Coexisting principles and logics of elder care: Help to self-help and consumer-oriented service? (original) (raw)
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International Journal of Care and Caring
Reablement has been positioned as a superior care ideal distinct from home care. Drawing on cross-national ethnographic data, this article instead demonstrates how the continuity and interdependency between reablement and conventional home care is more significant than suggested by policy rhetoric. Findings highlight the continuities and overlaps between activating and compensatory care, for example, how compensatory care might take the form of psychosocial reablement, activating and enabling even the frailest clients to age in place. The article concludes by pointing to the dangers of a narrow conception of reablement and argues for the benefits of more focused attention on clients’ psychosocial well-being.
Accounts of professional and institutional tension in the context of Swedish elderly care
Journal of Aging Studies, 2010
This article describes need assessment dialogues, the circumstances surrounding care, and the provision of residential care and in-home support for the elderly in Sweden, as seen from a communicative perspective. The purpose was to systematically describe and analyse the accounts of welfare officers concerning elderly care. The research questions were: How is the internal care context perceived and constituted through discourse? How do welfare officers manage the daily demands, expectations, tasks, and dilemmas in the encounter with the individual citizen? What significance do the welfare officers give their work and their professional tasks? Eleven interviews with welfare officers from elderly and handicapped care organisation of three municipalities were held, and a discursive analysis was made from the collected data. Four characteristic discursive phenomena in the welfare officers' accounts were observed: (I) the rights of the elderly, (II) living at home, (III) good relations, and (IV) the complaisance. The study shows that the dialogues with elderly contain communicative dilemmas and mixed loyalties. The welfare officers navigate between different perspectives and double approaches. She/he uses the navigating as a strategy and proficiency in their work. However, these proficiencies remain largely unnoticed and unreflected as techniques, strategies, or tools for attaining favourable care.
Choice, needs or equality? Discursive struggles about defining home care for older people in Sweden
Ageing and Society, 2021
Focusing on Swedish home care for older people, this article explores the discursive (re) production of home care as an institution. Equality and universal service provision have been described as defining features of the Nordic care regime. At the same time, Nordic research has highlighted a shift in social care policy, from a focus on universalism and egalitarian ideals towards a focus on freedom of choice, diversity and individualised services. This article takes as a starting point that home care for older people is formed by different and potentially conflicting ideas. We understand home care as a contested formation and define institutional change in terms of ongoing discursive struggles. The analysis draws on qualitative semi-structured interviews with key informants, including politicians, local authority officials and representatives of interest organisations. Informants were engaged in policy making, implementation or advocacy related to care for older people. We examine the meanings attached to home care for older people and the analysis reveals three different discourses-on choice, needs and equality. By comparing and contrasting discourses, we reveal silences, conflicts and tensions, and highlight the politics involved in (re)creating home care as an institution.
Journal of Social Service Research, 2018
In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples' choice and control. Data consist of qualitative interviews with users of home care services (n-12) and staff (n-12) and participant observations (n-7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about 'what' care and services, 'who' should provide the care and services, and 'how' the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.
The desire for control: Negotiating the arrangement of help for older people in Sweden
Journal of Aging Studies, 2010
The interface between formal (public) and informal help for older people is unclear and subject to change in many welfare states. Our aim in this study was to contribute to increased understanding of the experiences of older people, their next of kin, and the care managers from the municipalities in the process of negotiating help in the everyday lives of older people who can no longer manage on their own. We took a qualitative approach, using qualitative interviews as the main data collection method. The results revealed that the different actors had contrary interests that made it difficult for all parties to be content with the outcome of the negotiations. The everyday lives of dependent older people and their next of kin are strongly affected by the conditions of formal eldercare.
CareSam – A Cross-border Collaboration Contesting notions of elderly Care
Tiltai, 2016
This article presents findings and discussions generated on the basis of the Danish-Swedish development project CareSam. The article will on the one hand focus on how work in groups consisting of representatives from different levels in the elderly care sector at one time served as learning spaces and cultural encounters in which established notions of older people and elderly care were challenged and discussed. Inspired by action research these challenges were brought forth through discussions of and through insight in practical experiences. On the other hand it will focus on the tendencies to narrow the diversity of perceptions of elderly people and their care, which were also seen in the project and led to stories in which the meaningfulness of care work were honored. Departing from the interviews presented in the CareSam film and parts of the empirical material produced in connection to the work in the project-groups this paper will ask whether it is possible to represent care work for elderly people with all the ambiguities it holds: How can we as researchers represent both meaningfulness and straining dimensions of care work? Can we avoid either supporting Florence Nightingale-ideals or cementing negative cultural perceptions of help-needing elderly and the people who support them in everyday life? In answering these questions and thereby reflecting on our own work process we apply a caring, a learning and a political perspective. Hereby the article wishes to formulate a methodological point: The CareSam cross sector collaboration produced important experience near knowledge, but also lead to present somewhat one-sided understandings of elderly care. Applying theoretical perspectives to analyze the empirical material and the working process, nuances the understanding and makes it possible to maintain immediately conflicting dimensions in this kind of work.
The implementation of elder-care in France and Sweden: a macro and micro perspective
Ageing and Society, 2011
ABSTRACTThis paper presents results from a comparative project on the implementation of elder-care in France and Sweden. The transition to requiring care is understood as a process, and elder-care is seen as a part of a more general organisation of social care that reflects different welfare traditions. An overview of elder-care on the institutional level in the two countries is supplemented by case studies from the perspective of older people which identify ways of co-operation between actors, such as public eldercare providers, family members and help provided by profit and non-profit organisations. The interviews include approximately 20 older persons in each country as well as a small number of administrators and adult children. The study sheds light on how policies are implemented on the local level and puts the focus on who actually does what and when for older persons with care needs. The different roles played by the state, the family, the market and civil society are examin...
Care Work in Crisis. Reclaiming the Nordic Ethos of Care
Book edited by SIRPA WREDE, LEA HENRIKSSON, HÅKON HØST STINA JOHANSSON, BETINA DYBBROE Contents FOREWORD 11 INTRODUCTION 13 Care Work and the Competing Rationalities of Public Policy Sirpa Wrede, Lea Henriksson, Håkon Høst, Stina Johansson and Betina Dybbroe PART I DENMARK INTRODUCTION TO PART I 39 Crisis of Care in A Learning Perspective Betina Dybbroe ONE 47 A Crisis of Learning, Professional Knowledge and Welfare in Care Betina Dybbroe TWO 73 Neglected Opportunities for Personal Development: Care Work in a Perspective of Lifelong Learning. Helle Krogh Hansen THREE 95 A Crisis of Recognition in Care Work for Elderly People? Looking at Professional, Bodily and Gendered Hierarchies for Explanations Anne Liveng PART II FINLAND INTRODUCTION TO PART II 119 Care Work in the Context of a Transforming Welfare State Lea Henriksson and Sirpa Wrede FOUR 129 The Making of Medico-Managerial Care Work Culture in Public Home Care for the Elderly Lea Henriksson and Sirpa Wrede FIVE 151 Staffing Levels and Well-being of the Residents with Dementia Päivi Topo and Saila Sormunen SIX 177 Practical Nurses’ Work Role and Workplace Ethos in an Era of Austerity Laura Tainio and Sirpa Wrede SEVEN 199 Immigrant Nurses in Finland: Political Negotiations on Occupational Membership Suvi Nieminen and Lea Henriksson PART III NORWAY INTRODUCTION TO PART III 221 Care Work and Care Work Education in Norway: Problems of Modernisation Håkon Høst EIGHT 227 Reforming Auxiliary Nurse Education in Norway—A Story of Failed Modernisation Håkon Høst NINE 249 Social Capital in Public Home Care Services Karen Christensen PART IV SWEDEN INTRODUCTION TO PART IV 275 Focus on Knowledge Formation and Care Work Organisation Stina Johansson TEN 283 Academic strength and boundary work: contextualising elderly care Stina Johansson ELEVEN 303 To Organise for Care Work—Work Environment and Relational Aspects of Care Work in Sweden Petra Ahnlund TWELVE 323 Upper Secondary Health Care Programme as Means or Measure? On the Problem of Legitimacy and the View of Knowledge Petra Ahnlund and Stina Johansson THIRTEEN 341 The Neglect of Time as an Aspect of Organising Care Work Katarina Andersson EPILOGUE 363 The Unheard Voices of Care Workers and Care Researchers Kari Wærness