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User participation policies in Norway and England – the case of older people and social care
- Authors:
- CHRISTENSEN Karen, PILLING Doria
- Journal article citation:
- Journal of Social Policy, 48(1), 2019, pp.43-61.
- Publisher:
- Cambridge University Press
- Place of publication:
- Cambridge
User participation has become one of the most important concepts in the social care sector in many European countries, but the literature has mostly paid attention to disabled people or those with mental health problems. This article compares the user participation policies directed at social care for older people in Norway and England. Using a discourse analytical approach, a selection primarily of White papers from the 1960s until today are analysed. The analysis draws on the literature's discourse discussion, including a democratic/rights based discourse (full citizenship), a consumer discourse (consumers’ rights to choose welfare services), a co-production discourse (users and state/local authorities partnerships), and nuances of these discourses. The analysis shows that, while both countries start with variations of a democratic discourse, Norway develops a temporary and weak consumer discourse in a middle phase, then moves to co-production in current times. England, on the other hand, develops a comprehensive consumer discourse but also a surprisingly strong co-production discourse – the idea of a ‘Big Society’ – in early and current times. (Edited publisher abstract)
Tailoring reablement: a grounded theory study of establishing reablement in a community setting in Norway
- Authors:
- MOE Cathrine, BRINCHMANN Berit Store
- Journal article citation:
- Health and Social Care in the Community, 26(1), 2018, pp.113-121.
- Publisher:
- Wiley
Reablement is an interprofessional, home-based rehabilitation service that aims to enable senior residents to cope with everyday life and to prevent functional impairments. Systematic accounts of what practitioners actually do when establishing reablement are lacking. This study aims to generate a grounded theory of practitioners’ patterns of action when establishing reablement. The study is located in Norway, and grounded theory is the methodological approach. Data were collected from January 2014 to August 2016 through participant observations, focus group interviews and individual interviews. Informants are municipal healthcare employees in different organisational areas associated with the process of establishing reablement services (managers of conventional home care and representatives from the administration and service-provider offices). Altogether, 17 individuals are interviewed. The empirical data are analysed several times using open, selective and theoretical coding. The grounded theory, “tailoring reablement,” includes three phases—replicating, adapting and establishing—and the strategies of collaborating, developing knowledge, habituating and filtering. The theory of tailoring reablement also includes the impact of the contextual factors. The study seeks to bridge the gap between research and practice. The theory of tailoring reablement emerges from an inductive approach and theorises participants’ actions. The theory focuses on the phases from innovation to implementation. Establishing a new service model in a complex welfare setting requires a wide range of actors and agencies. Tailoring reablement also requires flexibility and professional autonomy. It is important to create terms and conditions for this within a stringent health and care service. The insights of this study have implications for practice development of reablement and can fit other public sector fields. (Publisher abstract)
Imagining transitions in old age through the visual matrix method: thinking about what is hard to bear
- Author:
- LIVENG Anne
- Journal article citation:
- Journal of Social Work Practice, 31(2), 2017, pp.155-170.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Dominant discourses of ageing are often confined to what is less painful to think about and therefore idealise or denigrate ageing and later life. The authors present findings from an exploratory psychosocial study, in a Nordic context, into three later-life transitions: from working life to retirement, from mental health to dementia and from life to death. Because, for some, these topics are hard to bear and therefore defended against and routinely excluded from everyday awareness, the authors used a method led by imagery and affect – the visual matrix – to elicit participants’ free associative personal and collective imagination. Through analysis of data extracts, on the three transitions, we illustrate oscillations between defending against the challenges of ageing and realism in facing the anxieties it can provoke. A recurring theme includes the finality of individual life and the inter-generational continuity, which together link life and death, hope and despair, separation and connectedness (Edited publisher abstract)
Responsibility for child and elderly care: who should cover the costs? A comparison of Baltic and Nordic countries
- Authors:
- GARCIA-FAROLDI Livia, DE MIGUEL-LUKEN Veronica, AYUSO Luis
- Journal article citation:
- Social Policy and Administration, 51(4), 2017, pp.638-658.
- Publisher:
- Wiley
Using data from the International Social Survey Programme (2012), this study compares public attitudes towards who should cover the costs of caring for children and older people in five Nordic countries (Finland, Sweden, Norway, Iceland and Denmark) and two Baltic ones (Latvia and Lithuania). The study found interesting differences between both groups of nations: citizens from Baltic countries consider the role of the family more important than their counterparts in Nordic countries. Results show Latvians holding the most familistic views in terms of covering costs, and Swedish people the least. Individual socio-demographic variables are less important than national contexts in explaining these attitudes. The article finds important variations among the social-democratic countries and, surprisingly, in the case of childcare, Sweden shows higher differences to Denmark than to Latvia and Lithuania. This finding suggests that the social-democratic bloc in this respect is more heterogeneous than what is generally thought. (Edited publisher abstract)
Burden of care, social support, and sense of coherence in elderly caregivers living with individuals with symptoms of dementia
- Authors:
- STENSLETTEN Kari, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(6), 2016, pp.1422-1435.
- Publisher:
- Sage
Family members are often the care providers of individuals with dementia, and it is assumed that the need for this will increase. There has been little research into the association between the burden of care and the caregiver’s sense of coherence or receipt of social support. This study examined the relationship between the social support subdimensions and sense of coherence and the burden of care among older people giving care to a partner with dementia. The study was a cross-sectional observation study of 97 individuals, ≥65 years old and living with a partner who had symptoms of dementia. The authors used the Informant Questionnaire on Cognitive Decline in the Elderly, the Relative Stress Scale, the Social Provisions Scale, the Sense of Coherence Scale, and a questionnaire on sociodemographic variables. They used multiple regression analysis in a general linear model procedure. The authors defined statistical significance as p < 0.05. With adjustments for sociodemographic variables, the association with burden of care was statistically significant for the subdimension attachment (p < 0.01) and for sense of coherence (p < 0.001). The burden of care was associated with attachment and with sense of coherence. Community nurses and other health professionals should take necessary action to strengthen attachment and sense of coherence among the caregivers of people with dementia. Qualitative studies could provide deeper understanding of the variation informal caregivers experience when living together with their partner with dementia. (Edited publisher abstract)
Anxiety among older psychiatric patients: a hidden comorbidity?
- Authors:
- BENDIXEN Anette Bakkane, ENGEDAL Knut
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.131-1138.
- Publisher:
- Taylor and Francis
Objectives: The authors' aims were to explore prevalence of anxiety among patients admitted to departments of geriatric psychiatry for treatment of various diagnoses and to examine how often anxiety was registered as a previous or ongoing diagnosis. Method: In all, 473 patients admitted to one of five departments of geriatric psychiatry were included in a quality register and examined according to a standardised protocol. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety during the first week after admission. Diagnoses were made at discharge. Results: Using a cutoff on the GAI of 8/9, the prevalence of anxiety for the following diagnostic groups was depression 65.3%, psychosis 28%, dementia 38.8% and mania 33.3%. Of 24 patients with a primary diagnosis of anxiety, 66.7% scored above 8 on the GAI. Of 236 patients with a GAI score above 8, only 22 (9.3%) were reported to have a comorbid anxiety disorder by the treating psychiatrist. In a multiple regression analysis, we found that the severity of depression (beta 0.585, p < 0.001), being female (beta 0.096, p 0.028) and the use of antipsychotic drugs (beta 0.129, p 0.006) and anxiolytic drugs (beta 0.129, p 0.005) were associated with a higher GAI score. Conclusion: Anxiety is common in geriatric psychiatric patients, regardless of the primary diagnosis. The findings suggest that anxiety is often a hidden comorbidity in various psychiatric disorders. A high score on the GAI was associated with the severity of depression, female gender and the use of antipsychotic and anxiolytic drugs. (Edited publisher abstract)
Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality
- Authors:
- DOHL Oystein, et al
- Journal article citation:
- Health and Social Care in the Community, 24(3), 2016, pp.297-308.
- Publisher:
- Wiley
This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. The study considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. The study identified a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, results also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. The analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services. (Edited publisher abstract)
Comparing nursing home assistive personnel in five countries
- Authors:
- LAXER Katherine, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.62-78.
- Publisher:
- Springer
- Place of publication:
- New York
Assistive personnel are the primary caregivers in long-term residential care (LTRC) in industrialised countries. The authors' goal is to describe and compare the work-related characteristics of assistive personnel in LTRC in five countries (Canada, Germany, Norway, U.K., and U.S), which may reflect how various societies view their responsibility to ageing populations and the workers who care for them. OECD and national statistical databases are used to assess and compare the work context for assistive personnel. Analysis of the statistical data is informed by on-site observations in nursing homes with reputations for high quality, close readings of these organisations’ documents and records, and interviews with LTRC staff. Pay is generally low and the work required of assistive personnel is often demanding in all countries studied. While most assistive personnel have completed high school, formal certification requirements vary considerably. Professionalisation is increasing in Norway with its high school major in eldercare, and in Germany, which has a 2-year certificate programme. Financial compensation for assistive personnel in Norway and Canada is greater than in the other countries. Union membership for assistive personnel ranges from very high in Canada to negligible in the U.S. Some countries studied have training programs of only a few months duration to prepare assistive personnel for highly demanding jobs. However, in Germany and Norway, training aims to professionalise the work of assistive personnel for the benefit of workers, employers, and residents. There are high rates of part-time and/or casual work among assistive personnel, associated with reduced employment-related benefits, except in Germany and Norway, where these benefits are statutory for all. Data suggest that unionisation is protective for assistive personnel, however union coverage data were not available for all countries. The need to improve the qualifications and training of assistive personnel was observed to be a national priority everywhere except in the U.S. Compensation is relatively low in the U.K., the U.S. and Germany, despite the important jobs performed by assistive personnel. Finally, to improve future research, statistical mapping of this critical component of the labour force in LTRC should be a greater priority across high-income countries. (Edited publisher abstract)
Prioritising care services: do the oldest users lose out?
- Authors:
- GAUTUN Heidi, GRODEM Anne Skevik
- Journal article citation:
- International Journal of Social Welfare, 24(1), 2015, pp.73-80.
- Publisher:
- Wiley
Population ageing is a major concern in most European countries. Demands for health- and care services will increase, as older people typically have a higher need for such services. Older users increasingly compete with younger users for the same limited care resources. By interviewing decision-makers in Norwegian municipalities, this study examines how staff in the Norwegian care sector make decisions regarding the allocation of services to younger and older users. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. The study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. (Edited publisher abstract)
Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital: a qualitative study of health professionals' experiences
- Authors:
- DAHL Unni, et al
- Journal article citation:
- International Journal of Integrated Care, 14(2), 2014, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: This is a study of an intermediate care hospital established in Central Norway to improve discharge from a general hospital to primary health care. The aim of the study was to investigate how professionals across health care levels experience the discharge of elderly patients, who are in need of continued care, from a general hospital via an intermediate care hospital compared to a direct discharge to primary health care in a municipality without intermediate care. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels. (Edited publisher abstract)