Hur kan biståndshandläggare stödjas i att utreda äldre pars behov? Det har forskare från Linköpings universitet undersökt i ett forskningsprojekt, där kommunikation står i fokus. 

The progression of dementia often leads to significant life changes, with particular emphasis placed on memory decline and increased forgetfulness. People living with dementia (PlwD) are frequently subjected to stereotyping as profound forgetful individuals, a phenomenon termed dementism. This paper develops a comprehensive conceptual framework of dementism grounded in the social psychological theory of ageing. The proposed framework identifies four key psychosocial factors: emotional reactions and beliefs, social attribution, exclusion and avoidance, and denial of humanness. This framework does not aim to replace existing social research paradigm in dementia studies but rather offer novel theoretical insights through a critical lens to advance the field. We argue that psychosocial and cultural principles are fundamental to dementia care, emphasising the importance of valuing personhood and the subjective experiences of PlwD. This approach promotes enhanced sensitivity, social equality and justice in dementia care practices. Building on this framework, we conclude with targeted recommendations for future research, particularly focusing on strategies to prevent discriminatory behaviours towards PlwD. We propose that implementing antioppressive practices can help remediate dementism and foster more inclusive respectful care environments. This framework provides a foundation for understanding and addressing the complex psychosocial challenges faced by PlwD, ultimately contributing to more dignified and person-centred approaches to dementia care.

När biståndshandläggare möter äldre par där det finns en demenssjukdom behöver de balansera olika perspektiv och behov. I kapitlet presenteras biståndshandläggares berättelser av hur de hanterar svåra situationer i behovsbedömningsmöten.  

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.

Background: Patients in old age often have complex care needs owing to multimorbidity and polypharmacy. This qualitative study is part of a larger ongoing Swedish intervention trial Secure And Focused primary care for older pEople (SAFE), including shorter care agreements based on person- centred patient goals.

Aim: To explore, in a primary care setting, the views of older and vulnerable patients on a more systematic, proactive approach to care planning, including establishing and documenting care agreements based on person- centred goals.

Design & setting: Individual semi- structured interviews with patients (n = 25) aged >75 years from 12 intervention primary healthcare centres in two counties in Sweden. Method: Interviews were conducted between June and October 2023. They were digitally recorded and transcribed verbatim. Latent qualitative content analysis was used.

Results: The following three categories, with 10 sub- categories, were found: I would like to live in the present, so why plan ahead? Let me decide versus they know best; and Care agreements usually went unnoticed. The latent theme — The ambivalence of care planning in the fourth age — was created to give a deeper meaning to the content of the categories. 

Conclusion: This study emphasises that older, vulnerable persons have varying attitudes towards participation in proactive care planning. This ambivalence may originate from the individual’s desire to have their autonomy respected and express future care preferences on the one hand, and to avoid or postpone end- of- life conversations and care planning on the other hand. Patients also expressed a desire to be more actively involved in care planning. Although care agreements have the potential to increase patient involvement in proactive care planning, they often went unnoticed. The conversation itself was essential.

Den som upplever behov av hjälp med aktiviteter i det dagliga livet har enligt socialtjänstlagen (SoL) möjlighet att vända sig till kommunens biståndshandläggare och få sin rätt till bistånd individuellt prövad. Då de flesta som erhåller denna typ av bistånd uppnått en hög kronologisk ålder, brukar de insatser som oftast beviljas kallas äldreomsorg. I SoL står dock inget om att hänsyn ska tas till (en vuxens persons) ålder då rätten till bistånd prövas. I det här kapitlet undersöker vi hur biståndshandläggare, trots detta, skapar och använder sig av informella ålderskategorier när de under så kallade ärendekonferenser diskuterar med sina kollegor om vilka behov enskilda individer har och hur dessa ska tillgodoses. Genom att fokusera på hur ålder görs i interaktion belyser vi hur handläggarna kategoriserar personerna som "för unga", "inte så gamla", "äldre" och "extraordinärt gamla" och hur "typiska" äldreomsorgsinsatser framställs som passande i vissa åldrar än andra.

Age categories are related to perceptions and norms concerning appropriate behaviour, appearances, expectations, and so forth. In Sweden, municipal home care and residential care are commonly referred to as “elder care”, primarily catering to individuals in their 80s or 90s. However, there is no set age limit reserving these services for an older age group.

In intra-professional case conferences, care managers convene with colleagues to discuss care needs and eligibility for elder care services. Despite their significance, these conferences have received limited scholarly attention. The aim of this study was to analyse how care managers categorise persons based on age in intra-professional case conferences when discussing care needs and appropriate support to meet these needs.

The study utilised data from 39 audio-recorded case conferences involving the discussion of 137 different cases, which were analysed using discourse analysis. Our findings showed that chronological age was frequently made relevant and applied in discussions about the appropriateness of usual elder care services.

Four themes emerged, representing how the care managers implicitly and explicitly categorised clients of different chronological ages as typical/normal or atypical/deviant in these discussions: the “too young”, the “not-so-old”, the “old”, and the “extraordinarily old”.

The findings contribute to research on ageing by demonstrating that, in an elder care context, being categorised as atypical/deviant (in terms of being younger) may be more beneficial than being seen as a normal or older elder care recipient. This underscores the importance of further research on the impact of informal age categorisations of clients on actual decisions about welfare services.

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.

Few studies have explored the moral and ethical dimensions of how, in practice, socialworkers talk about and handle cases as part of their daily work. At the same time,identifying and examining the ethical dimensions of actual social work practice can bechallenging because ethics is often hidden within the complex particularities of daily work.This article applies and develops Sarah Banks’ conceptualisation of “ethics work” toexamine how care managers in Sweden are “doing ethics”, while seeking and providingcollegial support and guidance on how to deal with the wishes of adult (potential) serviceusers who are reluctant to accept support – or whose wishes in the matter are difficult todetermine. The study is based on an analysis of 14 audio-recorded case conferences. With the help of Banks’ conceptualisation, the analysis makes visible how the case discussions inquestion encompass a complex “doing of ethics”, by means of which the welfare ofindividuals is balanced against care managers’ legal duty to adhere, without exception, tothe principle of self-determination. The findings suggest that further research that appliesand develops Banks’ conceptualisation of ethics work by examining “actual” social workpractice in situ, while recognising the particularities of the social and societal context inwhich this work is taking place, could provide new knowledge and understanding aboutboth the specific and common challenges that social workers face in different parts of the world. It could also make the ethical dimensions of social work practice more widely recognised and valued.

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.