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

Background: Social workers have a key role in needs assessment meetings with families dealing with dementia, providing information, support, and advocacy, while also assessing needs and making decisions about care services for several parties. These contacts are especially important during the introduction of home care services, where often the person has previously relied on informal support from relatives. The needs assessment process entails the involvement of all present parties, with the aim to reach a mutual agreement, a working alliance, regarding which services to apply for. Purpose: The aim of this case study is to explore how the participants, by means of different conversational practices, jointly create a working alliance between the different parties in one family. The study provides insights into the process of co-constructing a working alliance in the needs assessment process for elder care services. Methods: This article addresses the process by which social workers build a working alliance in a multi-party conversation with a family living with cognitive decline; a meeting that lasted 50 min. In this case study, we benefit from an inductive and detailed conversation analytic methodology. The theoretical framework of working alliances in institutional interaction has informed the analysis. Results: The findings illustrate how the social worker in this case study involves all parties in the decision regarding care services and explores the use of the conversational practices of mitigations, positive framing, adding information, and positioning, as a “we” achieve mutual agreement toward the end of several sequences. Conclusions: Drawing on the results of this case study, we argue that multi-party interaction involving relatives enables diversity in role-taking, where the professional, for instance, can pursue a more empathic role. Also, our results indicate that minimal agreement to a proposal is sufficient in a multi-party interaction involving clients with cognitive decline.

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

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.

In recent years there has been a move towards a more human rights-based approach to the issue of supported decision-making (SDM) with legislative changes strengthening the formal right of older people and people with disabilities to participate in care planning and decision making. According to the United Nations Convention on the Rights of People with Disabilities (UNCRPD),‘persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life’ (Article 12). This raises important questions however about how decisions are currently made and experienced in practice throwing up critical considerations for social workers who are required to assist and support individuals whose decision-making capacity may be impaired. SDM is viewed as a key mechanism for delivering the rights of persons with disabilities under the UNCRPD with several commentators highlighting its potential for older people and people living with dementia. SDM endorses the recognition of all persons as the holders of rights, with the entitlement to be at the centre of the decisions that affect them. In this chapter we will give an overview of the concepts of supported, shared and substitute decision making.We will thereafter draw on empirical research in adult social work to provide an in-depth understanding of how SDM can be utilised with older people with multiple health and care needs and how this might be applied in different settings in needs assessment practice. The chapter concludes with a synthesis of current research and thoughts about challenges and the future prospectsof SDM.

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.

Aim: To explore older patients experiences of the intervention Proactive healthcare for frail elderly persons. Background: Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients experiences in taking part of interventions aiming to enhance the care. Methods: Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. Findings: Older patients experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.

In many European countries a climate of austerity and cuts to health and social care budgets, alongside issues of population ageing, are creating particular challenges in the provision of services for older people in the community (Lymbery and Postle 2015; Donnelly Begley and O’Brien, 2018). The introduction of neoliberalism in many European welfare states since the late 1990s has also meant challenges in terms of the reorganization of social work policy and practice (Milner, Myers and O'Byrne, 2020). Budgets cuts have taken place and standardization has become commonplace, which has influenced changing legislative and policy drivers for gerontological social work (Ray, Bernard and Phillips, 2018). Social workers have a key role to play in ensuring the participation of all older people in assessments, care planning and decision-making in ways that uphold human rights, autonomy, and self-determination. The application of a critical gerontological lens is particularly important in a context of neoliberalism and scarce resources, where social workers are increasingly reliant on informal caregivers, mainly family members, to provide care and support to older people creating challenges and ethical dilemmas in practice situations.

As authors of this chapter, our writing has been influenced and shaped by our backgrounds as social work practitioners in the field of gerontological social work, and also as academics. Moreover, our experiences also originate from different social work traditions: Sweden (Olaison) and Ireland (Donnelly). This chapter will examine the impact that practice models and assessment instruments have on social work interventions within the context of the move towards a rights-based approach to care planning with older people and supported decision-making. The chapter concludes with a helpful checklist for students and practitioners on ‘Best Practices in Care Planning Meetings’ with older people.

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.

Objective: To explore frail older persons’ perceptions of the future and the end of life.

Design: Qualitative content analysis of individual semi-structured interviews.

Setting: Nine primary health care centres in both small and middle-sized municipalities in Sweden that participated in the intervention project Proactive healthcare for frail elderly persons.

Subjects/Patients: The study includes 20 older persons (eight women and 12 men, aged 76–93 years).

Main outcome measures: Frail older persons’ perceptions of the future and end of life.

Results: The analysis uncovered two main categories: Dealing with the future and Approaching the end of life. Dealing with the future includes two subcategories: Plans and reflections and Distrust and delay. Approaching the end of life includes three subcategories: Practical issues, Worries and realism, and Keeping it away.

Conclusion: This study highlights the diverse ways older people perceive future and the end of life. The results make it possible to further understand the complex phenomenon of frail older persons’ perceptions on the future and the end of life.

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.

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.

Based on an exploratory study, this article asks whether foreign-born background, gender, and age have any relevance for needs assessment documentation in Swedish elderly care. Using quantitative content analysis and multiple logistic regression analysis of case files (n=202) containing investigations (n=489) into requests for welfare services, this study explores whether the identification grounds of older people matter for documentation practices. The content analysis unveiled that case file descriptions of foreign-born older people are more extensive than the descriptions of Swedish-born. The multiple logistic regression analysis suggests also that gender and background seem to be relevant for how decisions are justified in case files. Age is not as relevant as the other categories. The most substantial finding is that foreign-born older people in this material are granted home care allowance to greater extent than Swedish born. The results partially support the critical debate about how clients are constructed in social work documentation since they give some indication that background, gender and age can play a role in how older people’s applications for care are processed in case files.

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. 

Purpose: Despite evidence that older persons want to be involved in care, little is known about how frail older people with significant care needs 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 an intervention of a health care model called Focused Primary care (FPC).'Methods: Individual semi-structured interviews were conducted with 20 older persons in five municipalities in Sweden.Results: The results show that 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 organizational levels were reported to a lesser degree. This included being able to understand the organizational system underpinning care. The relational dimensions of caregiving were emphasized by the older persons as the most central aspects of caregiving in relation to participation .Conclusions: Primary care should involve older persons more directly in planning and execution of care on all levels. An ongoing connection with one specialized elderly team and a coordinating person in Primary care who safeguards relationships is important fo rproviding participation in care for frail older persons with significant care needs living at home.

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.

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. 

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.

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.

This presentation departs from the ongoing debate on the role that documentation plays in the decision making processes of older people’s needs within social work. It is based on a study of documentation within need assessment practice in Swedish elderly care. The aim is to shed light on whether foreign-born background or native-born background, gender and age have any relevance to the ways in which older people’s needs are described  in the case files that are used in this practice.  The data – which has been analyzed using quantitative content analysis and multiple regression analysis - is comprised of case files (n=202) containing investigations (n=488) into requests for welfare services. The results of the analysis show that, women were granted home care (including practical services) more often than men. Foreign-born older people were granted home care grants to a greater extent than Swedish-born older people. Regarding the parts where judgments and decisions are made, there are differences in terms of how decisions are justified and presented in the case files: foreign-born older people’s assistance needs are more often connected to motivations about the additional workload that their relatives perform. The results partially support the critical debate about how clients are constructed through decision making processes in social work documentation. The study also adds new knowledge to this discussion by showing that categories such as gender and having a foreign-born background and to some extent also age makes a difference in relation to which services are being granted and to the way in which needs get documented. As such, the presentation will contribute to the debate on the challenges that a social justice and human rights- informed practice poses for documentation practices in social work and raises questions about the manner in which decision making processes are conducted

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.

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.

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.

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 are few studies in social work with older people today that cast light on how case conferences function as assessments. The focus of this presentation is one case that is considered as difficult as it falls between the cracks amongst two legislations (regarding services in elderly care and disability services). The data consist of recordings of two informal backstage meetings amongst social workers in one Swedish social work agency. The case conferences was analyzed using discourse analysis. Case conferences officially have an informal advisory stated function. However, the study demonstrates that the talk in the case conferences is rich in arguments about priorities and how to dismiss solutions with different dimensions of assessment making depending on which legislation the social workers rely on. The arguments used in case conferences to dismiss different solutions are related to (i) Cultural arguments including relatives' involvement in care, language reasons- and integration (ii) Organizational and legal arguments including organization's resources and economic arguments. (iii) Specific arguments related to the client or a group with the same diagnosis. The results show that case conference regarding elderly care services, relies more on cultural arguments, as these assessments are based on the Social Service Act which are a framework legislation which opens up for more interpretations by the social workers. The case conference regarding disability services are based more on legal and organizational arguments as it relies on the  ‘Act Concerning Support and Services to Persons with Certain Functional Impairments’ which is a civil rights legislations which gives clearer directives for the social workers. By making case conferences visible as everyday assessment practices, the findings suggests  that there is a de-clientificating process in practice  which is directed by categorization were cultural, organizational as well as legislative arguments are at play. As a result, there is no attempt to treat or change the individual’s social problems.

Dementia affects both the present and future of individuals receiving the diagnosis, and of the individuals with whom they have relationships. However, little is known about how couples jointly talk about their future with dementia, and how they adapt to it as a couple and as individuals. Based on conversational analysis of video-recorded interactions among 15 couples living with dementia in Sweden, study findings show that either or both spouses can actively request knowledge about the progress of dementia, but that spouses without dementia express more uncertainty about the future. Further, either or both spouses alternate between epistemic stances of knowing and unknowing, ascribe these stances to one another, and display similar or oppositional stances. The findings suggest a need for developing communicative practices for couples to jointly talk about dementia, and findings ways for practitioners to provide emotional support to these couples.

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.

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.

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.

Aim: To explore whether foreign-born background and gender have any relevance to the ways in which older people’s needs are described in case files used in need assessment practice within Swedish elderly care.

Methods:  The data – which has been analyzed using quantitative and qualitative content analysis - is comprised of case files (n=202) containing investigations (n=488) into requests for welfare services.

Findings: The analysis suggests that the backgrounds in question have relevance for the documentation of needs in case files. Differences between how the needs of Swedish-born and foreign-born older people are described in these case files can be discerned.

Conclusion: The findings raise questions about the implications that different backgrounds can have in case documentation and the ways in which this may impact resource allocation within elderly care. As such, these findings problematize the role that background can have for constructions of ‘clienthood’ in need assessment practice.

Research on the implications of cross-cultural interaction for needs assessment practice is scarce. This is particularly the case when it comes to research on care management within elderly care. Research in Sweden suggests, however, that there is a need to explore the ways in which care managers regard and experience cross-cultural interaction when assessing older people’s needs prior to granting access to elderly care services. This article is based on a project that aim to explore just that through focus group interviews with care managers (n=60). The analysis revealed that the kind of cross-cultural interaction that the interviewed care managers find the most challenging is the one involving older people that migrated late, do not speak the Swedish language and come from cultures that are deemed to be too different. The analysis dicloses the underlying assumptions about Otherness that the care managers alluded to when sharing their views on and experiences of cross-cultural interaction within the context of needs assessment practice. The article discusses the implications that these findings have for care management practice in this country considering that the legislation dictates that care managers need to attend to older people’s ‘uniqueness’. The analysis reveals namely that the uniqueness associated with certain client categories is too unique to cater for.

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.

This presentation departs from the ongoing debate on the role that documentation plays in the clientization of people within social work. It is based on a study of documentation within the context of need assessment practice in Swedish elderly care. The aim is to shed light on how older people’s needs are described in the case files that are used in this practice. The data is comprised of case files (N=202), containing investigations (N=488). Half of the case files concern older people with a Swedish background and half older people with an foreign-background. The results show that, on the whole, the documentation adheres to a standardized template including set headings under which older people and their needs are described in a similar manner. However, in the parts of the assessment that deal with social relations and health status, there are clear differences between how Swedish-born and foreign-born older people are described in terms of level of detail and what information is presented. Regarding the parts where judgments and decisions are made, there are differences in terms of how decisions are justified and presented: foreign-born older people’s assistance needs are more often connected to the additional workload that their relatives perform. The results partially support the critical debate about how clients are constructed in social work documentation. The study also adds new knowledge to this discussion by showing that there is an active categorization process in need assessment documentation in which older people in investigations are described in different ways. As such, the presentation will contribute to the debate on the challenges that documentation practices pose for social work and raises questions about how gender and background influence case documentation.