Abstract
Since the 1980s, research on care has stressed that the organisational conditions of work are crucial for workers’ and care receivers’ experiences of care quality. Working conditions in eldercare have been challenged by New Public Management (NPM) reforms, which emphasise standardised managerial control functions. Based on interviews conducted in two Swedish residential care homes we analyse how auditing, person-centred care and competence are implemented in everyday work. The dimensions studied are described with ambivalence: Both positive and negative aspects are linked to three dimensions of work. But, to foster a practice where logic of caring get more space in relation to the rationality of marketisation, there is need for organisational changes that promotes development where the aim of documentation is transparent in everyday work. Further, to achieve person-centred care, workers require conditions enabling them to respond to the person’s needs and not only what is written in care plans. The results show tensions between formal education and experience-based skills that contributed to make the relational and emotional aspects of care invisible and unrecognised. These struggles highlight tensions between two organisational logics—rationality of caring and marketisation—where one, rationality of caring, is devalued by the organisation but not in the everyday work.
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Notes
- 1.
Individualized care (IC) and person-centred care (PCC) are used synonymously in the chapter (see, e.g., Brownie & Nancarrow, 2013).
References
Abel, E., & Nelson, M. (1990). Circles of care: Work and identity in women’s lives. State University Press.
Ahnlund, P., & Johansson, S. (2016). Omvårdnadsutbildning som mål eller medel? Om legitimitetsproblem och kunskapssyn. [Care education as a goal or as a strategy? Legitimacy problems and perceptions of knowledge]. Socialvetenskaplig tidskrift, 13(3), 212–227.
Anttonen, A., & Meagher, G. (2013). Mapping marketisation: Concepts and goals. In M. Szebehely & G. Meagher (Eds.), Marketisation in Nordic eldercare. A research report on legislation, oversight, extent and consequences (pp. 203–217). Department of Social Work, Stockholm University.
Anttonen, A., & Sipilä, J. (1996). European social care services: Is it possible to identify models? Journal of European Social Policy, 6(2), 87–100.
Armstrong, P., Armstrong, H., & Scott-Dixon, K. (2008). Critical to care. The invisible women in health services. University of Toronto Press.
Baines, D. (2015). Neoliberalism and the convergence of nonprofit care work in Canada. Competition & Changes, 19(3), 194–209.
Baines, D., & Cunningham, I. (2013). Using comparative perspective rapid ethnography in international case studies: Strengths and challenges. Qualitative Social Work, 12(1), 73–88.
Banerjee, A. (2013). The regulatory trap: Reflections on the vicious cycle of regulation in Canadian residential care. In M. Szebehely & G. Meagher (Eds.), Marketisation in Nordic eldercare. A research report on legislation, oversight, extent and consequences (pp. 203–217). Department of Social Work, Stockholm University.
Banerjee, A., & Armstrong, P. (2016). Centering care: Explaining regulatory tensions in residential care for older people. Studies in Political Economy, 95(1), 7–28.
Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging, 8(1), 1–10.
Dahl, H. M. (2010). An old map of state feminism and an insufficient recognition of care. NORA—Nordic Journal of Feminist and Gender Research, 18(3), 152–166.
Daly, M., & Lewis, J. (2000). The concept of social care and the analysis of contemporary welfare states. British Journal of Sociology, 51(2), 291–298.
Daly, T., Struthers, J., Müller, B., Taylor, D., Goldmann, M., Doupe, M., & Jacobsen, F. (2016). Prescriptive or interpretive regulations at the frontlines of care work in the “three worlds” of Canada, Germany and Norway. Labour, 77, 37–71.
Daly, T., & Szebehely, M. (2012). Unheard voices, unmapped terrain: Care work in long term residential care for older people in Canada and Sweden. International Journal of Social Welfare, 26(4), 139–148.
Deusdad, B. A., Pace, C., & Anttonen, A. (2016). Facing the challenges in the development of long-term care for older people in Europe in the context of an economic crisis. Journal of Social Service Research, 42(2), 144–150.
Dewing, J. (2004). Concerns relating to the application of frameworks to promote person-centredness in nursing with older people. International Journal of Older People Nursing, 13(3), 39–44.
Edvardsson, D., Sandman, P. O., & Borell, L. (2014). Implementing national guidelines for person-centered care of people with dementia in residential aged care: Effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26(7), 1171–1179.
Eliasson, R. (Ed.). (1992). Egenheter och allmänheter. En antologi om omsorgens villkor [The specific and the general. An anthology on care and the conditions for care]. Arkiv Förlag.
Eliasson-Lappalainen, R., & Motevasel, I. (1997). Ethics of care and social policy. Scandinavian Journal of Social Welfare, 6(3), 189–196.
Elwér, S. (2013). Gender equality and health experiences: Workplace patterns in Northern Sweden. Dissertation, Umeå University.
Erlandsson, S., Storm, P., Stranz, A., Szebehely, M., & Trydegård, G.-B. (2013). Marketising trends in Swedish eldercare: Competition, choice and calls for stricter regulation. In G. Meagher & M. Szebehely (Eds.), Marketisation in Nordic eldercare: A research report on legislation, oversight, extent and consequences (pp. 23–84). Department of Social Work, Stockholm University.
Fejes, A. (2012). Knowledge at play. Positioning care workers as professionals through scientific rationality and caring dispositions. In A. Kamp & H. Hvid (Eds.), Elder care in transition. Management, meaning and identity. A Scandinavian perspective (pp. 83–105). Copenhagen Business School Press.
Fisher, B., & Tronto, J. (1990). Toward a feminist theory of caring. In S. Abel & M. Nelson (Eds.), Circles of care: Work and identity in women’s lives (pp. 36–54). State University Press.
Fläckman, B., Hansebo, G., & Kihlström, A. (2009). Struggling to adapt: Caring for older persons while under threat of organizational change and termination notice. Nursing Inquiry, 16(1), 82–91.
Government Bill. (2017:21). Läs mig! Nationell kvalitetsplan för vård och omsorg om äldre personer [Read me! National quality-plan on health and care for older people]. Fritzes.
Government Bill. (2019:20). Stärkt kompetens i vård och omsorg [Improved competence in health- and care work]. Fritzes.
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.
James, N. (1992). Care = organisation + physical labour + emotional labour. Sociology of Health & Illness, 14(4), 488–509.
Keisu, B-I. (2017). Dignity: A prerequisite for attractive work in elderly care. Society, Health and Vulnerability, 8(1). Open Access. https://doi.org/10.1080/20021518.2017.1322455.
Koren, M. J. (2010). Person-centered care for nursing home residents: The culture change movement. Health Affairs, 29(2), 312–317.
Larsson, K. (2004). According to need? Predicting us of formal and informal care in a Swedish urban elderly population. Dissertation, Stockholm University.
Lundgren, E. (2000). Homelike housing for elderly people – Materialized ideology. Housing, Theory and Society, 17(3), 109–120.
McCormack, B., Borg, M., Cardiff, S., Dewing, J., Jacobs, G., Janes, N., Karlsson, B., McCance, T., Mekki, T. E., Porock, D., van Lieshout, F., & Wilson, V. (2015). Person-centredness – the ‘state’ of the art. International Practice Development Journal, 5(Suppl 1), 1–15.
McDonald, C. L., & Merrill, D. A. (2002). “It shouldn’t have to be a trade”: Recognition and redistribution in care work advocacy. Hypatia, 17(2), 67–83.
Meinow, B., Parker, M. G., & Thorslund, M. (2011). Consumers of eldercare in Sweden: The semblance of choice. Social Science & Medicine, 73(9), 1285–1289.
Moberg, L. (2017). Marketization in Swedish eldercare: Implications for users, professionals, and the state. Dissertation, Uppsala University.
NBHW. (2019). Öppna jämförelser – Äldreomsorg [Open Comparisons: Elder care]. National Board of Health and Welfare.
NBHW. (2020). Vård och omsorg om äldre. En lägesrapport [Nursing and caring for older people. An actual review]. National Board of Health and Welfare.
Rostgaard, T. (2011). Care as you like it: The construction of a consumer approach in home care in Denmark. Nordic Journal of Social Research, 2. Open Access. https://doi.org/10.7577/njsr.2042.
Schön, P., Lagergren, M., & Kåreholt, I. (2016). Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: Results from a population-based study. Health & Social Care in the Community, 24(5), 631–638.
Sevenhuijsen, S. (1998). Citizenship and the ethics of care: Feminist considerations on justice, morality and politics. Routledge.
Social Service Act. (2001:453). From June 2001.
SOSFS. (2012:3). Socialstyrelsens föreskrifter. Värdegrund i socialtjänstens omsorg om äldre. [Regulations and general advice value grounds for Social Services care for older people]. Socialstyrelsen.
Storm, P. (2013). Care work in a Swedish nursing home. Gendered norms and expectations. In A. Hujala, S. Rissanen, & S. Vihama (Eds.), Designing wellbeing in elder care homes (pp. 148–161). Aalto University publication series, Crossover 2/2013.
Storm, P., Braedley, S., & Chivers, S. (2017). Gender regimes in Ontario nursing homes: Organizations, daily work and bodies. Canadian Journal on Aging, 36(2), 196–208.
Storm, P., & Stranz, A. (2018). Äldreboendet i marknadiseringens tid: Konkurrens, organisering och vardagsomsorg [Residential care homes for older people in the time of marketisation: Competition, organization and daily care work]. In H. Jönson & M. Szebehely (Eds.), Äldreomsorger i Sverige. Lokala variationer och generella trender (pp. 169–184). Gleerups.
Strandell, R. (2020). Care workers under pressures: A comparison of the work situation in Swedish home care. Health and Social Care in the Community, 28(1), 137–147.
Stranz, A. (2013). Omsorgsarbetets vardag och villkor i Sverige och Danmark. Ett feministiskt kritiskt perspektiv [The everyday realities and conditions of care work in Sweden and Denmark. A feminist critical perspective]. Dissertation, Stockholm University.
Stranz, A., & Sörensdotter, R. (2016). Interpretation of person-centered dementia care: Same rhetoric, different practices? A comparative study of nursing homes in England and Sweden. Journal of Aging Studies, 38, 70–80.
Stranz, A., & Szebehely, M. (2018). Organizational trends impacting on everyday realities: The care of Swedish elder care. In K. Christensen & D. Pilling (Eds.), The Routledge handbook of social care around the world (pp. 45–57). Routledge.
Szebehely, M. (2017). Residential care for older people. Are there lessons to be learned from Sweden? Journal of Canadian Studies, 50(2), 499–507.
Szebehely, M., & Meagher, G. (2018). Nordic eldercare–weak universalism becoming weaker? Journal of European Social Policy, 28(3), 294–308.
Szebehely, M., Stranz, A., & Strandell, R. (2017). Vem ska arbeta i framtidens äldreomsorg? [Who will work with care in the future?]. Working paper. Department of Social Work, Stockholm University.
Szebehely, M., & Trydegård, G.-B. (2012). Home care for older people in Sweden: A universal model in transition. Health and Social Care in the Community, 20(3), 300–309.
Tronto, J. C. (1993). Moral boundaries: A political argument for an ethic of care. Psychology Press.
Trydegård, G. B. (2012). Care work in changing welfare states: Nordic care workers’ experiences. European Journal of Ageing, 9(2), 119–129.
Tufte, P., Clausen, T., & Nabe-Nielsen, K. (2012). Client-related work tasks and meaning of work: Results from a longitudinal study among eldercare workers in Denmark. International Archives of Occupational and Environmental Health, 85(5), 467–472.
Wærness, K. (1984). The rationality of caring. Economic and Industrial Democracy, 5(2), 185–211.
Wærness, K. (2005). Social research, political theory and the ethics of care in a global perspective. In H. M. Dahl & R. Eriksen (Eds.), Dilemmas of care in the Nordic welfare state: Continuity and change (pp. 15–30). Ashgate.
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Storm, P., Stranz, A. (2021). Organising Auditing, Person-Centred Care and Competence in Swedish Residential Care Homes. In: Keisu, BI., Tafvelin, S., Brodin, H. (eds) Gendered Norms at Work. Aligning Perspectives on Health, Safety and Well-Being. Springer, Cham. https://doi.org/10.1007/978-3-030-77734-0_7
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