Det finns begränsat med forskning kring hur biståndshandläggare inom äldreomsorgen arbetar med ensamhet hos äldre personer. Med anledning av detta är studiens huvudsakliga syfte att undersöka hur biståndshandläggare i Dalarnas kommuner arbetar med att utreda sociala behov till följd av ensamhet hos äldre personer samt att ta reda på vilka kommunala sociala insatser som erbjuds för dessa individer och på vilka grunder. Studien är genomförd utifrån en kvantitativ ansats, där vi har använt oss av en enkät, som innehåller frågor som avser att besvara syftet. Tolkningsramen för analysen av det empiriska materialet utgörs av Lipskys teori om gräsrotsbyråkrati. Studiens resultat visar att det finns behov av att både utöka och utveckla kommunernas utbud av sociala insatser för äldre personer samt att utveckla rutiner för hur man ska arbeta med ensamhet hos äldre personer. Studien påvisar ett behov av mer forskning, både internationell och nationell, kring hur biståndshandläggare arbetar med att identifiera ensamhet hos äldre personer. / There is limited research on how care administrators in elderly care work with loneliness among older people. For this reason, the study's main purpose is to examine how care administrators in Dalecarlian counties are working to investigate the social needs as a result of loneliness among older people and to find out which municipal-based social interventions that are offered for these individuals and on what grounds. The study was conducted based on a quantitative approach, were we have used a questionnaire that includes questions designed to answer the study’s purpose. Interpretative framework for the analysis of the empirical material consists of Lipsky 's theory of street-level bureaucracy. The study’s results show that there is a need to both expand and develop the municipal-based social interventions for the elderly and to develop procedures on how to work with loneliness among older people. The study demonstrates a need for more research, both international and national, about how care administrators are working to identify loneliness among older people.

The aim of this study was to highlight care managers view on and experience of the working method Individual need in center (IBIC) and to analyze the consequences of the implementation. IBIC is a method for care managers to identify and adapt the intervention according to the individual’s needs. We performed six individual qualitative interviews with care managers, hence three from Kungsbacka municipality and three from Karlskrona municipality. The results from the interviews indicated that all care managers experienced that their work environment had on some level been affected by the implementation of IBIC. However, there were care managers that recounted that it wasn’t the IBIC method itself that affected their work situation. It was the work system that was used to document the IBIC investigations that was the substantial problem. The analysis showed that care manager’s experiences of IBIC did not accord with Socialstyrelsen’s goal with IBIC. The three core components of IBIC were not distinct enough, which was essential for an implementation to be successful and having positive outcomes. Moreover, care managers experienced that colleague- and manager support was a significant factor in the work environment. Even though they had support from both their colleagues and their managers, the care managers had to use different coping strategies to manage the daily workload. These factors contributed to a stronger sense of coherence (KASAM in Swedish), which is also a contributing factor for the coping process.

<p>Families of children with disabilities often have many different contacts with professional representing different principals. This places high demands on their professional work together to meet the needs of families and use resources efficiently. The method used is a literature review which aims to describe what is needed to achieve good collaboration between different professions around families with children with disabilities, and that from an organizational perspective to examine why there are often gaps in collaboration and how this affects the parents' life situation.</p><p>The theories in this study originated from organizational and sociological theories. The most central concept in this study is collaboration from an organizational perspective. The results show that the interaction is problematic, due to that collaborative organizations often have rules which are incompatible and a lack of accountability on who is liable makes impairment in the interaction. Lack of cooperation affects parents' life situation in that they always have to fight for their rights and they often feel that they face a lack of knowledge from the professional. In order to achieve a successful interaction is required, inter alia, an open mind and that the collaborative professions feel they have an equal status.</p>

Families of children with disabilities often have many different contacts with professional representing different principals. This places high demands on their professional work together to meet the needs of families and use resources efficiently. The method used is a literature review which aims to describe what is needed to achieve good collaboration between different professions around families with children with disabilities, and that from an organizational perspective to examine why there are often gaps in collaboration and how this affects the parents' life situation. The theories in this study originated from organizational and sociological theories. The most central concept in this study is collaboration from an organizational perspective. The results show that the interaction is problematic, due to that collaborative organizations often have rules which are incompatible and a lack of accountability on who is liable makes impairment in the interaction. Lack of cooperation affects parents' life situation in that they always have to fight for their rights and they often feel that they face a lack of knowledge from the professional. In order to achieve a successful interaction is required, inter alia, an open mind and that the collaborative professions feel they have an equal status.

Uppsatsen undersöker via fem intervjuer hur biståndshandläggare resonerar kring ett biståndsärende gällande hemtjänstinsatser i äldreomsorgen och hur de motiverar sina bedömningar och beslut. Intervjuerna har företagits på biståndsenheten i Östersund i Jämtlands län. En vinjett som beskriver ett påhittat biståndsärende har stått som utgångspunkt för alla intervjuer och en fenomenologisk hermeneutisk analysmetod har använts vid framtagandet och tolkandet av resultaten. Resultaten som framkommit i studien antyder att biståndshandläggarna i Östersund tenderar att se till både sociala, fysiska, medicinska och psykiska behov hos kunden vid biståndsbedömning. När det kommer till gränssättning av hemtjänstinsatsers omfattning tenderar handläggarna också att vara relativt generösa i sina bedömningar. Hur gränserna sätts verkar emellertid vara något otydligt, delvis eftersom de inte har hjälp av några fastställda riktlinjer och att begreppet skälig levnadsnivå är så pass svårdefinierat. Förslag på framtida forskning, som ges i uppsatsen, är dels att utreda om det stämmer att biståndshandläggarna i Östersund är lika bra på att se helhetsbilden vid biståndsbedömning som studiens resultat föreslår. Att mer noggrant undersöka hur socialtjänstlagens begrepp skälig levnadsnivå tolkas av biståndshandläggarna – och hur det påverkar dem i deras bedömningar – är också ett förslag till vidare forskning. / Through five interviews the essay examines how care managers reason about a case concerning home help services in elderly care and how they motivates their judgments and decisions. The interviews have been undertaken in the city of Östersund in Jämtland. A vignette describing a fictitious case has been the starting point for all interviews and a phenomenological hermeneutical analysis has been used in the producing and interpretation of the results.                       The results emerging from the study suggests that care managers in Östersund tend to look to both the social, physical, medical and psychological needs of the customer when making their decisions. When it comes to setting boundaries of home care interventions the care managers also seem to be quite generous. How to set the boundaries does however appear to be somewhat unclear, partly because they do not have the help of established guidelines and that the concept of decent standard of living (skälig levnadsnivå) is so difficult to define. One suggestion for future research that is proposed in the paper is to investigate whether it is true that care managers in Östersund are as good as it seems to see the big picture of customers needs as the study suggests. Another suggestion is to more closely examine how the concept of decent standard of living is interpreted by care managers and how it affects them when they make their judgments and decisions.

Studien ämnade söka förståelse och kunskap om biståndshandläggarnas yrkesroll inom äldreomsorgen. Utifrån detta fördjupade vi oss i de svårigheter som kan uppstå under handläggningsprocessen och vilka stödresurser som finns tillgängliga. Vi har använt oss av en kvalitativ forskningsansats med hjälp av sex semistrukturerade intervjuer med biståndshandläggare som arbetar inom äldreomsorg i olika kommuner i Stockholms län. Resultatet analyserades utifrån teoretiska referensramar som belyser olika typer av dilemman på både individuellt och strukturellt plan. Dessa teorier var Lipskys teori om Gräsrotsbyråkrati, konsekvensetik, dygdetik samt begreppen äkta dilemman och skendilemman.  Studien kom fram till att det finns ett flertal svårigheter som biståndshandläggare möter i arbetsvardagen. Vidare framkom att biståndshandläggarna upplever att de är alltför styrda av riktlinjer och lagar vilket minskar deras inflytande. Studien bekräftar tidigare forsknings resultat inom området. / The study aimed to seek understanding and knowledge about care managers professional role in elderly care. Whit that basis we went in-depth of the difficulties that can occur during the process of care managing and what kind of support resources that are available. We used qualitative research approach and performed six semi structured interviews with care managers in the elderly care in different municipalities in the county of Stockholm. The result was analyzed with the basis of theoretical reference frames that illustrate different kinds of dilemmas on both an individual and a structural level. The theories we used were Lipskys theory about street level bureaucrats, consequence ethics, virtue ethics and the concept of real dilemmas and deceptive dilemmas. The study shows that there are a number of difficulties that care managers face in their everyday work environment. Furthermore it emerged that care managers experience that they are too controlled by guidelines and laws which would therefore diminish their influence. The study is verifying of earlier research made in the same field.

The purpose of the study was to describe care managers’ experiences of assessment process in care measures for elderly, focusing on the relatives’ influence. The study was carried out with five care managers in Stockholm city through qualitative semi-structured interviews. The study´s empirical data was analysed with Lipsky’s theory of freedom of action and concepts of power such as; structural power, intentional power and normative power. The conclusion of our study is that care managers’ freedom of action is limited by both budget demands and how the services unit decides to organize itself. Law, guidelines, budget and the superior managers’ opinions affect how the care managers are expected to execute their work in the assessment process. The result of our interviews about the relatives’ influence and participation in the assessment process show that care managers are influenced by structural power, intentional power and normative power. The care managers’ experience of the relatives’ participation in the assessment process was both positive and negative. The relatives are most often helpful in describing the elderly’s need of help in the assessment process. The study’s interviewed persons show that the relatives are the ones appealing against the decision. What the care managers considered as negative with the relatives’ participation was that some relatives assertively questioned the care managers’ decision. In some specific cases, the relatives contacted the care managers’ supervisors when they did not agree with the decision. Furthermore, the care managers experience that the relatives are essential in highlighting the elderly's need of help in the assessment process, specially in the cases in which the elderly has a dementia disease and has difficulties in perceiving their need of help. Since the elderly´s relatives participate in the assessment process, the care managers experience that they need to consider them as an additional party to the case of the assessment process. / Syftet med studien är att beskriva biståndshandläggares erfarenheter av bedömningsprocessen av vårdinsatser för äldre med fokus på anhörigas inflytande. Studien har genomförts med fem biståndshandläggare i Stockholms stad genom kvalitativa semistrukturerade intervjuer. Studiens empiri analyseras med hjälp av Lipskys teori om handlingsutrymme och maktbegrepp såsom; strukturell makt, intentionell makt och normativ makt. Slutsatserna av vår studie är att biståndshandläggarnas handlingsutrymme begränsas av budget och hur verksamheten väljer att organisera sig. Lagen, riktlinjerna, budgeten och chefens åsikter genomsyrar hur biståndshandläggarna förväntas bedriva sitt arbete i bedömningsprocessen. Resultatet av våra intervjuer om anhörigas påverkan och deltagande i bedömningsprocessen visar att biståndshandläggarna påverkas av strukturell makt, intentionell makt och normativ makt. Biståndshandläggarnas erfarenhet av anhörigas deltagande i bedömningsprocessen var både positiv och negativ. Anhöriga är oftast behjälpliga med att beskriva den äldres hjälpbehov i bedömningsprocessen. Studiens intervjupersoner erfar att det är de anhöriga som överklagar beslut. Det som biståndshandläggarna ansåg negativt med anhörigas deltagande var att vissa anhöriga påstridigt ifrågasatte biståndshandläggarnas beslut. I särskilda fall kontaktade anhöriga biståndshandläggarnas chefer när de inte godtog biståndshandläggarens beslut. Vidare erfar biståndshandläggarna att anhöriga behövs för att synliggöra den äldres hjälpbehov i bedömningsprocessen, särskilt i de fall då den äldre har en demenssjukdom och har svårt att själv inse sitt hjälpbehov. Genom att anhöriga deltar i bedömningsprocessen upplever biståndshandläggarna att de behöver ta hänsyn till de äldres anhöriga som ytterligare en part i bedömningsprocessen.

The purpose of this study was to understand, by means of Connell’s and Hirdman’s gender theories, whether the older persons’ gender as well as the family situation affect the assessments in elderly care. Previous studies show that social workers do not consciously take gender into consideration, while also showing that gender is important for the assessment and decision. Based on the purpose, we asked the questions how are the assessments of care managers affected by the gender of older persons and in what way are the assessments of care managers affected by older persons family situation? This study was based on eight interviews with care managers in eldery care. The result was divided into the following two main themes assistance management and the older person. Connell’s and Hirdman’s gender theories helped us answer our main questions and analyze our result. The result showed that the unaware subconscious ideas of male and female, older persons’ perceptions of male and female as well as the elderly’s division of different chores in the household are affecting the care managers’ needs assessments in such a way that men and women are granted and apply for different assistance. Depending on who needs help in a couple, if the older person lives alone or with someone as well as other families’ perceptions of what the husband and wife are capable of doing affects the needs assessments of care managers.

The purpose of this study is to understand how eldercare managers, in their assessments of home care, needs to make individual decisions and at the same time keep to municipality’s guidelines. Our research questions deal with how eldercare managers make individual assessments and at the same time consider general municipality’s guidelines in their estimations of need for homecare assistance and how eldercare managers experience that individual assessments and general municipal guidelines relate to each other in estimations of needs for homecare assistance. Nine qualitative, semi-structured interviews were conducted with social workers working with needs assessments within the eldercare. The results were analyzed through Lipsky’s theory on street-level bureaucracy and the concept of discretion. Our main conclusions from this study is that it is a complex work to estimate needs for homecare assistance when considering both individual assessments and general municipal guidelines. Our results showed that the needs of the individual are more important in the cases where guidelines and the person’s needs differ. Our study also showed that the eldercare managers, as a rule, follow the guidelines as long as they coincide with the assessment of individual needs, but the guidelines function as a guidance and not as something definite. The eldercare managers don’t feel that the relation between municipality guidelines and individual decisions is a problem. The complexity was rather evident in the lack of judicial security and justice in the work with the assessment of individual needs.

I Sverige har synen på hur den äldre ska bo gått från att institutionsvård är det bästa till att kvarboende i det ordinära hemmet ska eftersträvas. Under Ädelreformen på 1990-talet fördes kvarboendeprincipen fram på allvar och kostnadsansvaret för de äldre togs över till större delen av kommunerna. Idag har de flesta kommuner inrättat särskilda boenden för äldre som behöver vård och omsorg som inte kan tillgodoses i det ordinära boendet. För att få komma till ett särskilt boende behöver den äldre få ett bifall på sin ansökan. Det är biståndshandläggarens uppgift att utreda den äldres ansökan och sedan fatta ett beslut. Ansatsen för denna uppsats är att försöka ta reda på vilka faktorer som väger tyngst vid biståndsbeslut av insatsen särskilt boende till individer över 65 år. Forskningsfrågorna har bland annat handlat om kommunen storlek påverkar biståndsbedömningen, om det skiljer sig beroende på hur biståndshandläggarens delegation ser ut, om det finns några alternativ mellan ordinärt boende och särskilt boende och vilken roll som kvarboendeprincipen spelar i biståndsbedömningen. För att få kunskap kring de aspekter som vägs in i biståndsbeslut fattade för särskilt boende gjordes en kvantitativ webbenkät. De aspekter som biståndshandläggaren fick värdera var den fysiska-, psykiska- och kognitiva funktionsförmågan, den sociala aspekten kring den äldre, utbudet av platser på särskilt boende samt kostnaden för hemtjänsten i jämförelse med kostnaden för särskilt boende.  Förfrågan om att besvara enkäten skickades ut till Sveriges alla 290 kommuner. Det blev ett relativt stort bortfall och det var endast 132 av kommunerna som besvarade enkäten. Respondenterna bestod av biståndshandläggare som handlade ärenden för personer under och över 65 år enligt Socialtjänstlagen på myndighetssidan. Dock var fokuset på hur de tänkte kring ärendehandläggningen av klienterna över 65 år. Det som framkom var att behovet alltid måste vara i fokus. Resultaten pekar på att den fysiska- och den kognitiva funktionsförmågan väger tyngst vid besluten. Genom fritextsvaren i webbenkäten och analysen av den insamlade data går det dock att se att det är ett komplext ämne. / In Sweden, the view of how the elderly should live has gone from institutional care being the best to the remaining accommodation in the ordinary home is something we should strive after. During the Noble Reform in the 1990s, the principle of remaining resident was taken seriously and the responsibility for the cost of the elderly was taken over by most of the municipalities. Today, most municipalities have set up housing, especially housing, for the elderly who need care and care that cannot be met in ordinary housing. In order to be allowed to come to a special accommodation, the elderly need to have their application approved. It is the task of the assistance officer to investigate the elderly person's application and then make a decision. The approach for this thesis is to try to find out which factors weigh most heavily in the development assistance decision of the initiative, especially housing for individuals over 65 years of age. The research questions have included whether the size of the municipality affects the development assistance assessment, whether it differs depending on what the development assistance officer's delegation looks like, whether there are any alternatives between ordinary housing and special housing and what role the residual housing principle plays in development assistance assessment. In order to gain knowledge about the aspects that are considered in development assistance decisions made for special housing, a quantitative online survey was conducted. The aspects that the development assistance officer had to evaluate were the physical, mental and cognitive functional ability, the social aspect around the elderly, the supply of places in special housing and the cost of home care in comparison with the cost of special housing. The request to answer the questionnaire was sent to all 290 municipalities in Sweden. There was a relatively large drop-out rate and only 132 of the municipalities answered the survey. The respondents consisted of development assistance officers who handled matters for persons under and over the age of 65 in accordance with the Social Services Act on the authority side. However, the focus was on how they thought about the case management of clients over 65 years of age. What emerged was that the need must always be in focus. The results indicate that physical and cognitive functioning weigh most heavily in decisions. However, through the free text answers in the web survey and the analysis of the collected data, it is possible to see that it is a complex topic.