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.

Int J Soc Welfare 2010: 19: 339-347 (C) 2010 The Author(s), Journal compilation (C) 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This is a study of encounters between social workers and citizens in one type of welfare organisation, the municipal elder care system. The article sheds light on how older peoples claims are dealt with in the processing of home care applications. Twenty encounters between social workers and older people were studied using discourse analysis. The findings reveal that discursive practices are part of the routine when the applications are processed. The application handling follows an agenda-bound pattern that is visible in the encounters. In these standardised procedures, oral discourse is embedded in routines that also include the use of texts. However, within this institutional order, there is also an important element of negotiation between the parties. It is therefore claimed that the encounters include a negotiated order that does not exist on its own, but is achieved in the ongoing interaction.

This paper reports results from a study of meetings between old persons, their relatives and the care managers who work with assessments of home care. According to the Swedish Social Welfare Act old persons who are in need of care are entitled to apply for home care. The formal decision concerning home care is made by the assessment managers who handle these type of applications within the municipality. Old persons and their family members - such as spouses or children - are moreover supposed to have influences on how home care is organized. The issues related to home care may often comprise conflicting interests - both within the family, and between the old persons, their family members and the case managers. The data consist of 20 Swedish home care assessment meetings. The assessments were studied, as institutional practices in which the participants used discursive positioning in order to argue for their version in the decision-making. The results show that the home care assessment meetings functioned as a situated practice in which old persons were positioned both by care managers and their relatives as potential home care receivers. Although the old persons had the final saying in the decision process family members were prominent in constructing the old person as in need of care. This highlights further questions about old persons individual rights within the decision-making in this type of situation. It also poses questions about relatives and their needs in the caring practice for the future development of the old age care system.

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.

Introduction: Despite evidence that older persons want to be involved in care, little is known about how older people with complex health problems living at home experience participation in care provided by different stakeholders. This study investigates the experiences of participation in care by older people, following their involvement in a proactive intervention based on a new health care model called Focused Primary Care. Material and methods: Individual semi-structured interviews were conducted with 20 older persons in five municipalities in Sweden. All the interviewees had participated in the intervention. Results: The older persons highlighted opportunities and limitations for participation on a personal level i.e. conditions for being involved in direct care and in relation to independence. Experiences of participation on an organisational level were reported to a lesser degree. In order to keep care contacts together and improve participation, a coordinating person (called “the spider in the net”) was requested who could safeguard the staff’s relationship with the older person. Conclusions: Primary care should to a greater extent involve older persons more directly in the planning and execution of care. There is considerable potential for developing the health and primary care sector to better target the needs of older persons with complex health problems, and to enhance their participation and independence. Interventions, like the one followed in this project, can play a critical role in realising the needs of older persons, where providing participation in care is recognised as a significant goal to assist them in navigating the care system. 

Research on care managers' experiences of the needs assessment process is scarce even though the literature on needs assessment practice is relatively extensive. One of the research areas that has not received attention yet is the way in which care managers experience the challenges that are presumably posed by increased ethnic, cultural, linguistic and religious diversity among prospective elder care recipients. This article addresses this research gap. It is based on a project that aims to shed light on care managers' experiences of the needs assessment process in general and cross-cultural needs assessment meetings in particular. The data are constituted of focus group interviews with care managers in Sweden (N=60). In this article we focus on care managers' experiences of needs assessment with older people who have immigrated late-in-life, who come from cultures considered different from the Swedish one and who have not mastered the Swedish language. This was the group of older people that the care managers mostly thought of when asked to describe their experiences of cross-cultural needs assessment meetings. The interviewed care managers discussed the challenges that these meetings present, which were related to communication due to language barriers, different demands and expectations, insecurity regarding what is customary in such meetings, as well as perceived passivity among late-in-life immigrants. The article discusses the contributions of the findings to research on care management practices in general, as well as to needs assessment practice in particular.

The key issue in this article is to identify and interpret how older LGBTQ adults use impression management strategies in social interaction with non-LGBTQ persons in everyday life situations. The collection of data consists of 15 semi-structured interviews with older LGBTQ adults (65+) in Sweden. A reconstructive methodology for analyzing the material were used and we focused mainly on the latent meaning in the interviewee’s communication. Our findings indicate that the interviewees employed specific impression management strategies. Some of the informants disclosed their LGBTQ identity while others instead tried to conceal this part of their identity, and this depended on individuals’ openness and/or visibility. We also noted differences in using a defensive or assertive impression management strategy and differences between the older LGBTQ adults. A thorough understanding of how older LGBTQ persons deal with being LGBTQ in social interaction with non-LGBTQ persons could be useful knowledge in a practice context. By illuminating the different initial positions of older LGBTQ adults as well as their different impression management strategies in every day social interaction we hope this will be practical knowledge also in different social service settings. This could facilitate the acceptance and the inclusion of older LGBTQ persons. The findings can hopefully be useful for social service personnel to help older LGBTQ adults feel secure about disclosing their LGBTQ identities.

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.

The aim of this report is to present references that originate from the Nordic countries,including Sweden, Finland, Denmark, and Norway, and that have been assigned the keyword“everyday life” or one of its Nordic counterparts and published in the period 1990 through2008. The presentation includes information on the total number of references from eachcountry, the most frequent authors and the institutions to which they belong, and the referencetypes and the number of each type. Based on an analysis of some limited information aboutthe dissertations and the journals, it is discussed how Nordic everyday life research may becharacterized.

In total 560 references were found in the search procedure that is described in the report. Thenumber of references from the different countries is: Finland 176, Sweden 171, Denmark 110,and Norway 103. The analysis imply that the field of Nordic everyday life research is big,multifaceted, and multi- and interdisciplinary. It is performed mainly within the frame ofvarious social science subjects, but also to quite a great extent within subjects of healthscience, and to a minor extent within technology subjects. Some of the references seem torepresent studies with a more comprehensive view on the everyday lives of a certain group ofpeople located in the same place or sharing some characteristic and they try to capture bothwhat people do and what they think and experience. Other studies are narrower and focus on,for example, attitudes towards food or how computers are used or should be designed. Inother words Nordic everyday life research is hard to define clearly. The limited analysis andthe fact that the international field of everyday life research is not well known, do not allowconclusions to be drawn about either a typically Nordic character of everyday life research, ordifferences between the Nordic countries. However, the work of mapping Nordic everydaylife research will continue and the plans of constructing an open-access Everyday LifeResearch Database that will be easily accessible on the Internet are presented.

There is mounting evidence that Swedish elder care is unable to adequately address the unique needs of older lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and that social work research and services do not focus on individual variations within the LGTBQ-group. There are negative consequences for older LGBTQ individuals, including poor service utilization. Significantly, service utilization is associated with improved outcomes across the life course. Based on interviews with 15 participants living at home in Sweden, this qualitative study explores how older Swedish LGBTQ adults assess elder care alternatives for their future. Findings indicate that feeling accepted as individuals is essential, but that this did not necessarily mean being recognized as an LGBTQ individual. Feeling welcome individually transcended the need to be recognized as LGBTQ. Implications for social work include increasing cultural competence for work with diverse older adults, including LGBTQ persons, and advocating for person-centered care.

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.

Research has shown that there is an increasing awareness that elder care is not addressing the unique needs of older LGBTQ, lesbian, gay, bisexual, and transgender persons. Many LGTBQ people entering old age today have worse health and, to a lesser extent than other older groups, tends to seek help from health and social services. Few studies within gerontological social work have however focused on how older LGBTQ persons express their needs, and wishes of future social services. This presentation addresses this knowledge gap by focusing on how older LGBTQ reason about possible good alternatives to meet their needs when they are entering a phase where they need care. The study is based on a qualitative interview study with (n= 15), older LGBTQ persons in Sweden who live at home and where only two of them have had prior experiences of services. The analysis shows that, the overall most important issue for the older LGTBQ persons, was to be able to be open with their sexual orientation and/or gender identity within a future elder care setting. It was essential for the LGBTQ persons that the engagement of staff must be based on respect and that they should be able to meet every person as an individual. Regarding the issue of need for education and knowledge among staff about LGBTQ issues the interviewed expressed a wish that staff should have knowledge about these issues. For some it was important to be seen as an LGBTQ-person and to others it was mostly important being met in a welcoming and affirmative way, but not focusing too much on their LGBTQ-identity. The results provide support for the debate on the importance of addressing the unique needs of older LGTBQ persons and highlight the importance for social work to address the diversity of needs and wishes that is present within the group in regards to entering elder care.

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

Tolkande innehållsanalys är inte en ny metod. Den utvecklades som en specifik forskningsteknik under 1900-talet av sociologer och socialpsykologer som intresserade sig för att undersöka fenomenet kommunikation. Metoden användes också av pedagoger i studier av läroplaner och läroböcker för att identifiera fördomar och stereotyper om människor med till exempel olika födelseland eller funktionsvariation. Innehållsanalys associeras vanligtvis med den breda kategorin kvalitativa metoder och används på en rad olika texter, till exempel nedskrivna intervjuer, statliga utredningar, myndighetsrapporter, debatter i riksdagen och tidningsartiklar.

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.

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.

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.

In Sweden, Covid-19 has affected elder care and the services provided for older people to a greatextent. In the needs assessment process care managers, in their role as street level bureaucratsare facing an indefinite closure or limitation of services to offer older people. Also, as older peopleare encouraged to isolate themselves, care managers are now performing assessment meetingsby phone rather than face-to-face. Drawing on an initial analysis of audio-recorded telephonemeetings between care managers and older couples, we present two different approaches ofassessing 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 allregular services were still possible to offer the older people, only to be utilized once Covid-19 haspassed. In the second approach, care managers use professionalism in relation to the discretionembedded in their role as social workers to find solutions outside the regular system. The findingssuggest supporting innovative approaches in remote assessments allowing care managers to usetheir relational competence more in conversations, as well as initiating technical education formanaging the challenges embedded in this new digital landscape. 

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.

Samtal och relationer är centrala inom alla områden av socialt arbete, och med hjälp av samtalsanalys kan vi synliggöra mönster av hur mening och relationer skapas inom samtal. Samtalet är ett av de viktigaste verktyg som socionomer har att tillgå, och kunskap om hur samtal görs efterfrågas ständigt. Inom socialt arbete diskuteras också ofta makt, ojämlikhet och asymmetrier i relationer, samt hur dessa tar sig uttryck mellan klient och socialarbetare.

Dementia is a chronic illness that not only has substantial effects on the life as well as future for the individuals diagnosed, but also affects those with whom these individuals have relationships. This has implications that need to be addressed by professional practice, not least since social work research has shown that the support available for couples managing dementia is insufficient. There are few studies today of how couples jointly talk about their future with dementia and how they adapt to it as a couple and as individuals. Therefore, this article explores how couples in which one of the spouses has a diagnosis of dementia jointly talk about an uncertain future with dementia. The study benefits from using the conversation analytic method when studying video-recorded interactions among 15 couples living with dementia. The results show that either or both spouses can actively request knowledge about the progression of dementia, but at the same time, the spouses without dementia express awareness of the uncertainty that is connected to a future with dementia. Moreover, either or both spouses may also express contentment with “not knowing.” In all examples, one or several of the participants alternate between taking epistemic stances of knowing and unknowing as well as ascribing stances to others, and spouses can display similar or oppositional stances. The findings suggest a need for developing communicative practice for couples to jointly talk about dementia, as well as a need for social workers to find ways of providing emotional support.

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.

Words of Conflict, Words of War: How the Language We Use in Political Processes Sparks Fighting is a fascinating exploration of the narratives leaders use to position both themselves and others in the course of political processes that lead to peace or conflict. Drawing on the relatively new field of "positioning theory," expert essays provide insights into the ways words position us—for better or worse—and influence our intended results. The focus on narratives, from the interpersonal to the international, leads to a better understanding of political processes and conflict resolution.

Part one of the study deals with micropolitics and personal positioning. Part two explores positioning by political parties and factions. Links between micro and macro are illustrated by leadership studies of individuals such as President Barak Obama, President Mahmoud Ahmadinejad, President George W. Bush, Governor Sarah Palin, and the Reverend Ian Paisley. The focus throughout is on how a leader can use language to redirect collective politics in support of conflict or of peace.

   "This volume focuses on how high quality care is provided and the practices and policies that support this. It will offer case studies (both policy- and practice-oriented empirical studies) from countries that share a basic orientation to social welfare: Canada, Denmark, Finland, Iceland, Sweden and the United Kingdom. This book will be essential reading for students, practitioners and researchers who wish to understand diverse problems in service provision for the elderly and the complexities of policy responses in different health and social care contexts"--

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

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.

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.

Antologin tar upp en rad forskningsetiska frågor i forskningens vardag inom främst humanistisk-samhällsvetenskaplig forskning. Fokus ligger främst på frågor som kan väckas vid kvalitativ fältforskning. Aktuella forskningsetiska principer presenteras och boken lyfter fram etisk medvetenhet samt reflexivitet som en viktig del i forskningsprocessen

Elder care has undergone a marketization 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 analyzed through discourse analysis. The results show that a managerialist thinking has had a partial impact on the assessment process where the documentation requirements have entailed bureaucratization 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.

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.

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.

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.

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.