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.

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. 

Summary: Social work practice has a history of collegial, intra-, and interprofessionaldiscussions that take place backstage, that is, without the presence of clients. Because oftheir backstage character, these discussions may be considered even more important toexamine than meetings at which clients are present and that are in a way already open tothe public. The purpose of the present review was to provide insight into this practiceby identifying and synthesizing recent empirical findings from existing studies using naturalisticdata, published in English in peer-reviewed journals. Findings: We identified four types of interaction among practitioners in relation tothe case discussed and three types of content that were raised and shared, as well asan apparent mismatch between formal reasons for the discussions and the purposethey serve in practice. A lack of common vocabulary for conceptualizing the discussionsand of attention given to their backstage character was identified in the included studies. Applications: The review highlights an important area for further research and stressesthe importance of not being blinded by formal purposes or ideological underpinningsin examining intra- and interprofessional discussions in social work; it shows that it isimportant to look into what is actually going on in practice.

Research has explored how social workers in team constellations perform assessments of the needs of clients in case conferences. However, the process in which gatekeeping is applied in the categorization of clients as inappropriate receivers of support in collegial discussions has received less attention. This article presents findings from a case study of a complex case where a 64-year-old person with dementia was assessed by two teams of social workers handling the same case under two different forms of legislation (elder care and disability services). The data consist of recordings of two case conferences in one Swedish social work agency. The conferences were analysed using positioning theory. The findings suggest that the conferences contained different storylines where the social workers categorized the client as an inappropriate receiver of support. Furthermore, the discourses for gatekeeping differed depending on how the social workers positioned the client in the different storylines in the case conferences. The study shows that institutional and professional responsibilities are central to the assessments that the social workers perform, and that there is a risk that the client will be subject to gatekeeping when the case is handled on an ambiguous legal basis in different legislations, which may result in the client falling between two stools. The findings suggest that research needs to explore, in a more systematic manner, how social workers’ gatekeeping practices are performed in collegial team discussions.

Recommendations for how practitioners “should communicate about their work, so as to become ‘more efficient’ and make better use of their ‘team’” are increasingly being requested. However, if we want social work practice to change or improve, we first need to acquire insight into its actual content(s), that is, what practitioners do in different working contexts and how they interact. Based on a systematic review of recent empirical findings from studies on inter- and intra-professional case discussions in social work practice using naturalistic data, this presentation aims to provide insight into backstage case discussions and to provide directions for further research. Goffman´s concept of backstage implies that the discussions in focus take place metaphorically, away from an audience consisting of clients or significant others. In synthesizing the included studies, we identified five types of interaction among practitioners in relation to the case discussed and three types of content that were raised and shared, as well as an apparent mismatch between formal reasons for the discussions and the purpose they serve in practice. A lack of common vocabulary for conceptualizing the discussions and of attention given to their backstage character was also identified. The presentation will highlight an important area for further research and stress the importance of not being blinded by formal purposes or ideological underpinnings in examining intra- and inter-professional discussions in social work; it shows that we should look into what is actually going on in practice.

European local authorities increasingly use social media to present services and activities organized for citizens living in the particular area. Previous studies found that authority-managed social media visually depicted older adults as being active, sociable, happy, and physically capable, reflecting the normative “third age” representation. Yet few studies to date have examined how local authorities produce the photos of older adults for social media posting. Drawing on semi-structured interviews with communication officers in a Swedish municipality, the purpose of this study is to investigate the production process for social media photos of older adults within local authorities from an institutional logics perspective. The analysis illustrates that communication officers strive to create a good image of the municipality and its services, follow municipal policy and EU law on data protection, seek photos through particular sources, adjust to and develop photographic standards of good photos, and endeavor to promote social media engagement in the photos. These motives and work practices of communication officers contribute to the visual representations of older adults as engaging in municipal services, being socially active, and staying physically capable. The analysis also indicates that both social media and bureaucratic logics encourage officers to produce photos of older adults that highlight the bright side of later life. The findings contribute to previous studies on online representations of older adults generated by local authorities, by showing how the third age representation may come about in practice, and which logics may influence officers to generate such representation. Furthermore, the knowledge provided could be used as a basis for assessment and improvement on authorities' production for social media photos of older adults, which in turn contributes to more diverse and thoughtful representations of older adults and later life in authority-managed social media.

Mass media are one of many institutions that contributes to the construction of stereotypical images of ageing and old age and studies have shown that older people have primarily been associated with negative depictions in newspapers and television programs. In recent years, European public bureaucracies have increasingly used social media tools for communicating with citizens. However, few ageing research and media research have dealt with public administrators and their work routines of depicting older citizens in social media. This study aims to investigate how Swedish local authorities generate social media pictures of older people, and what consequences the institutional practices may have on reducing ageist representations. This research performed an analysis on the Facebook photos of older people posted by local authorities and conducted semi-structured interviews with communicators in the aspects of sourcing and selecting photos of older people, designing and evaluating social media posts. This study found that communication guidelines and assignments from the municipality (re)direct communication resources and practices which may decrease the proportion of pictures of older people. Moreover, it found that local authorities have been adaptive to social media and published favourable photos of active and healthy older people, while they failed to address the heterogeneity of older people when it comes to health and function. While the institutional practices of capturing positive later life may contribute to up-grading stereotypical images of older people as sick and dependent, they could simultaneously be considered as ableist and as giving a false impression of long term care.

Trots att kommunala riktlinjer uppmärksammats som avgörande för hur välfärdens ambitioner för äldreomsorgen tillämpas på lokal nivå genom att vägleda biståndsbedömare i deras bedömningar och beslut så saknas ingående analyser av hur sådana styrdokument är utformade. Syftet med artikeln är att belysa hur det kommunala ansvaret för att tillgodose individuella behov avgränsas i kommunala riktlinjer för biståndsbedömning avseende äldre människor enligt Socialtjänstlagen, liksom hur avgränsningarna underbyggs och legitimeras. Ambitionen är att öka förståelsen för biståndshandläggares arbetsvillkor samt att bidra med underlag för diskussioner om äldreomsorgens styrning. En analys av 51 strategiskt utvalda kommuners riktlinjer har genomförts med stöd i teorin om framing. Analysen visar hur kommuner i riktlinjerna framställs som ansvariga för att tillhandahålla vissa insatser snarare än att, i enlighet med de ambitioner som fanns då SoL infördes, tydliggöra vad som på den lokala nivån är att betrakta som en skälig levnadsnivå när det gäller livsföring i övrigt. Det utrymme som lagen lämnar för lokala anpassningar legitimerar i riktlinjerna istället ett begränsat och specificerat insatsutbud. Begränsningar av det kommunala ansvaret underbyggs och sker även genom såväl korrekt som inkorrekt hänvisning till rättspraxis samt genom att äldres behov av stöd på ett rättsligt tveksamt sätt hänvisas till anhöriga. Riktlinjernas utformning riskerar för det första att – vid tillämpning – ha en negativ inverkan på rättssäkerheten eftersom normerande utbud av insatser är svåra att kombinera med principen om individuell bedömning. För det andra försätter det biståndshandläggarna i en situation där de riskerar att hamna i kläm mellan att följa SoL och lokala föreskrifter då dessa ger motstridiga budskap. För det tredje kan variationer av äldreomsorgens styrning på lokal nivå leda till systematiska skillnader i tillämpningen av lagen. En kartläggning som genomfördes innan artikeln färdigställdes visar att 2019 hade 274 av Sveriges 290 kommuner riktlinjer för biståndsbedömning.

National surveys show that most users of aged care in Sweden are generally content with the support they receive. The chapter argues that such views are constrained by a narrowed user gaze that becomes quite clear when concepts and models that are used in disability policies and services are introduced into the equation. The central argument of this chapter is that the ageing experience, as it is typically constructed in Swedish society, provides older people and their relatives with a particular, and problematic ‘user gaze’ and that disability theory can be used to refashion this ‘user gaze’. The chapter suggests that people who acquired impairments as younger adults and who live their (later) lives supported by disability services may introduce newer and better ways of evaluating services that challenge some taken for granted understandings within the system of aged care.

Successful ageing is one of the most influential concepts in gerontology. Characterisations of successful ageing have generally promoted the importance of individual effort and the maintenance of high physical and cognitive function. The individualising focus and normative features at the heart of the concept of successful ageing have attracted some criticism, particularly from proponents of disability studies, who have argued that the concept of ‘successful ageing’ is stigmatising and should be abandoned. However, this chapter proposes that the concept remains useful and should be reworked, rather than abandoned altogether. By expanding on the principle of Normalisation, this chapter proposes a Scandinavian Model of Successful Ageing that might be used for the measuring successful ageing. Unlike previous measures, the Scandinavian Model does not measure individual achievement, but rather redirects attention from normative to comparative standards in order to ensure the fair distribution of social rights for all people, whether they age with or into disability.

Since Robert N. Butler (1969) introduced the term ageism to research, a number of attempts to define and conceptualize the phenomenon have been proposed (Iversen et al. 2009). Most have followed Butler in defining ageism as prejudice and discrimination based on age, with older people as the victimized category (See “Self reported ageism”). Some definitions describe ageism as affecting people of all ages, and in fact, investigations show that younger people are most affected by negative treatment that they ascribe to their age (Bratt et al. 2018). The definitional ambiguity has resulted in confusion on the causes of ageism; it is likely that different types of dynamics are present for persons of different ages. The present text will focus on ageism – and ableism – as a problem for older people.

The concept of ageism has been used to cover a wide range of phenomena, from skewed knowledge and intolerant values to attitudes and behaviors toward older people. Ageism has been described as the “denial of basic and civil rights of elders” and has been qualified as an ideology (Estes 2011, p. 300). Commonly age discrimination has been described as the manifestation of ageist attitudes and prejudice, specified as hostile forms of discrimination (e.g., neglect or mistreatment), but also in more compassionate, subtle ways (e.g., patronizing and “elder speech”), and even positive discrimination (Cary et al. 2017; Chonody 2016; Palmore 2015). This line of thought is pursued through the use of the attitude concept that is divided into a cognitive, an affective, and a behavioral component (Iversen et al. 2009): discrimination is the behavioral manifestation of individual or societal attitudes on age. Within the constantly growing field of research on ageism (Levy and Macdonald 2016), much interest has been devoted to different arenas where ageism appears (e.g., Ayalon and Tesch-Roemer 2018) and texts and tools for discovering and combating ageism have been provided (e.g., Palmore 1990, 2015; Levy 2016).

Less frequent and elaborated in gerontological literature is the concept of ableism. Ableism could be defined as the devaluation and discrimination of people based on perceived functional inability. The phenomenon has been devoted explicit interest in disability studies (e.g., Goodley 2014; Burch and Sirotkin 2018). According to Renee Butts (2017), in the Salem Press Encyclopedia, the concept was probably coined in the 1980s and refers to the discrimination of people with disabilities, conveying that they are of lesser value than the “able-bodied.” This definition is useful when identifying discrimination of persons with disabilities but as it rests on the dichotomy able-bodied – disabled – it downplays the fact that ableism has its roots in a greater societal order. Simply put, the logical counterpart to devaluation based on functional inability is the valuing of people based on ability, a principle that people in general tend to support in many situations (the system of education, the labor market, sports, and so on).

Purpose:

International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care.

Design and Methods:

We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology.

Results:

The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular.

Implications:

The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.

Aim: It has been found by researchers that older adults are statistically underrepresented and associated with negative stereotypes in the mass media. Older adults are generally viewed as incompetent from stereotyped media content, which may make them socially excluded from a set of opportunities and resources. The media portrayals are conceived as value-expressive and constructing the image of older adults and ageing. The purpose of this study is to investigate how Norrköping municipality portrays citizens at different life stages in social media with a special emphasis on the use of age stereotypes in the photos used.

Method: The material consists of the photos collected from 32 Facebook accounts produced by municipal bodies during the entire year of 2018. The analysis is based on a categorization of various features of the photos in order to statistically describe the relation between signs, activities and contexts associated with distinct life stages. Further, the meaning of frequently-used symbols in the photographs is analysed.

Result: The study concludes that old age persons are numerically underrepresented in the material. A number of signs and activities in the photographs, and contexts beyond the photographs, that stereotypically corresponded to five distinct life stages (infancy, childhood, adolescence, adulthood and old age) are identified. Old age is repetitively portrayed in the context of coffee drinking and foot bathing on Norrköping municipality’s Facebook page, while adolescence is depicted with practical training at high schools to an excessive degree. Besides, the result suggests that certain minorities of citizens did not show up in the municipal social media: people with disabilities, migrants, people with dementia and on forth.

Conclusion: The municipality communicates stereotypical images of life stages through associating with specific contexts in the photographic coverage. Therefore, communication professionals need to be aware of the stereotypical construction of life stages in the media.

This chapter critically examines established attempts to counter ageism, highlighting how they have failed to include the so-called fourth age, and might instead contribute to further stigmatization of older people with impairments and care needs. Drawing upon models from disability policies, an equal rights framework will be introduced that could be used to combat discrimination and improve everyday conditions of older people in need of long-term care. In this chapter, the equal rights framework will call into question existing cases of “institutional ageism” whereby older people with impairments are excluded from government programs benefiting younger people with disabilities. Instead of acting as a normative reference group, as the standard that older persons may fail or manage to live up to, it is possible to use the third age as a comparative reference group. We argue that society should make available for older persons with impairments living conditions and lifestyles that are typical for healthy active seniors, that is, for the group of older people that are commonly referred to as constituting the third age. These conditions and activities should then not be regarded as normative, but as typical, and thus possible to refer to when defining social rights.

The literature across different fields defines ageism ambiguously and widely covers a span of intolerant knowledge, values, attitudes and behaviors towards older adults or more generally toward people of a certain age. In this chapter we provide an overview of how ageism is defined, measured, and assessed in health care and long-term care. In so doing, we aim to bridge the gap between the concept and measurement of ageism in these two contexts and to provide some general insights into the approaches, which researchers can apply to assess ageism in these settings. In this chapter, we therefore aim to answer the following questions namely (i) Why is it important to know how ageism in healthcare and long-term care has been empirically studied? (ii) What evidence for the existence of ageism among key stakeholders (e.g. health care professionals and long-term care workers, family members and older adults) is reported in empirical research covering these two contexts? and (iii) Which are the conceptual and methodological approaches used to measure and assess ageism involving these key stakeholders in the two contexts?

Residential care is often considered as the appropriate way to meet the needs of older people with extensive care needs. However, relocation to residential care inevitably entails disruptions for the individual, not only in terms of housing, but also in terms of relationships and the content of everyday life. Is residential care then really the optimal way to care for older people with extensive care needs? The aim of this presentation is to discuss the possibilities of maintaining – and developing - identities and life styles in later life despite extensive care needs by learning from disabilty activism and ideology and the support system of personal assistance. Ideologically, this support, and the related system of direct payment, is based on the idea within disability activism that the right to live like others, included to be self-determinant and autonomous, for (younger) people with extensive disabilities can be realized through personal assistants that serve as the so called assistance users “arms and legs”. Drawing on two case studies the presentation will show how some people living with dementia in today’s Sweden may pursue active lives at – and out-side – their (ordinary) home, also in the late(st) stages of the disease, supported by family members and personal assistants. The case studies comprise a variety of empirical materials (participant observations, video recordings and audio-recorded interviews with spouses and assistants) and seem to be the first to explore the phenomenon of living with dementia supported by personal assistants. Building on a conceptual framework originally developed by Corbin and Strauss (1985) the presentation will illustrate a variety of work in which the assistants, the individuals with dementia and their spouses engage. Focus will be on the biographical work carried out by the assistant and on how models of thought in disability ideology are embedded in their efforts.

I detta kapitel kopplas den internationella diskussionen kring medborgarskap och demenssjukdom och hur denna kan hjälpa till att förstå den svenska situationen för personer demenssjukdom till frågan kring ställföreträdarskap vad gäller beslutsfattande och personer med demenssjukdom.

Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia.

In Sweden, every citizen has equal right to social-care. The purpose of this session is to investigate how social support is distributed for people with dementia and to compare this distribution in an ethnicity perspective. A statistical analysis will be presented based on data in progress.

We will present voice as an analytical framework to enhance the problematization and investigation of citizenship for people living with dementia. We will also discuss the strengths and the potential of using such a framework when doing research on citizenship in general, and more specifically, for people living with dementia. The analytical framework that we will propose focuses on the multiple accounts of voice in use. Thus, the framework does not only embrace the issue of "whose voices?", but also the various ways voice has been conceptualised, framed and understood in different theoretical and empirical contexts as well as how these together in different ways have the potential to shed light on the possibility for people with dementia to remain participative actors in their neighbourhood, in society and furthermore, to have the opportunity to claim full citizenship.

This article addresses the role of the Church of Sweden Abroad, with its 45 parishes in foreign countries, for older Swedes who live or stay abroad, permanently or for long or short periods. The article is based on a research project comprising three studies: a qualitative study, an analysis of websites and information material, and an Internet-based survey. The results highlight the important role played by the parishes for older visitors, in terms of providing community, support, and religious services. However, people above the age of 65 were virtually invisible on the church websites and in other information material. This paradox is discussed and the concept of ageism is used in the analysis.

During recent decades, there has been a growing recognition that people cannot be assumed incapable of making decisions about their own care solely on the basis of a dementia diagnosis and international agreements and legislative changes have strengthened the formal right for people with dementia to participate in decisions on care services. This raises important questions about how these decisions are currently made and experienced in practice. The aim of this presentation is to address this question and highlight directions for further research.

The presentation is based on a systematic review and qualitative synthesis of recent empirical findings. For inclusion in the review, a publication had to meet the criteria of being published between 2005 and 2013 in a peer-reviewed journal, and be written in English. Twenty-four articles were identified, all representing qualitative studies. Relevant findings were extracted and synthesized along dimensions of involvement of the person with dementia in decisions on care services. Three overarching ways in which people with dementia are involved, primarily, in the informal part of a process of decisions were identified: excluded, prior preferences taken into account, current preferences respected. Several articles seemed to be based on the assumption that decisions on care services are invariably and solely made within the family and without participation of the person with dementia.

Our study emphasizes the need for more updated research about international debates and agreements concerning capabilities and rights of people with dementia and about the (potential) formal contexts of care decisions in the country concerned.

Background: During recent decades, there has been a growing recognition that people cannot be assumed incapable of making decisions about their own care solely on the basis of a dementia diagnosis and international agreements and legislative changes have strengthened the formal right for people with dementia to participate in decisions on care services. This raises important questions about how these decisions are currently made and experienced in practice. In this review, we address this question and highlight directions for further research.

METHODS:

We searched CINAHL, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, and PubMed. Twenty-four pertinent articles were identified, all representing qualitative studies. Relevant findings were extracted and synthesized along dimensions of involvement of the person with dementia in decisions on care services, using an integrative approach to qualitative synthesis.

RESULTS:

We identified three overarching ways in which people with dementia are involved, primarily, in the informal part of a process of decisions: excluded, prior preferences taken into account, and current preferences respected. Several (10) articles seemed to be based on the assumption that decisions on care services are invariably and solely made within the family and without participation of the person with dementia.

CONCLUSIONS:

The review emphasizes the need for more updated research about international debates and agreements concerning capabilities and rights of people with dementia and about the (potential) formal contexts of care decisions in the country concerned. This, we argue, is vital for future knowledge production in the area.