Att förhandla om behov : Processandet av äldre personer till hemtjänstmottagare inom ramen för det gerontologiska sociala arbetets praktik

The study concerns the needs assessment processes that older persons undergo to gain access to home care. The participation of older persons, their relatives and municipal care managers was studied from a communicative perspective. The assessment meetings functions as formal problem-solving events. The older persons´ accounts are negotiated discursively in interaction. Various storylines are used by the older persons and their relatives whether they view home care as an intrusion, as a complement or as a right. In case of divergent opinions the older person has the final say as prescribed by the Swedish social service act. One conclusion is that the role of relatives is not defined and a family perspective is not present. In the study the institutional structure of the assessment process was also analyzed. Older persons are processed into clients; their needs are fitted within the framework of documentation and institutional categories. In the transfer of talk to text all the particulars are not reflected and two types of documentation was identified; a fact-oriented objective language or an event-oriented personal language. Care management models and a managerialist thinking has influenced the assessment process by bureaucratisation of older people trough people processing, which is in contradiction to the individual-centric perspective prescribed by the law. The introduction of care management models in gerontological social work has lead to an embedded contradiction and constitutes a welfare political dilemma. Improved communicative methods are needed in order to achieve a holistic assessment situation.Studien tar sin utgångspunkt i de bedömningsprocesser äldre personer genomgår för att få tillgång till hjälp i hemmet. Bedömningsprocessen där äldre, deras anhö-riga och kommunala behovsbedömare deltog studerades ur ett kommunikativt perspektiv. Interaktionen vid behovsbedömningssamtalet fungerar som en pro-blemlösningsprocess. Den äldre personens redogörelse för behov förhandlas diskursivt i interaktionen och tre olika berättelselinjer identifierades, baserade på om de sökande betraktar hemtjänsten som ett intrång, som ett komplement och stöd eller som en rättighet. När olika åsikter uttrycks har de äldre sista ordet i enlighet med Socialtjänstlagens föreskrifter. En slutsats är att de anhörigas roll i behovsbedömningsprocessen inte är definierad och att ett familjeperspektiv sak-nas. I studien analyserades också bedömningsprocessens institutionella struktur. De äldre behovssökande processas till att bli klienter, deras behov anpassas till dokumentationens ramverk och kategoriseras i enlighet med institutionella kate-gorier. I transfereringen av tal till text redovisas inte samtliga element i samtalet. Två typer av utredningstext identifierades, den faktaorienterade och den händelse-orienterade. I studien diskuteras det marknadsekonomiska tänkande som kommit att påverka bedömningsprocessen genom byråkratisering vilket står i motsatsställ-ning till det individcentrerade perspektiv som lagen förespråkar. Introduktionen av marknadsmodeller i det gerontologiska sociala arbetet har medfört en inbyggd motsättning och utgör ett välfärdspolitiskt dilemma. Förbättrade kommunikativa metoder behövs för att uppnå en holistisk bedömningsprocess

Kommunikation i livet på äldre dagar : Om användningen av samtalsanalys i forskning om äldreomsorgens vardag

Kapitlet inleds med en beskrivning av det forskningsprogram med rubriken Kommunikation i äldre människors livsmiljö, som bedrivits vid Tema Äldre och åldrande/NISAL sedan starten år 2000. Därefter ges ett exempel från vår forskning om behovsbedömning i äldreomsorgen där samtalsanalys är den metodologiska ansats som används. Vi visar här hur denna typ av forskning kan användas som verktyg för att studera situationer där samtalens deltagare – de äldre själva, deras närstående och handläggarna – har delvis olika åsikter om de äldre personernas hjälpbehov. Kapitlet avslutas med några tankar om vad samtalsanalytisk forskning kan bidra med för typ av kunskap och vad sådana studier i sin tur kan få för konsekvenser för utformningen av äldreomsorgen

Persuasion in practice : Managing diverging stances in needs assessment meetings with older couples living with dementia

The Swedish Social Services Act stipulates an individual perspective that promotes self-determination. In practice, this means that relatives lack formal rights to intrude on a person with dementias right to self-determination in decisions about elder care services. However, the Social Services Act also states that family members who are caring for a close relative should be offered support. This legislation may lead to contradictions within social work practice with couples. The aim of the present article is to explore how social workers manage needs assessment meetings in which couples living with dementia express diverging stances and the partner with dementia resists an offer for elder care services. We benefit from conversation analytic theory and methodology. The findings suggest that social workers accomplish persuasion through these four conversational practices: providing information about the offer, mitigating the offer, positive framing of the offer and laying down conditions for the offer. Also, local alliances with the partner of the person with dementia were demonstrated throughout. The analysis shows that PwDs provide resistance to the offered services, but there are no examples of a PwD influencing the outcome in terms of offered services. The results raise questions about the effectiveness of persuasion in needs assessment meetings. The findings also add to the critical debate on how social workers may be constrained by institutional logics and where relational competence is needed to balance and coordinate decision-making when assessing the needs of older couples living with dementia.Funding Agencies|Forskningsradet om Halsa, Arbetsliv och Valfard [2019-01069]</p

“I See What You Mean”—A Case Study of the Interactional Foundation of Building a Working Alliance in Care Decisions Involving an Older Couple Living with Cognitive Decline

Background: Social workers have a key role in needs assessment meetings with families dealing with dementia, providing information, support, and advocacy, while also assessing needs and making decisions about care services for several parties. These contacts are especially important during the introduction of home care services, where often the person has previously relied on informal support from relatives. The needs assessment process entails the involvement of all present parties, with the aim to reach a mutual agreement, a working alliance, regarding which services to apply for. Purpose: The aim of this case study is to explore how the participants, by means of different conversational practices, jointly create a working alliance between the different parties in one family. The study provides insights into the process of co-constructing a working alliance in the needs assessment process for elder care services. Methods: This article addresses the process by which social workers build a working alliance in a multi-party conversation with a family living with cognitive decline; a meeting that lasted 50 min. In this case study, we benefit from an inductive and detailed conversation analytic methodology. The theoretical framework of working alliances in institutional interaction has informed the analysis. Results: The findings illustrate how the social worker in this case study involves all parties in the decision regarding care services and explores the use of the conversational practices of mitigations, positive framing, adding information, and positioning, as a “we” achieve mutual agreement toward the end of several sequences. Conclusions: Drawing on the results of this case study, we argue that multi-party interaction involving relatives enables diversity in role-taking, where the professional, for instance, can pursue a more empathic role. Also, our results indicate that minimal agreement to a proposal is sufficient in a multi-party interaction involving clients with cognitive decline.Funding agencies: The work is supported by funding from the Swedish Research Council for Health, Working Life, and Welfare (2019-01069) and the Kamprad Family Foundation for Entrepreneurship, Research, and Charity (2021-0209)</p

Needs assessment in social work with older people in times of Covid-19 : Initial ideas from an empirical study

In Sweden, Covid-19 has affected elder care and the services provided for older people to a great extent. In the needs assessment process care managers, in their role as street level bureaucrats are facing an indefinite closure or limitation of services to offer older people. Also, as older people are encouraged to isolate themselves, care managers are now performing assessment meetings by phone rather than face-to-face. Drawing on an initial analysis of audio-recorded telephone meetings between care managers and older couples, we present two different approaches of assessing services for older couples in this current time. The approaches are referred to as «business on hold» and «exploring new options». In the first approach, the meetings unfold as if all regular services were still possible to offer the older people, only to be utilized once Covid-19 has passed. In the second approach, care managers use professionalism in relation to the discretion embedded in their role as social workers to find solutions outside the regular system. The findings suggest supporting innovative approaches in remote assessments allowing care managers to use their relational competence more in conversations, as well as initiating technical education for managing the challenges embedded in this new digital landscape

'I don’t want to go back into the closet just because I need care' : recognition of older LGBTQ adults in relation to future care needs

There is increasing awareness in research about the social service needs of older LGBTQ adults. However, there are few studies that deal with differences in this community regarding elder care services. As a rule, transgender individuals are not included in these studies. This study focuses on how older Swedish LGBTQ adults reason about openness in an elder care context concerning their future needs for services and adopts Nancy Fraser’s theoretical framework of recognition. The material consists of fifteen semi-structured interviews with older LGBTQ adults. The results indicate that the main concern for older LGBTQ individuals is being accepted for their preferred sexual orientation and/or gender identity in elder care. However, there were differences regarding that concern in this LGBTQ group. There were also a variety of approaches in the group as to preferences for equal versus special treatment with respect to their LGBTQ identity. In addition, there were differences as to whether they prefer to live in LGBTQ housing or not. The findings contribute to existing knowledge by highlighting the diverse views on elder care services in both this group of interviewees and its subgroups. These findings emphasise the importance of the social work practice recognising different preferences and having an accepting approach. The results can further provide guidance on how to design elder care services for older LGBTQ adults.Inom forskningen finns idag en ökad medvetenhet om HBTQ-äldres behov av äldreomsorgsinsatser. Få studier har hittills belyst skillnader inom gruppen gällande önskemål av framtida insatser från äldreomsorgen. I dessa studier är transpersoner ofta inte inkluderade. Föreliggande studie fokuserar på hur svenska äldre HBTQ-personer ser på öppenhet i ett framtida äldreomsorgsammanhang samt hur detta relaterar till önskningar om behov av insatser. Studien utgår från Nancy Frasers teoretiska resonemang om erkännande. Materialet består av femton semi-strukturerade intervjuer med HBTQ-äldre. Resultaten visar att de flesta äldre HBTQ-personerna vill bli accepterade för den egna sexuella läggningen och könsidentiteten/könsuttrycket i ett framtida äldreomsorgssammanhang. Hur denna önskan ser ut skilde sig dock åt inom HBTQ-gruppen. Det fanns också olika uppfattningar om man huvudsakligen föredrar likabehandling eller om man istället vill att särskild hänsyn ska tas till den egna HBTQ-identiteten. Även inställning till huruvida man föredrar att bo på ett HBTQ-boende eller inte delade gruppen av intervjuade. Resultaten bidrar till existerande forskning om äldre HBTQ-personer genom att synliggöra de skillnader som finns inom gruppen gällande inställning till att använda framtida äldreomsorgsinsatser. Vidare påvisar resultaten vikten av att det sociala arbetet har ett öppet och erkännande förhållningssätt för olika preferenser. Resultaten kan vidare bidra till vägledning kring hur man utformar äldreomsorgsinsatser för HBTQ-äldre

Kommunikation i livet på äldre dagar : Om användningen av samtalsanalys i forskning om äldreomsorgens vardag

Kapitlet inleds med en beskrivning av det forskningsprogram med rubriken Kommunikation i äldre människors livsmiljö, som bedrivits vid Tema Äldre och åldrande/NISAL sedan starten år 2000. Därefter ges ett exempel från vår forskning om behovsbedömning i äldreomsorgen där samtalsanalys är den metodologiska ansats som används. Vi visar här hur denna typ av forskning kan användas som verktyg för att studera situationer där samtalens deltagare – de äldre själva, deras närstående och handläggarna – har delvis olika åsikter om de äldre personernas hjälpbehov. Kapitlet avslutas med några tankar om vad samtalsanalytisk forskning kan bidra med för typ av kunskap och vad sådana studier i sin tur kan få för konsekvenser för utformningen av äldreomsorgen

Kommunikation i livet på äldre dagar : Om användningen av samtalsanalys i forskning om äldreomsorgens vardag

Kapitlet inleds med en beskrivning av det forskningsprogram med rubriken Kommunikation i äldre människors livsmiljö, som bedrivits vid Tema Äldre och åldrande/NISAL sedan starten år 2000. Därefter ges ett exempel från vår forskning om behovsbedömning i äldreomsorgen där samtalsanalys är den metodologiska ansats som används. Vi visar här hur denna typ av forskning kan användas som verktyg för att studera situationer där samtalens deltagare – de äldre själva, deras närstående och handläggarna – har delvis olika åsikter om de äldre personernas hjälpbehov. Kapitlet avslutas med några tankar om vad samtalsanalytisk forskning kan bidra med för typ av kunskap och vad sådana studier i sin tur kan få för konsekvenser för utformningen av äldreomsorgen

I don’t want to go back into the closet just because I need care”: Recognition of older LGBTQ adults in relation to future care needs

ABSTRACTThere is increasing awareness in research about the social service needs ofolder LGBTQ adults. However, there are few studies that deal withdifferences in this community regarding elder care services. As a rule,transgender individuals are not included in these studies. This studyfocuses on how older Swedish LGBTQ adults reason about openness inan elder care context concerning their future needs for services andadopts Nancy Fraser’s theoretical framework of recognition. The materialconsists of fifteen semi-structured interviews with older LGBTQ adults.The results indicate that the main concern for older LGBTQ individuals isbeing accepted for their preferred sexual orientation and/or genderidentity in elder care. However, there were differences regarding thatconcern in this LGBTQ group. There were also a variety of approaches inthe group as to preferences for equal versus special treatment withrespect to their LGBTQ identity. In addition, there were differences as towhether they prefer to live in LGBTQ housing or not. The findingscontribute to existing knowledge by highlighting the diverse views onelder care services in both this group of interviewees and its subgroups.These findings emphasise the importance of the social work practicerecognising different preferences and having an accepting approach.The results can further provide guidance on how to design elder careservices for older LGBTQ adults