The increasing size of the elderly population has been described as a major challenge for Western eldercare.In light of such demographic changes, welfare technology has been presented as a solution.It has been claimed, in both international and Swedish government policy, that digital technologies can improve how care is given and received.However, there is limited knowledge about what happens to articulations of care when national goals filter down to municipal local level where the actual care is practised.The aim of this article is to analyse how care and welfare technology are described in municipal strategy documents, and to discuss potential consequences of such articulations for everyday eldercare.A critical policy analysis, building on theories about articulation, was conducted on a selection of 19 policy documents (N = 19) from 18 municipalities.The key analytical results show that care tends to be articulated as an organizational matter and that care is transferred into the future of older people's lives, through self-care and prevention.Interdependence, frailty and alternatives when welfare technology fails to create independence, are not brought up in the documents.Overall, such rearticulations of care indicate a more disembodied eldercare in the future.

Older adults’ perspective on the effects of welfare technology in eldercare: individual expectations on independence, social meetings and loneliness Welfare technology (WT) has been identified as a potential solution for challenges within eldercare, with policymakers emphasising its capacity to reduce reliance on care staff. Policy discussions surrounding WT also highlight other anticipated benefits, such as mitigating loneliness, facilitating increased social interaction between caregivers and care recipients, and promoting greater independence for the latter. These expectations are permeated by a techno-optimism. Needing care means being vulnerable, and care builds on relationship and interdependence. How older adults think about WT and its consequences for social aspects of care is important for a successful implementation. The individual perspective is relatively unknown. This study aims to investigate how potential users perceive WT and its consequences for feelings of loneliness, opportunities for social interaction in care settings, and levels of independence. To accomplish this, a questionnaire was administered to approximately 5000 individuals between the ages of 65 and 90 residing in Västerbotten. The findings suggest that the techno-optimism visible at the national level is not widely shared by older adults. A majority expressed skepticism regarding the potential of WT to positively influence social aspects of care, and most of the respondents believe that WT will contribute to increased feelings of loneliness. Furthermore, a majority did not perceive a need for various technologies in eldercare and expressed a preference for care provided by human caregivers rather than technology-based alternatives. These attitudes where not effected by age. The group of 65-year-olds that have grown up with technology and are more digital were as skeptical towards WT as the older age groups. We interpret these results to indicate that the inherent relational nature of care can make it unsuitable for direct replacement with technology. An increased expected frailty and vulnerability that follows from needing to receive care may mean that technology is an inappropriate solution.

Summary An interview study was conducted with persons receiving home care services and personal assistance in Sweden (13 individuals, 25 interviews) with the aim to analyze their experiences of managing personal and intimate care. The analytical approach was guided by phenomenologically informed research and Erving Goffman's theoretical work on self-presentation and social life as it differs in frontstage and backstage settings. Findings A reflected approach to the complex challenges associated with becoming and being a person in need of personal and intimate care was revealed. This involved continuous adaptations and attuning to organizational and relational conditions of formal home care. Being a recipient of personal and intimate care does not mean being passive. It entails relating to and sustaining the care relation, where even choosing to accept suboptimal conditions is an act of agency. The recipients’ private homes were hybridized, transformed both into a waiting room, with the recipient on standby and into a workplace. The homes thus partly lost their character as a backstage realm where one could avoid the gaze of others. This also led to a hybridization of the personal sphere, in the form of marginal scope for true privacy, necessitating strategies for protecting one's own space. Applications It is important both to acknowledge the intrusive nature of personal and intimate care, which results in extensive hybridization of the home and personal sphere and to recognize care recipients’ agency in the relationship that care establishes.

Sweden, as a welfare state, has a long tradition of providing formal home care and support to their citizens in their own homes, either through home care services or personal assistance. A large percentage of frail elderly and persons with disability who receive formal home care require personal and intimate care, such as help with eating, showering, getting dressed and personal hygiene. Managing intimacy and safeguarding the care recipient’s integrity pose particular challenges for staff. The aim of this qualitative interview study is to describe and analyse care workers’ (CWs) and personal assistants’ (PAs) strategies for managing situations and challenges related to provision of personal and intimate care in the context of formal home care. Semi-structured interviews with eleven CWs and nine PAs were conducted. Our analysis reveals a complex repertoire of relational and communicative strategies, within an overall approach—which we labelled ‘empathetic attuning’—of relating to the current situation and task at hand whilst safeguarding integrity. These strategies were intertwined with dimensions of time. The possibility to accomplish satisfactory personal and intimate care rests on structural and organisational conditions that promote sustainable working conditions, where relations characterised by continuity, integrity and respect can be realised.

Sweden has a long tradition of providing social care and support to its citizens in their own homes through formal home care, delivered either by home care services or personal assistance. A majority of people given support by formal home care need assistance with personal and intimate care. The focus of this interview study was on exploring care recipients', care workers', personal assistants' and care unit managers' perceptions and experiences of intimate and personal care in the context of formal home care in Sweden. In total, 57 interviews were conducted with 42 persons. Three themes emerged in the analysis: Personal Hygiene, Personal Sphere, and The Contextual Variability of Intimacy. Interviewees described intimate care as being inseparable from a person's service needs as a whole. Highlighted was how caring for and washing intimate body parts, intrusion into recipients' personal spheres, and the need to preserve integrity vary depending on situational, temporal and relational aspects. To safeguard the care recipient's influence, integrity and dignity in the reception/provision of care work, home care services and personal assistance, it is important to raise awareness of the variation in perceptions of intimate and personal care in education and inhouse training.

This article aims at exploring how community home care of older people is provided and organized at night. In times of welfare decline, organizational changes, and an increasing aged population, questions arise about home care and support for older people. In Sweden, as in many other Western countries, "ageing in place" is a guiding principle in care provision for older people, which put increasing pressure on home care services. Still, nighttime care represents a research gap within health and social care research, nationally and internationally. This telephone interview survey examines 41 operations managers' perceptions of organization and care provision and how they account for the goals and work of home care at nighttime in a selection of 37 Swedish municipalities. The analysis was inspired by thematic content analysis where three central themes were categorized: organizational context of nighttime care, working conditions, and challenges of nighttime care. Our results reveal that organizational context varied depending on the demography and size of the municipality. The work situation was characterized by constantly unforeseen events to manage. Multiple challenges were identified on societal and political levels, as were limited resources and recruitment problems. In conclusion, our analysis has identified unpredictability as a core feature of nighttime care work. The complexity of the provision of nighttime care was not recognized as important for the municipal organization. To provide high-quality care at night in ordinary housing, there is a need both to focus on organizational aspects and to have sufficient resources and time.

This article aims to explore and analyse how good and dignified care is perceived and expressed at night-time within elder home care services, in which night-time care represents a knowledge gap. Dignity has become a legislated value in Swedish eldercare, aiming to increase the quality of care and to clarify the ethical values of everyday care practice. The data presented here come from a qualitative case study with in-depth interviews with six care unit managers and 14 care workers in four municipalities. The analysis of the interviewees' perceptions and expressions of good care were informed by Nodding's concepts: responsiveness, receptivity, and relatedness. The results showed that there was a relative unawareness of the new goals of the dignity policy and there was no specific guidance regarding dignity during night-time care. The care unit managers' perspective was mainly administrative and related to the policy level and the staff's ability to care. The care workers' view of good and dignified care included aspects of ideal characteristics and user-centredness with a focus on older people's individual needs. However, good care was conditioned by time. The dignity policy, as described in national documents, was perceived by the interviewees as vague and with unreachable goals constructed on the structural level. In social care practice, however, expressions of good and dignified care were already found in care ethics, regardless of the dignity policy. By bringing relationality to the dignity discourse on the structural policy level, recognition of care may be emphasized.

Bakgrund: Socionomer är en viktig profession i samhällets sociala skyddsnät och verksamma i många möten med sårbara grupper i kris. Den pågående globala coronapandemin är en stor kris som drabbat världen och speciellt äldre personer har drabbats hårt av pandemins konsekvenser. Syfte: Studiens syfte var att undersöka och beskriva biståndshandläggares/socionomers erfarenheter av krishantering och möten med äldre personer under covid-19-pandemin. Metod: En kvalitativ design med individuella semistrukturerade intervjuer genomfördes. Deltagarna rekryterades med ett ändamålsenligt urval och åtta biståndshandläggare intervjuades i en kommun i norra Sverige. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Tre kategorier identifierades: erfarenhet av egen krishantering, nya perspektiv i arbetet, erfarenhet av kommunens krishantering och samhällsansvar. Slutsats: Ett nytt arbetssätt har identifierats som innebär arbete på distans i hemmet. Äldre personers delaktighet i sin egen omsorg har minskat och försvårats under pandemin samt ensamhet, isolering, psykisk ohälsa och egenvald vanvård har ökat. Tjänsteutbudet har förändrats som en följd av distansarbete och pandemin och utbildningsbehov i krishantering har identifierats.

The aim of the article is to analyse and problematize care managers' argumentation of individual needs when assessing migrant customers within Swedish public elderly home care services. According to legislation, need for assistance should always be assessed individually. In recent decades of service decline, standardization of needs has been part of the distribution of elderly care services. Simultaneously, the stratum of older people has become more diverse, which means that a wider spectrum of needs is presented to the care managers. Ten interviews with care managers were analysed with a focus on their arguments regarding the care needs of elderly people with migrant backgrounds seeking assistance. The theoretical conceptions of the two perspectives of care and services were used to analyse the understanding of care managers' arguments. Our analysis shows that the service perspective with assistance and support that are standardized for Swedes is poorly suited to people born outside Sweden and socialized into other expectations of family and society. The meaning of individual needs was imprecise and contradictory when confronted with diverse cultural codes. When general standards were used in the arguments by referring to regulations and local guidelines, immigrants' individual needs were not prioritized. Our analysis suggests that the tension between national standards, local guidelines and individual needs has to be discussed further, where theoretical tools related to care and services may be useful in guiding care managers' professional arguments of individual needs and cultural sensitivity in the needs assessment.

The aim of this article is to broaden the understanding of how Swedish disability policies are constructed to meet the objectives of the ratified UN Convention on the Rights of Persons with Disabilities (CRPD) regarding active citizenship and full participation on an equal basis with others. The study examines two policy domains: health and employment. Recently issued legal documents are analyzed using the approach of directed content analysis and the theories of ‘social risk’ and ‘governance’. The results suggest that the policy area of employment implicitly and explicitly overshadows the policy area of health and related rights accounted for in the CRPD. A more nuanced perspective in disability policies concerning employment in relation to active citizenry and full participation is required, accompanied by social policy schemes that encompass the perspective of the CRPD as a whole in all support-to- work services, instead of the limited focus of finding full-time employment

Welfare technologies have within the last few years become a new mantra for reforming the Nordic public health and social care, and are increasingly making their impact on working life of care professionals.Welfare technologies – a term exclusively used in a Nordic context – is a broad and loosely defined concept that covers a wide array of technologies such as tele-care solutions, automatic toilets, eating robots, GPS-trackers, and many others. They are envisioned as leading to a new and smarter form of retrenchment, promising better quality, empowerment of clients, and work that is smarter and more qualified (e.g., Danish government et al. 2013). Together with other reform initiatives like coproduction, rehabili- tation, and user-involvement, welfare technologies aim at enabling a change in the role of the clients/patients, stressing their resourcefulness and potentials and encouraging to self-responsibilization and self-care (Rose 1998; Triantafillou 2017).This implies a fundamental reorganization of care work, a transformation of what care and care work is about, and consequently of meaning and identity in work (see, e.g., Barnes & Cotterell 2012; Järvinen 2012; Kirkegaard & Andersen 2018; Meldgaard Hansen & Kamp 2018). More concretely, we may expect changes in work tasks, social relations and forms of cooperation between occupational groups, and new relations to clients/patients and their relatives. This may not only imply new challenges and strains in work but may also present new possibilities for employees to engage creatively in shaping work in ways that makes care work more meaningful and sustainable. (...)

Mental illness in various shapes and forms is the new national disease. It’s increasing among young adults and is more commonly occurring among university students than the rest of the population. Studies show a correlation between mental illness and lesser study results and the interruption of studies. Studiehalsan are overburdened and it can take a while before you get help; a preventive intervention is needed to combat the strains of studying. The aim of this study was to investigate the impact of the creative process in theatre in relation to students’ mental health and studies to see if theatre can be used in social work as a preventive intervention of mental illness. The method chosen for this study was qualitative interviews with five young adult students (18-29 years old) studying at university and participating in theatre in their spare time. In analysing the results, I applied two theories: KASAM – Sense of Coherence as well as the Six criteria of psychological well-being which help to understand well-being. These illustrate the complexity of the relation between the creative process and the students’ mental health and ability to study. This study found that students’ participation in the creative process of theatre had positive effects on their mental health and studying abilites. This study has attempted to highlight the importance of using art, specifically theatre, as a preventation in social work. (Less)

Sweden, like other Western countries, has a disability legislation that coexists with the Active Labour Market Policies. ALMP address a discourse emphasizing the importance of the able and productive 'citizen-worker', who is expected to craft his/her own success through meaningful personal goals and ambitions. This discourse also impacts disability groups who are actualized for support-to-work interventions, such as people with high-functioning autism (HFA). The objective of this paper is to analyse how narratives targeting ambitions and self-realisation in work life are expressed by individuals with HFA in relation to the citizen-worker discourse. This ethnographic study comprises 26 qualitative interview narratives by 11 participants with HFA. Findings indicate that the participants have developed a strong citizen-worker identity. The will is an essential point of gravity, expressed through notions of individual meaningfulness and ambitions of being perceived as resources in any vocational context. Barriers to these ambitions are experienced as personally counteractive support-to-work practices. These results suggest that disability legislation and policies are caught in a mantra of stagnating normalisation, resulting in disability-worker interventions that are incompatible with meanings emphasized in the citizen-worker discourse, which is the new 'normal' of today. (C) 2019 Association ALTER. Published by Elsevier Masson SAS. All rights reserved.

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This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV’s narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

This article examines the assumptions regarding how Swedish state supervision (SSV) of eldercare is to achieve its intended effects. It explores how SSV is intended to work to ensure and improve eldercare quality, and theoretically and empirically assesses the validity of its guiding assumptions with programme theory methodology. The theoretical assessment suggests that most intended effects are partly achieved, though the quality-enhancing assumption finds little support in caring research. The assumption that the supervised parties will improve their compliance with laws and regulations has some validity, but this compliance is temporary and confined to the aspects of eldercare being supervised. Twenty-four interviews with the chairs of Social Welfare Committees and care unit managers provide empirical support for all but two intended effects. SSV has not increased 'awareness of national regulative demands in eldercare' or contributed to 'general quality improvement in eldercare'. Four unintended effects of SSV were also recognised in the interviews-for example, unsupervised caring activities were less prioritised. The authors conclude that, although SSV does little to improve eldercare quality, it is needed for transparency and accountability as well as to hold local governments and public and private service providers to account for compliance with national statutes.

The provision of intimate and personal care constitutes a challenge for both careworkers and care recipients and is still a neglected area of research. An observational study of the interaction between the careworkers and care recipients in night-time home care services was conducted in a large municipality in Sweden. The results were analysed in light of previous research and theorising on strategies for handling intimacy in intimate care. The study highlights what appears to be a tension between the ways in which the recipient of care is conceptualised as an active consumer of care in present-day guidelines and the strategies chosen on the part of both caregivers and care recipients, when intimacy and integrity is most at stake, and framed as it is by the care recipients' situation of dependency and vulnerability. Home care services night-time was shown to be a case that markedly differs from many other settings of intimate care, but in the interactional routines intimate care came forth as a smooth and minimally obtrusive activity. The careworkers and care recipients engaged in strategies such as disattention, eye-discipline, middle-distance orientation, and objectification, thereby serving the purpose of balancing the transgressions of thresholds of intimacy.

Äldreomsorgen har på senare år genomgått stora förändringar i riktning mot olika former av marknadslösningar. Kundvalssystemet är en sådan, som idealt sett antas öka både brukarinflytandet och kvaliteten i hemtjänsten. Artikeln utgår framförallt från äldre med hemtjänstinsatser och personalens erfarenheter av omsorg och arbete i en kommun som infört kundval.