Change, reorganization and quality of home carefor elderly people in Sweden during the 1990s : paper to 17:e Nordiska konferensen i gerontologi 23-26 maj 2004 i Stockholm

During the 1990s several kinds of reorganization has taken place in public services in Sweden. Reorganizations according to the idea of market economy have been most salient and debated. In many municipalities private companies have started to organize home care service for elderly, financed by tax. Public home care organizations have reorganized the working organization and managing structure, partly to save money and partly to reach better quality of care. The home care services have a key role in the care of the elderly in the society. The quality of care is important for the possibility for elderly to stay as long as possible in their ordinary homes. We have performed a longitudinal study of the reorganizations during the 1990s in order to explore the consequences for quality of care. The study was performed in seven districts in three different municipalities representing different types of municipalities and different kinds of reorganizations. It comprises private companies, traditional public organizations, public organizations with changed managing structure and co-ordination of home help and home health care. Quality of care is studied through assessment of the communication in the organization, the psychosocial working environment of the caregivers and the quality of the care work. Politicians, managers, ca. 100 care givers and ca. 500 elderly receiving help and care have been interviewed four times during the period (1993, 1995, 1997 and 2002/2003). The traditional organization within small districts with small autonomous working teams and easy accessible supervisor expose the best quality. There are no unambiguous differences between public and private organizations. There is however a tendency for successive decline of quality for private companies after they have been established. Other aspects of the reorganizations, e. g. to have special officials for assessment of help need, do not contribute to better quality but create new communication gaps in the organization and have negative influence on the working environment. Stability in the composition of the care worker teams, leadership, decision-making processes in the organization and the district area promote high quality of care. The reorganizations during the 1990s seem on the whole to function contrary to promotion of high quality in the care and service for the elderly

The frail elderly, family network and public home help services : a pilot study of the parties' perception of the help and their reciprocal relationships

The family with the elderly and the home help workers’ team constitute two organisations, which meet in the care work. In this context the family is extended and often constitute not only members from the nuclear family but also other members of the network of relatives, whom take part in the care of the elderly. The extended family may in some cases include four generations (Finch & Mason, 1993). Home-help for elderly people have expanded in Sweden during the period 1960 - 1980. This was due partly upon the prevailing ideology that it is important for frail elderly to stay in their own homes. Due to this expansion the local communities have developed their public home-care organisations. Different kinds of autonomous group organisation predominate (Olsson et al, 1995). Small work groups take responsibility for home help service in local areas. Home-helpers organise their job themselves, exchange experiences and give each other emotional support. In Sweden both home care and institutional care of the elderly has decreased during the 1980th and 1990th in spite of the fact that the proportion elderly over 80 years (4,5 % of the total population) has increased 60 % since 1980. Twenty-two per cent of the women and 16 % of the men over 80 were cared for in their own home 1996. This development is said to have caused relatives to care for their frail elderly in the homes side by side by the home help services in an increasing degree (Johansson, 1991; Szebehely, 1998). Public care and service has an important impact on the interaction pattern between family members (Hendriksen, 1989; Johansson, 1999; Bass m fl, 1999). Home care may serve as an intervention that influences the health, well-being and life quality of the elderly and other family members. This intervention may have positive as well as negative effects. Problems and conflicts may arise in the interaction between the family members and between the family and the public help services (see McGoldrick & Gerson, 1989). We need more knowledge about these processes. In a research project1 the family and the home help services are studied as two organisations, which interact in the care of the elderly. We start with the hypothesis that the relation between the parties will have an impact on the character and quality of the care. We also think that the quality of the interaction will have an impact on the health and wellbeing of the elderly (see Olsson, 1991, 1998; Olsson & Ingvad, 1999)

Klimatdimensioner i omsorg om äldre : utvecklingen av ett instrument för hjälpares och hjälpmottagares upplevelse av omsorgsrelationen

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True wood

I arbetet med en stol har jag utgått från det ursprungliga i trä. Min vision har varit att bevara och lyfta fram materialets inneboende och primära egenskaper. Jag har formulerat en bild av detta: -En gåtfullhet ligger som dagg över stolen och speglar den magi man kan finna i skogens träd. Min tillverkning bygger på en ärlig utformning gentemot trädet. I vårt nutida Sverige med masskonsumtion av möbler glöms materialens ursprung bort. På grund av det högteknologiska raffinerandet av materialet döljs tillverkningsprocessen. Jag vill visa materialets ursprung och låta brukaren förstå att trä har varit levande. Jag lyfter värdet på hantverket genom en speciell metod där jag skapar i harmoni med materialet. Jag följer dess ådring och utnyttjar kraften i träets förmåga att röra sig genom att göra sammanfogningar utan främmande element. Detta gestaltar jag i form av en stol med en annorlunda historia i produktionen och i tänkandet av produkten. Jag vill genom min undersökning höja värdet på trä och dela med mig av kunskap och förståelse för hantverk

Maktdimensionen i omsorgsrelationer

Bakgrund: Vårdbiträdet och den äldre formar tillsammans en dynamik i sitt sociala samspel. Här presenteras resultat från en avhandling om omsorgsrelationer i hemtjänsten. Metod: Djupintervjuer av äldre och vårdbiträden; fallstudier kring biståndsärenden med hjälp av deltagande observation av den äldres och vårdbiträdets samspel samt av samspelet i vårdbiträdets arbetsgrupp. Resultat: Det är vanligt att vårdbiträdena antingen underordnar sig eller anpassar sig till vårdtagaren, vilket är ett handlade som till en del har sin grund i att vårdbiträdena fäster vikt vid hur den gamla värderar dem och deras arbete. Genom att betona svaghet, hjälplöshet och genom att vara krävande eller generös kan den äldre styra vårdbiträdena. Den äldre tolkar vårdbiträdets handlingar i omsorgssituationen som uttryck för hur hon är värderad av vårdbiträdet. Engagerade omsorgshandlingar motsvarar den äldres känslomässiga förväntningar på respekt och positiva värderingar. I upptrappade konflikter kan vårdbiträden uttrycka en negativ värdering av den äldre genom att uppträda mer opersonligt i sitt handlande och vara mindre omsorgsfull i sitt arbete. Vårdbiträden kan försöka påverka pensionären genom att göra sig svag. Slutsats: Känslomässiga samspelet mellan den äldre och vårdbiträdet utgör en aspekt av maktdimensionen i omsorgsarbetet

Caring and relations : On emotional interaction in home help

This dissertation examines the interaction between municipal home-helpers and care re-cipients from a social psychological perspective. One of the starting points is a critique of some classical works in the caring science inspired by women’s studies for not taking into consideration that care-giving work constitutes social interaction. The aim is to analyse how elderly people and the home-helpers perceive and interpret each other, what they expect of their mutual relationship, how they influence each other’s actions in their emotional interaction, and how the old person’s family and the home-helper’s work team influence their relationship. The empirical investigations, analysed with qualitative methodology, comprise thematically structured in-depth interviews with 48 home-helpers in six work groups, and 40 case studies of assistance cases, based on interviews with the old person (25 cases) and participant observation of the parties (15 cases). The home-helpers and the old people perceive their relationship as instrumental, friendly, emotional, insecure (recipients), laborious or charged with conflict (home-helpers). It is shown that what the old person and the home-helper expect of their emotional relationship is linked to social needs such as respect, acknowledgement, and appreciation from the other. These aims influence the experiences and actions of the two parties and, thereby, the care-giving work. Commonly, the home-helper subordinates herself to the old person or adapt to the recipient, e.g. by listening and “adjusting” to the old person. Psychological constructions play an important role in the home-helpers’ perceptions of the care situation in emotional conflicts. In escalated conflicts the home-helpers may act more impersonally and showing less care in the work. The old people may express confirmatory feelings for the home-helpers, deepen their dependence, and towards the home-helper they represent in various ways who they are and what they stand for. The old persons’ conflict actions can be understood as attempts to value themselves positively

Att bedöma äldre människors behov: biståndshandläggares arbete inom äldreomsorgen kollegiegranskat

Denna rapport härstammar från en kollegiegranskning i äldreomsorgen. Tio biståndshandläggare har undersökt sin verksamhet såsom den ter sig i en annan kommun inte så långt därifrån. De skriver kunnigt och engagerat om biståndsbedömning och ställer frågor kring hur detta arbete bör bedrivas. Bengt Ingvad och Christer Neleryd har sammanställt granskningarna. I ett inledande och avslutande kapitel kommenterar de var och en på sitt sätt arbetet med att handlägga bistånd

The emotional climate of care-giving in home-care services

The emotional aspects of the care-giving relationship in home-care services are studied, starting from the home-care recipients' and the home-care workers' perception of the emotional climate. Their experiences of the care-giving relationship and the influence from different aspects of the care-giving situation and social processes in the work organisation are explored. Two hundred and twenty-two recipients and their home-care workers in three typical Swedish municipalities were studied. The emotional climate is described with the help of a scale of 85 adjectives. Results show that home-care workers are more likely to experience the climate with a higher degree of emotionality. There is symmetry between the parties in the perception of a negative climate. However, if one party perceives the climate as close the other party is more likely to perceive it as rational or instrumental. The organisational processes, especially the group climate of the work team, principally influence the home-care recipients' perceptions. The workers' perceptions are principally influenced by age and gender of the recipients and the workers' own age. The emotional climate is constructed in a process between the parties, depending on their responses to each other. Tendencies to perceive a specific climate are strengthened or weakened by context variables and this in turn changes the care-giving interaction