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Negotiating needs: Processing older persons as home care recipients in gerontological social work practices
Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-9293-4932
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Att förhandla om behov : Processandet av äldre personer till hemtjänstmottagare inom ramen för det gerontologiska sociala arbetets praktik (Swedish)
Abstract [en]

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.

Abstract [sv]

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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 118 + papers 1-4 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 464
Keyword [en]
Care management, old age care, home care, assessment processes, institutional interaction, communication, discourse analysis, gerontological social work
Keyword [sv]
Behovsbedömning, äldreomsorg, hemtjänst, bedömningsprocesser, institutionella samtal, kommunikation, diskursanalys, gerontologiskt socialt arbete
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-15968ISBN: 978‐91‐7393‐742‐9 OAI: oai:DiVA.org:liu-15968DiVA: diva2:132445
Public defence
2009-01-16, K 1, Kåkenhus, Campus Norrköping, Linköpings universitet, Norrköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2008-12-18 Created: 2008-12-18 Last updated: 2015-01-19Bibliographically approved
List of papers
1. Assessment for home care: Negotiating solutions for individual needs
Open this publication in new window or tab >>Assessment for home care: Negotiating solutions for individual needs
2006 (English)In: Journal of Aging Studies, ISSN 0890-4065, Vol. 20, no 4, 367-380 p.Article in journal (Refereed) Published
Abstract [en]

This article explores care management as an activity that regulates the distribution of society's resources for home care. It focuses on interaction in assessment meetings, which are part of the planning of services and care for old people in Sweden. The aim was to acquire an understanding of how old people, as applicants, account for their needs for care, and how these accounts are negotiated and positioned in talk. Twenty home care assessments were audio-taped and the data were analyzed using discursive analysis. It was found that the assessment meetings had an institutional structure within, which old people, as applicants and with individual needs for care, were assessed within fixed institutional categories. Furthermore, analysis showed how interaction during assessment meetings functioned as formal problem-solving, in which applicants' accounts of their health issues were negotiated, contributing to the construction of their identity as home care receivers.

Place, publisher, year, edition, pages
Elsevier, 2006
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-15964 (URN)10.1016/j.jaging.2005.11.004 (DOI)
Available from: 2008-12-18 Created: 2008-12-18 Last updated: 2015-01-19
2. Home care as a family matter?: Discursive positioning, storylines and decision-making in assessment talk
Open this publication in new window or tab >>Home care as a family matter?: Discursive positioning, storylines and decision-making in assessment talk
2008 (English)In: Communication & Medicine: An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1613-3625, Vol. 5, no 2Article in journal (Refereed) Published
Abstract [en]

Home care arrangements for older people are coordinated via a client-centred assessment process. This article describes how storylines and discursive positioning are used among older people and their relatives when divergent opinions of care needs are expressed. Eleven assessment interviews were studied using discourse analysis. The results show that relatives and older people advanced three major storylines, and positioned themselves within them with respect to the need for help. These storylines were based on whether the persons viewed home care as an intrusion into daily routines and relationships or as a complement and support in everyday life, or as a right. The content of the storylines and the ways in which positions were shaped within them illustrate how positioning is incorporated as part of the ongoing reflexive process in interaction in which participants form an image of the older person's needs. Assessments clarify the views of the participants on home care, but they also reflect the discourses that are prevalent in the aged care community and in society in general. The article raises questions about strengthening older people’s participation in the decision making process and also whether a new communicative practice is needed for assessments, i.e., one that proceeds on the basis of a broader family perspective.

Keyword
Assessment interviews, aged care, storylines, positioning, discourse analysis, decision making
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-15965 (URN)
Available from: 2008-12-18 Created: 2008-12-18 Last updated: 2015-01-19
3. Creating images of older people as home-care receivers: Categorizing needs in social work case files
Open this publication in new window or tab >>Creating images of older people as home-care receivers: Categorizing needs in social work case files
2010 (English)In: Qualitative Social Work, Vol. 9, no 4, 500-518 p.Article in journal (Refereed) Published
Abstract [en]

Central to the assessment process in case management is how older people’s needs are constructed through documentation and case files. This article examines how older people’s needs are categorized in written documentation. Sixteen case files from three social work districts in Sweden were studied using discourse analysis. The results identified two general types of case files; the fact-oriented (using objective language) and eventoriented case file (using more personal language) – which depicted the older individuals quite differently. All case files employed several need categories; though social needs were important in describing living conditions, it was medical and physical needs that impinged on home care decisions. This raises questions about how case documentation depicts older people through society’s eyes and about the discourses prevailing in gerontological social work.

Place, publisher, year, edition, pages
Sage Publications, 2010
Keyword
Case files; documentation; categorization; case management; discourse analysis; gerontological social work
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-15966 (URN)10.1177/1473325010367820 (DOI)
Available from: 2008-12-18 Created: 2008-12-18 Last updated: 2015-01-19Bibliographically approved
4. Requests and outcomes in care management: Processing older persons as clients in old age care
Open this publication in new window or tab >>Requests and outcomes in care management: Processing older persons as clients in old age care
(English)Manuscript (Other academic)
Abstract [en]

Old age care has undergone a marketisation in recent years in which various models for care management have been introduced with the aim of making assessments efficient. This article investigates the effects the care management model has on resource allocation for home care when handling the requests of older persons in the needs assessment process. Sixteen tape-recorded assessment conversations with associated case-file texts were analysed through discourse analysis. The results show that managerialist thinking has had a partial impact on the assessment process where the documentation requirements have entailed bureaucratisation in terms of the transfer that occurs from talk to text. The findings from the study nevertheless indicate that the assessment conversations have clear elements of an individual-centred perspective in which there is room for a care rational dialogue. This constitutes a welfare policy dilemma today. Providing for older people’s requests should be on the basis of quality and an individual-centred perspective and care management has had a contrary effect in which focus is directed instead towards needs assessment and bureaucratic processes.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-15967 (URN)
Available from: 2008-12-18 Created: 2008-12-18 Last updated: 2015-01-19

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