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Emergency department social work in the UK and Sweden: evaluation by older frequent emergency department attenders
- Authors:
- McLEOD Eileen, OLSSON Mariann
- Journal article citation:
- European Journal of Social Work, 9(2), June 2006, pp.139-157.
- Publisher:
- Taylor and Francis
Social work based in hospital emergency departments (EDs) in Sweden and the UK reflects a wider European social/health care policy trend. A key focus is on diverting older frequent ED attenders from ‘inappropriate’ hospital re-attendance or emergency admission, because of social care problems. However, previously there has been no evaluation of the significance of ED social work for health and well-being, from the standpoint of older frequent ED attenders themselves. In a preliminary way, our paper provides this through drawing on a small scale Swedish/UK study. Its comparative account of service user feedback underscores the importance of ED social work as a facet of European social work. It indicates that ED social work contributes to the quality of care within emergency departments, acts as a key access point to social services, and can promote both short and longer-term health. At the same time, some serious shortcomings emerge. These include under-developed referral systems, and limitations to community based services following ED social work assessment, which reflect the under-resourcing of social care provision in both countries. Moreover, service users’ experience in both Sweden and the UK reveals the risk of ED social work with older frequent ED attenders being used as a substitute for follow-up medical/nursing care when that is also required.
Creating images of old people as home care receivers: categorizations of needs in social work case files
- Author:
- OLAISON Anna
- Journal article citation:
- Qualitative Social Work, 9(4), December 2010, pp.500-518.
- Publisher:
- Sage
The process of needs assessment for older people is based on an individuals’ perspective, central to which is how their needs are constructed through documentation and case files. This paper investigates how older people’s needs are defined in home care case files. It examines how this categorisation process is evident in case file documents written by case managers. Discourse analysis was applied to 16 case files from three social work districts in Sweden, resulting in the identification of two general types of case files: the fact-oriented using objective language; and event-oriented case file using more personal language. These two types of case file were shown to depict the individuals quite differently. All case files used several need categories – though social needs were important in describing living conditions, it was medical and physical needs that impinged on home care decisions. The author concludes that the results have practical consequences for the formulation of individual home care assessment, as there is still limited space in the case files for older peoples’ own views.
Letters from Sweden: low expectations
- Author:
- LINDELOF Margareta
- Journal article citation:
- Community Care, 20.6.02, 2002, p.43.
- Publisher:
- Reed Business Information
Reports on how users' apparent satisfaction with home care services in Sundsvall, Sweden is not necessarily a reflection of the quality of those services.
Merely a rhetorical promise? Older users' opportunities for choice and control in Swedish individualised home care services
- Authors:
- DUNER Anna, BJALKEBRING Par, JOHANSSON Boo
- Journal article citation:
- Ageing and Society, 39(4), 2019, pp.771-794.
- Publisher:
- Cambridge University Press
A policy shift has taken place in Sweden towards individualised elder-care and consumer choice. The aim of the study is to investigate how older users of home care services view and experience their opportunities of exerting influence and having choice and control in their everyday living, in terms of receiving preferred services that are flexible and responsive to their actual needs and priorities. The study was conducted in three local elder-care authorities, reflecting diverse present models of organising home care services in Sweden. Data consisted of responses to a postal survey (N = 2,792) and reports from qualitative interviews (N = 28) with older users. Our findings point to similarities rather than differences between the views and experiences of the users in the three participating local municipal elder-care authorities. A majority of users were positive about their home care services. The experiences ranged from being active and enabled to choose between providers and services, to being more or less passive dependants having to rely on the decisions of family and staff. The importance of supportive relationships, and interdependence between older people and their formal as well as informal support networks, became clear. Our findings may guide policy makers in refining home care services, irrespective of preferred model. In particular, efforts to facilitate staff continuity and prevent high staff turnover need to be prioritised. (Edited publisher abstract)
Being disconnected from life: meanings of existential loneliness as narrated by frail older people
- Authors:
- SJOBERG Marina, et al
- Journal article citation:
- Aging and Mental Health, 22(10), 2018, pp.1357-1364.
- Publisher:
- Taylor and Francis
Objectives: This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people. Method: Data were collected through individual narrative interviews with 23 people 76–101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL. Result: Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning. These intertwined themes were synthesized into a comprehensive understanding of EL as ‘being disconnected from life’. Conclusion: Illness and physical limitation affects access to the world. When being met with indifference and being unable to share one's thoughts and experiences of life with others, a sense of worthlessness is reinforced, triggering an experience of meaninglessness and EL, i.e. disconnection from life. It is urgent to develop support strategies that can be used by health care professionals to address older people in vulnerable situations, thereby facilitating connectedness. (Publisher abstract)
How older people perceive and experience sense of security when moving into and living in a nursing home: a case study
- Authors:
- BOSTROM Martina, et al
- Journal article citation:
- European Journal of Social Work, 20(5), 2017, pp.697-710.
- Publisher:
- Taylor and Francis
Sense of security is important throughout the lifespan not at least in advanced age with increased risks of functional declines and decreased social capital. Despite this, knowledge concerning older person’s perceptions and experiences of sense of security when moving into nursing homes is scarce. This study is a longitudinal, descriptive, exploratory case study with in-depth interviews and observations of three older persons in the age of 87, 88, and 91 years in a mid-sized municipality in the south of Sweden, in order to highlight how sense of security is experienced when moving into and living in a nursing home. Data were analysed using qualitative content analysis, which resulted in one main theme and four categories. The main theme, ‘Adaptation and sense of security’, indicates older persons’ need to adapt to the new context of the nursing home, and how this relates to their sense of security. The categories – ‘Control’, ‘Struggling for understanding’, ‘Lack of influence’, and ‘Grasping’ – suggest that older persons’ sense of security is reduced when they must adjust to routines without sufficient management and understanding. When able to maintain control over daily routines, and felt as a part of the new context, they perceived a sense of security. (Publisher abstract)
Structure and process quality as predictors of satisfaction with elderly care
- Authors:
- KAJONIUS Petri J., KAZEMI Ali
- Journal article citation:
- Health and Social Care in the Community, 24(6), 2016, p.699–707.
- Publisher:
- Wiley
The structure versus process approach to quality of care presented by Donabedian is one of the most cited ever. However, there has been a paucity of research into the empirical validity of this framework, specifically concerning the relative effects of structure and process on satisfaction with elderly care as perceived by the older persons themselves. The current research presents findings from a national survey, including a wide range of quality indicators for elderly care services, conducted in 2012 at the request of the Swedish National Board of Health and Welfare in which responses from 95,000 elderly people living in 324 municipalities and districts were obtained. The results revealed that the only structural variable which significantly predicted quality of care was staffing, measured in terms of the number of caregivers per older resident. More interestingly, process variables (e.g. respect and access to information) explained 40% and 48% of the variance in satisfaction with care, over and above the structural variables, in home care and nursing homes respectively. The findings from this large nationwide sample examining Donabedian's model suggest that quality in elderly care is primarily determined by factors pertaining to process, that is, how caregivers behave towards the older persons. This encourages a continued quality improvement in elderly care with a particular focus on process variables. (Publisher abstract)
User choice in Swedish eldercare – conditions for informed choice and enhanced service quality
- Authors:
- MOBERG Linda, BLOMQVIST Paula, WINBLAD Ulrika
- Journal article citation:
- Journal of European Social Policy, 26(3), 2016, pp.281-295.
- Publisher:
- Sage
Proponents of user choice argue that this type of policy arrangement improves the quality of public social services since users are expected to select the most highly performing providers. In order for users to make informed choices, however, they need quality information about the services offered by different providers. In this article, we carry out a case study, investigating whether information about service quality was presented to users of home-based elderly care in Sweden. The analysis is based on unique data regarding the information of 223 providers in 10 municipalities. The results suggest that the information was poor and lacking in important quality dimensions. This indicates a lack of real user power since it is virtually impossible for users to make informed choices without relevant information. It also makes it less likely that the general quality level of home-based services will increase as a result of the user choice. (Publisher abstract)
Framing of intimate care in home care services
- Authors:
- KALMAN Hildur, ANDERSSON Katarina
- Journal article citation:
- European Journal of Social Work, 17(3), 2014, pp.402-414.
- Publisher:
- Taylor and Francis
Provision of intimate care is a challenge for the care worker, as well as for the recipient of care, in terms both of how this care is to be performed and of how to manage feelings such as anxiety and embarrassment. In home care services, most intimate care work is performed by non-professionals who have received little or no formal or in-house training, and who are at risk of being left to devise their own methods or coping strategies. This article reports on a participant observation study of intimate care in home care services in Sweden. The strategies used to handle intimacy in care work displayed similarities, as well as dissimilarities, to those of professional framing identified in earlier studies of medical and nursing practice. There are similarities in terms of how framing was accomplished in a balance between a distanced matter-of-fact stance and one of personal acknowledgement created in interplay between care workers and care recipient. There are dissimilarities in terms of the challenges presented by the home care setting. As the relationship between care worker and care recipient in intimate care is a particularly precarious one, lack of guidance and formal training may hamper care and lead to neglect. (Publisher abstract)
Developing quality in personal social services: concepts, cases and comments
- Editors:
- EVERS Adalbert, et al
- Publisher:
- Ashgate
- Publication year:
- 1997
- Pagination:
- 318p.,bibliog.
- Place of publication:
- Aldershot
Looks at the challenge of introducing business originated concepts of quality assurance into personal social services. Includes papers on: quality development as part of a changing culture of care in personal social services; business and professional approaches to quality improvement; quality management in Finland; the developing role of user involvement in the UK; professionals and quality initiatives in health and social services; measuring quality in personal social services; combining user interests with professionalism in the organisation; quality management and assurance in residential and nursing home care in Britain and Germany; user centred performance indicators in community care in Scotland; developing domiciliary care markets in Britain; management in public care services; user involvement influencing quality in Denmark; quality in home care and nursing; national and local quality strategies in Finland; and quality measurements and some unintended consequences.