När biståndshandläggare möter äldre par där det finns en demenssjukdom behöver de balansera olika perspektiv och behov. I kapitlet presenteras biståndshandläggares berättelser av hur de hanterar svåra situationer i behovsbedömningsmöten.  

Age categories are related to perceptions and norms concerning appropriate behaviour, appearances, expectations, and so forth. In Sweden, municipal home care and residential care are commonly referred to as “elder care”, primarily catering to individuals in their 80s or 90s. However, there is no set age limit reserving these services for an older age group.

In intra-professional case conferences, care managers convene with colleagues to discuss care needs and eligibility for elder care services. Despite their significance, these conferences have received limited scholarly attention. The aim of this study was to analyse how care managers categorise persons based on age in intra-professional case conferences when discussing care needs and appropriate support to meet these needs.

The study utilised data from 39 audio-recorded case conferences involving the discussion of 137 different cases, which were analysed using discourse analysis. Our findings showed that chronological age was frequently made relevant and applied in discussions about the appropriateness of usual elder care services.

Four themes emerged, representing how the care managers implicitly and explicitly categorised clients of different chronological ages as typical/normal or atypical/deviant in these discussions: the “too young”, the “not-so-old”, the “old”, and the “extraordinarily old”.

The findings contribute to research on ageing by demonstrating that, in an elder care context, being categorised as atypical/deviant (in terms of being younger) may be more beneficial than being seen as a normal or older elder care recipient. This underscores the importance of further research on the impact of informal age categorisations of clients on actual decisions about welfare services.

The purpose of this paper is to explore how care managers in team conferences jointly solve problems related to difficult cases involving clients with cognitive decline, focusing specifically on their professional roles and judgements. Team conferences in a Swedish social work setting mean that social workers assess and interpret previously collected information and discuss how to proceed with cases. We use conversation analysis to study two case sequences from 137 audio-recorded cases, focussing on professional judgements and accomplishing agreement. We show how care managers make use of different conversational practices, such as hypothetical talk and shared authority as a 'we' when conveying institutional routines, as well as when providing support to care managers. We also show how the care managers make use of expanding techniques that challenge their manager's advice. This paper offers new perspectives on how organisational norms are reproduced and how shared professional judgements are accomplished.

Few studies have explored the moral and ethical dimensions of how, in practice, socialworkers talk about and handle cases as part of their daily work. At the same time,identifying and examining the ethical dimensions of actual social work practice can bechallenging because ethics is often hidden within the complex particularities of daily work.This article applies and develops Sarah Banks’ conceptualisation of “ethics work” toexamine how care managers in Sweden are “doing ethics”, while seeking and providingcollegial support and guidance on how to deal with the wishes of adult (potential) serviceusers who are reluctant to accept support – or whose wishes in the matter are difficult todetermine. The study is based on an analysis of 14 audio-recorded case conferences. With the help of Banks’ conceptualisation, the analysis makes visible how the case discussions inquestion encompass a complex “doing of ethics”, by means of which the welfare ofindividuals is balanced against care managers’ legal duty to adhere, without exception, tothe principle of self-determination. The findings suggest that further research that appliesand develops Banks’ conceptualisation of ethics work by examining “actual” social workpractice in situ, while recognising the particularities of the social and societal context inwhich this work is taking place, could provide new knowledge and understanding aboutboth the specific and common challenges that social workers face in different parts of the world. It could also make the ethical dimensions of social work practice more widely recognised and valued.

ObjectiveTo investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.DesignIndividual interviews. Latent qualitative content analysis.SettingTen nursing homes in Sweden.SubjectsPhysicians, nurses and nurse assistants working in Swedish nursing homes.Main outcome measuresParticipants' experiences of working in nursing homes during the COVID-19 pandemic.ResultsFour manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.ConclusionDuring the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce. The COVID-19 pandemic has affected both patients and staff in nursing homes, in Sweden and worldwide.Our study highlights that during the COVID-19 pandemic, nursing home staff encountered several ethical challenges which caused moral distress.Moral distress stemmed from not being given adequate conditions to perform their work, thus not giving the residents appropriate care.Moral distress could also originate from nursing home staff's feeling of being forced to act against their moral values.

Team meetings are central to social workers’ decision-making practices. These meetings often function as a forum for collegial consultations, when applications are processed and recommendations on decisions are discussed. In this paper, we present findings from a case study on team talk and decision-making practices in gerontological social work. The data come from a body of material gathered within the framework of a larger project covering the process of assessing elder care for older persons in three Swedish municipalities. The case concerns an application, due to homelessness, from a couple for an apartment in special housing. The team meeting was analysed using a data-driven perspective within a micro-analytical approach to talk, focusing in detail on how conflicting perspectives in the assessment of the couple’s needs are dealt with, and how tensions between divergent views and opinions are handled in relation to institutional and professional conversational frames. The findings show how the care managers (in Sweden the professional title for social workers working in elder care) negotiated the boundaries of responsibility and power within both the institutional and professional frames, revealing that the institutional frame dominated when it came to making decisions. The findings have implications for practice, as they give insight into the interactional dynamics involved in social workers’ assessments when navigating different conversational frames within their decision-making practices.

Within a context where New Public Management [NPM] has become increasingly influential in shaping everyday working practices, social workers often handle risks in their everyday work using formalised bureaucratic procedures, among other strategies. As the COVID-19 pandemic progressed, rapid changes occurred in Swedish elder care that social workers were required to address in their everyday work. Intra-professional case conferences amongst social workers provide one opportunity to discuss individual viewpoints and obtain suggestions from colleagues on how to proceed with a case. These discussions have so far received little scholarly attention. In this study we used a data set consisting of 39 audio-recorded case conferences to analyse social workers intra-professional discussions about risks during the COVID-19 pandemic. In the case conferences, social workers discussed the risks that were accentuated by the pandemic, such as the risk of spreading COVID-19 to clients, the risk of unmet care needs amongst clients, risks related to accountability, and the risks pertaining to blurred boundaries between different organisations. The collegial discussions in case conferences included opportunities for social workers to use their collective professional experience and competency to establish creative solutions on the go and to discuss various ways of handling and balancing different risks while continuing to carry out their work in the changing and unknown situation. Our findings highlight the importance of collegial support in social work in dealing with accentuated risks during the pandemic.

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.

Ärendekonferenser utgör en central del av det sociala arbetets praktik och fungerar som ett informellt forum för beslutsfattande där biståndshandläggare diskuterar ärenden tillsammans med kollegor. Syftet med dessa möten är bland annat att skapa samsyn i bedömningar av ärenden. Hur klienters rätt till stöd skapas och förhandlas i ärendekonferenser kan ha avgörande betydelse för vilket stöd klienter faktiskt får från socialtjänsten. Genomen fallanalys av ett ärende som rör äldreomsorg visar vi i det här kapitlet hur biståndshandläggare i en ärendekonferens diskuterar klientens rättigheter. Analysen visar hur dessa rättigheter tillämpas och utmanas i diskussioner i relation till insatsen särskilt boende genom tolkningar av aktuell lagstiftning och lokala riktlinjer.