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.  

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.

In this chapter, we investigate how a couple where one of the spouses is diagnosed with dementia handle challenges in narrations of past shared events that arise when the spouse with dementia has limited access to these events. Partners of people diagnosed with dementia recurrently have to take into consideration that their spouse may not remember details in stories they tell, even though the person with dementia is a main participant in the events being retold. The design of such stories is complex as the interactants must keep track of both the content of the story and manage the potential sensitivity of telling a story that should already be known to both spouses. We show how the spouse without dementia (re)organizes the participation framework in resourceful ways and delicately deals with her spouse’s limited memory using a variety of face-saving practices. The analyses highlight how issues related to knowledge and dementia can benefit from using an interactional and distributed perspective. While access and rights to knowledge is usually divided between participants depending on the knowledge domain and the participants’ relation to the topic, in the case of a dementia disease a more flexible approach towards such divisions could be advantageous.

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.

Vid bedömningar av äldres behov kan biståndshandläggare behöva möta och balansera flera parters perspektiv och behov. I kapitlet presenteras utmaningar kopplade till denna problematik i ett utredande samtal som en biståndshandläggare inom äldreomsorgen har med ett par som lever med demenssjukdom. Vi visar hur biståndshandläggaren arbetar för att följa socialtjänstlagen och de kommunala riktlinjer som finns för att bevilja insatser samtidigt som de också ska beakta klientens självbestämmande och anhörigas behov av indirekt stöd. Denna balansakt kan anses utgöra en central del av det sociala arbetet inom myndighetsutövande samtal.

The general approach to a life with dementia is negatively charged, and alternative views are rarely found in research or in media coverage. This case-study explores conversational practices for framing dementia in a more positive light, employed by a husband of a wife with dementia. Framing regards the structured experiences of dementia, drawing on Goffmans Frame Analysis. Benefitting from conversation analysis, this article presents principal results of four conversational practices used by the spouse without dementia: mitigating trouble, normalising trouble, justifying trouble, and praising. The conclusions drawn are that the practices contribute to the challenging of the dominant negative framework of the dementia experience, as they facilitate talk which emphasises the wife with dementias positive progression and skills in managing the household chores. Despite a positive framing of dementia, this couple still embed their talk in the overall negative framework of loss and decreased cognitive competence. The visualisation of a positive framing could add to a broadened view of dementia, which in turn could contribute to greater well-being for those affected. However, the results may also imply a risk of one spouses conversational practices of normalising and mitigating trouble being dominant in interaction and thereby neglecting the other spouses experience of the situation.

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.

This conversation analytic study investigates how couples manage conflicting knowledge claims when one of the persons has dementia (PWD). The data are video-recordings of 16 couples talking with a third party. The analysis focuses on the negotiation of epistemic rights, more precisely how partners initiate repair and correct claims made by the PWD on matters belonging to the latters epistemic domain. We identified three main practices for correcting the PWD: (1) correcting the statement, thereby claiming epistemic authority for oneself and denying it to the PWD, (2) inviting the PWD to self-correct, thereby attributing some epistemic authority to the PWD, and (3) disagreeing and providing reasons for ones alternative claim, establishing a more symmetric epistemic gradient. The PWDs responses to the corrections displayed different degrees of acceptance, ranging from self-denigration to resistance and insistence.