commented on the profound impact of these visits:
“They (the older people) mostly complain about isolation; they are mostly grateful for having somebody come over and talk to them… They share their stories and sometimes even cry, sometimes we cry with them.”
This statement highlights the necessity of addressing isolation in rural and small-town settings across Bulgaria. For some elderly individuals, the social patronage service is literally lifesaving. One interviewee shared a story of an incident she had, where she had fallen and been unconscious for two days. The deliverers, noticing her absence, contacted a relative, who discovered her and called help. Such stories highlight the critical role that these services play in safeguarding the lives and wellbeing of the pensioners who use the service.
Clinging to one’s home as expression of lost stability
Many older individuals report that they have been offered to move in with their families in different cities or countries, but they often refuse to leave their homes. The notion that for many of the older people “the home is like a fortress” was illustrated during an interview with the social patronage staff and director. They shared the story of an older man who lived alone and had been robbed a few times during the night. Despite his constant anxiety that this might happen again, he refused to move to a care home or to join his family who lives in Plovdiv, clinging to his home out of a deeply rooted attachment. For many of his generation, homes are not merely physical structures but symbols of a lifetime of effort, emotional resilience, stability in a time of massive change, and nostalgia for the old times where several generations lived under one roof and took care of each other. Even when these homes become unsuitable for living, the thought of leaving them is unthinkable and even unbearable in some cases for these homes have often been transferred from generation to generation and are thus filled with family memories.
The psychological impact is profound. The sense of loss and dislocation that comes with the deterioration of their homes and communities adds to the emotional burden of the older people. This isolation and loneliness, stemming from broken dreams and economic hardship, cast a shadow over the aging process for many in Vidin. However, there is a silver lining. Witnessing the situation of their elders, some younger people choose to stay in Vidin to care for their parents, unwilling to see them suffer. Among them is a young woman working in the social patronage service, showing a new, more positive view of the future:
“After starting this job, I realized I do not want to leave my parents to age alone so I have decided to stay here (in Vidin) with them.”
The resilience of the older people in Vidin is a testament to their strength and determination. Despite the many challenges they face, including economic hardship, health issues, and social isolation, many elderly individuals continue to find joy and purpose in their daily lives. This resilience is often supported by the strong bonds they form with social workers and the sense of community that these interactions foster but also from one more philosophical and existential view on life that helps them go through hard times easier. When asked how it feels to get older and if it is scary, one of the respondents said:
“If I am afraid, I will get sick again from nerves and stress. I am not afraid. Be positive, do not be afraid of anything because when you are afraid you put yourself and your organism through stress and from there to worse things. If I feel sick, I tell myself I will be fine. Have optimism for life. Do not be afraid – when you are afraid you only hurt yourself.”
In conclusion, the importance of social interaction and the impact of emotional bonds between service providers and users underscore the need for comprehensive support systems to address the unique challenges faced by the older people in such settings. As Vidin continues to navigate through its social and economic challenges, the stories of its older residents and the dedicated social workers who support them offer valuable insights into the resilience and adaptability of older people and the ones taking care of them.