In the planning and delivery of services the voice and choice of consumers have appeared as the foremost key factors. For a large number of organisations the received feedback from customers about the quality of services, which are the criteria and indication of their level of satisfaction play a crucial role in the improvement of quality. Although across developed western communities, the importance of customers’ views has gained acceptance, few studies have been dedicated to the exploration of the voice of the residents in care homes. The review of the literature regarding residents’ satisfaction and quality in care homes revealed that the voices of residents in care homes are usually not heard or are absent. Moreover, the adoption of quality improvement tools in health care has lagged behind that in other industries and there is generally a failure to use an appropriate methodology in care homes, one based on residents’ voice, for improving quality. As a result, the main aim of this research is to investigate residents’ voice regarding improving their satisfaction in care homes. Further, the researcher seeks to obtain data by using an appropriate methodology to assist care home managers in enhancing the quality of the services they offer by assigning weights to quality indicators pertaining to improving quality and residents’ levels of satisfaction. For this purpose, this research employs both qualitative and quantitative approaches to develop a research process entailing: (1) a comprehensive literature review to recognise the phenomenon; (2) interviews with fifteen older people who lived in three different care homes in order to discover the most important residents’ needs and requirements in such homes; (3) a resident survey with one hundred and two residents in thirty five care homes. These were conducted to assess their preferences for the importance of demanded qualities; their satisfaction with provided services and the attributes of each demanded quality based on the Kano model, in order to identify the priority of improvement. Next, (4) there was the development of the House of Quality (HoQ) to optimize quality to assure residents’ satisfaction; and finally, (5) an evaluation study was conducted with thirteen service providers, in order to assess the accuracy and appropriateness of the methodology. This research has contributed towards a better understanding of the residents’ voice, and applying it for enhancing quality and residents’ satisfaction in care homes. For the first time residents’ requirements are prioritised and classified in this context through accurate methods. Moreover, an understanding of the attributes of care home residents’ needs in relation to a Kano model has been elicited. The novelty of this proposed methodology is in utilising the Quality Function Deployment (QFD) in care homes to translate the voice of residents’ regarding their requirements into service planning. The research methodology and results facilitate care home managers with a hierarchy for improvement planning at both service and executive management levels.

Värdighet var ett centralt temai vård av äldre. Självbild, autonomi och integritet var några viktiga teman och värderas högt i relation till uppfattning av värdighet hos svenska äldre personer. Samtidigt fanns det studier som indikerade att när invandrarpatienter betraktades i vårdsituationen bedömdes ofta deras individuella skillnader inom ramen för deras speciella kultur. Är tolkning av begreppet värdighet detsamma i andra kulturer som den svenska? Kultur hade inte varit ett särskilt utforskat ämne inom svenska vården. Det kan vara avintresse för vården att ha kunskap om och förståelse för patienters olika värderingar och perspektiv i en alltmer globaliserad värld. Syftet var att belysa kulturs betydelse för uppfattning av begreppet värdighet för äldre personer. Metoden var en allmän litteraturstudie som byggde på 18 vetenskapliga artiklar om äldres värdighet från olika världsdelar. Resultatet från europeiska studier stämde väl överens med de svenska, där informanterna lyfte fram identitet, autonomi, oberoende, och integritet somde viktigaste faktorerna för värdighet. Dessa faktorer var också centrala teman enligt informanterna i de asiatiska studierna, dock med mer betoning på respekt från omgivningen och familjen och sociala relations betydelse för ens värdighet. Tankar om döden och acceptans inför smärtan och döden var annat återkommande tema hos de äldre från asiatiska länder. De flesta studier från USA hade jämfört tolkning om värdighet mellan grupper av personer med olika kulturella bakgrunder och fann att människor från olika bakgrunder hade i stort sätt samsyn på värdighet, men de kunde ha olika seder och vanor och därmed handlade olika i konkreta situationer. Slutsatser som drogs från resultatet var att samhälles kultur tjänade som förmedlare och upprättare av samhälletsvärderingar till individen. Kultur hade viss betydelse för människans uppfattning av begreppet värdighet och dess innebörd, vilket var viktigt för vårdpersonal att känna till för att utföra värdighetsbevarande vård för äldre personer med olika kulturella bakgrunder. / Dignity was an essential theme within geriatrics care. Self-image, autonomy and integrity were the underlying elements that the Swedish elderly value highly. In the meantime there were studies that indicated elderly people with immigrant background were often judged by the Swedish health care providers according to their cultural origins rather than their personal attributes. Did the term of dignity mean the same thing in other countries as in Sweden? Culture as a theme had not been particularly explored in the Swedish health care context. It would be interesting for the health care workers to have more knowledge and deeper understanding for patients´ different perspectives and values in an increasingly globalized world. The aim was to explore the cultural significance on the perception of the concept of dignity for the elderly. Method was a general literature review based on 18 research articles from different countries. The results from the European countries were similar to that from the Swedish ones. The participants valued highly independence, identity and integrity and considered these values as the most relevant for dignity. Even the participants from Asian studies shared these points of view, yet with more emphasis on the importance of family and respect from others. Social relationship mattered for dignity. Another topic from the Asian studies were the elderly´s accepting attitude towards pain, suffering and death. Studies from the United States were often based on comparisons on interpretation of concept dignity between groups with different cultural backgrounds. The results indicated that most people shared the same opinion upon the question but people had different customs and habits but could behave in different ways under a certain situation. Conclusions to be drawn from the results were the culture was a society´s agent for promoting its values to its people. Culture mattered for the understanding of the concept dignity. This knowledge could be useful for the health care workers engaged in conserving dignity for the elderly.

<p>The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services.</p><p>Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation.</p><p>Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings.</p><p>Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics.</p><p>In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.</p>

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed. / <p>Härtill 4 uppsatser</p>

This thesis with title "Aging Czech population as a problem of the future and the question of sustainability of social care for the elderly" aims to highlight this actual topic. The demographic prognoses predict a growing proporsion of seniors in population and it could imply much greater demand for social services in the future. Therefore, it is necessary to discuss this question today. In my thesis, I use evaluation research methods to try answer if the current system is sustainable.

The effectiveness of legal regulation of care for the elderly - summary From the projected demographic development, one can conclude that the proportion of the elderly in the society will grow significantly in the future. Advancing age is generally accompanied by the weakening of self-reliance and the need of help from others to take care of oneself. The aim of this work is to capture the latest trends in taking care of the elderly and its legislative anchorage in the laws of the Czech Republic. The fundamental law from which I start is the act no. 108/2006 Sb. on social services. This act brought a large number of changes and new institutions into the department of care (not only for seniors), from which the most important was the introduction of care subsidy. The work is focused mainly theoretically, it is divided into seven chapters and further particular sub-chapters. The first chapter deals with embedding the social services into the social security law system, and also briefly with their historical development. These bases represent essential determinants that affect both the current state of social services, as well as their possible future development. The need for effective regulation of social services for seniors can be seen in the demographic indicators, which confirm the long-term trend towards...

<p>Author: Nilsson Linda</p><p>Title: Appraisal talk- new ideals and new forms</p><p>The purpose of this study was to examine the concept of the appraisal talk. More specifically its aim was to find out more about the function and the meaning of the appraisal talk, for the organization, managers and co-workers point of view, and if there was any specific method applied. Two of the central questions were: How did the managers and co-workers describe the function and the meaning of appraisal talks? Were there any differences or similarities of the respondent’s point of view, depended of their position in the organization? The method of analysis was qualitative with a critical reflective approach. The study was based on interviews with three managers and four co-workers, in the public service of elderly care in Kalmar municipality. A central finding of the study is that the implementation of the appraisal talk is a tool for the organization to make effectiveness, but also to create a meaningful atmosphere. It seems to depending on the respondent’s position in the organisation. The managers use a solution focused work method in the appraisal talk.</p>

Author: Nilsson Linda Title: Appraisal talk- new ideals and new forms The purpose of this study was to examine the concept of the appraisal talk. More specifically its aim was to find out more about the function and the meaning of the appraisal talk, for the organization, managers and co-workers point of view, and if there was any specific method applied. Two of the central questions were: How did the managers and co-workers describe the function and the meaning of appraisal talks? Were there any differences or similarities of the respondent’s point of view, depended of their position in the organization? The method of analysis was qualitative with a critical reflective approach. The study was based on interviews with three managers and four co-workers, in the public service of elderly care in Kalmar municipality. A central finding of the study is that the implementation of the appraisal talk is a tool for the organization to make effectiveness, but also to create a meaningful atmosphere. It seems to depending on the respondent’s position in the organisation. The managers use a solution focused work method in the appraisal talk.

The currenly growing preference for "active aging" aims to promote the longest possible physical and mental vitality. Caring for the spiritual development and spiritual needs of older people is usually thought to be a private matter, or an area within the competence of churches, and related to traditionally religious older people. With regard to the bio-psycho-socio-spiritual unity of the person, it is evident that spirituality ? and spiritual needs as its expression ? belong in the life of every individual, though it is primarily an individual experience linked to a particular personality and life history. Through spirituality they seek to answer questions relating to the purpose and pursuit of life, to higher values, to the processing of suffering and evil, and to some questions having eschatological character. This dissertation defines spirituality's everyday place on the path to a good life in old age. The empirical part of the dissertation is a qualitative study called Spiritual Needs in the Daily Life of the Elderly in Southern Bohemia. The first part shows the development of religiosity or spirituality of two dozen South Bohemians over seventy-five years, focusing on the period of early religious socialization, stages of working life under the rule of Communism, and the present form of religiosity or spirituality. The second part presents a possible typology of their fundamental spiritual needs: dignity, sense of continuity in ones life story, hope, faith and love. On the basis of these findings, recommendations are then put forward for pastoral, social, and geragogical practices.

In Sweden the need to recruit care assistants is increasing because of a growing older population together with their demands to stay in their own homes as long as possible. Swedish municipalities are responsible for organizing the social care and services for elderly with a coordination of some private provider companies. Moreover, to improve the care work a range of information and communication technologies (ICTs) e.g. safety alarm and electronic health record system are used to support care assistants’ daily activities and communication with elderly. Thus qualitative research aims to explore the care assistants’ use and experiences of existing ICTs. Furthermore, it examines the impact of the ICTs on their daily activities. The thesis pay attention also to care assistants demands, ideas and visions about future ICTs. The research found that care assistants were satisfied with the ICTs, they use today. However, the research also identified some problems related to ICT, which the care assistants are confronted with during their everyday work e.g. alarm buttons loosen and falsely triggered sensors. Care assistants expressed their ideas and visions about the ICT’s degree of involvement in their care activities and elderly’s lives. They had contradictions in their point of views related to the use of monitoring technologies for elder’s care. They also had negative feelings about these technologies. In short, the thesis explored two things; firstly, it reflected ICTs and care assistants’ demands and ideas related to the ICTs. Secondly, the daily activities of care assistants were examined. Therefore this research brings forward care assistants’ activities and makes their work more noticeable in order to be used in the development of new IT systems in the social care work.