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.

Biståndshandläggare inom äldreomsorgen står inför en utmaning då gruppen äldre kommer att öka, vilket innebär att allt fler kommer att vara i behov av äldreomsorg. Det är därmed av vikt att uppmärksamma biståndshandläggares arbetssituation för att synliggöra om tillräckliga förutsättningar finns för att utföra arbetet i framtiden. Syftet var att undersöka och få en förståelse för vad biståndshandläggare inom äldreomsorgen upplever som utmanande samt hur biståndshandläggare hanterar utmaningar i arbetet. I studien har en kvalitativ metod använts och åtta semistrukturerade intervjuer har genomförts med biståndshandläggare inom äldreomsorgen i Sverige. En hermeneutisk ansats har använts i studien. Michael Lipskys teori om gräsrotsbyråkrater användes för att analysera biståndshandläggarnas roll som gräsrotsbyråkrater, deras handlingsutrymme samt resursbrist i arbetet. Aaron Antonovskys begrepp känsla av sammanhang användes för att analysera hur biståndshandläggarna hanterar motgångar i arbetet. I resultatet framkom att biståndshandläggarna upplever att det är utmanande att förhålla sig till organisatoriska ramar och samtidigt tillgodose äldres behov. Vidare visade resultatet att biståndshandläggarna upplever känslor och reaktioner i sitt arbete, bland annat stress på grund av hög arbetsbelastning. Ytterligare ett resultat var att biståndshandläggarna hanterar känslor och reaktioner på egen hand, genom handledning samt genom kollegialt stöd. Studien uppmärksammade att åtgärder behöver vidtas för att biståndshandläggare ska ha tillräckliga förutsättningar för att utföra arbetet i dag och i framtiden. / Care managers in elderly care are facing a great challenge. Due to the growing size of the elderly population, more and more people will be in need of care services. Therefore, it is important to bring attention to care managers’ work situation in order to make sure that their conditions are sufficient for their future work. The aim was to examine and understand care managers’ experiences of challenges in their work and how they cope with challenges. To answer the aim of the study, qualitative research has been conducted using semi-structured interviews with eight care managers working within Swedish elderly care. In this study, a hermeneutic approach has been used. Michael Lipsky´s theory about street-level bureaucracies was used to analyze care managers as street-level bureaucrats, their discretion, and the lack of resources. Aaron Antonovsky’s term Sense of coherence was used to analyze care managers’ conditions to cope with tribulations within their work. The results indicated that care managers find it challenging to stay within the institutional framework and at the same time meet the needs of the elderly. The result also showed that care managers experience an array of emotions and reactions in their work, an example being stress due to a high workload. Furthermore, the results pointed out that care managers cope with emotions and reactions through individual strategies, supervision, and support from colleagues. The study highlighted that measures need to be taken to ensure that care managers have sufficient conditions in order to carry out their work in the present and in the future.

The aim of this study was to examine in what way municipal guidelines affect care managers aid assessments process. The study also examined if it is possible for care managers to make aid assessment decisions that exceed references in municipal guidelines and whether there was a resistance from colleagues or managers when care managers make those decisions.   The method used for this study was a qualitative method and the empirical data was obtained by semistructured interviews with 5 care managers. The interviews were conducted in Sweden in a medium sized municipality in Skåne. The results from the study were then analyzed with the help of Michel Foucault's concept of Governmentality. The results were also analyzed with Michel Foucault's concept of the normalization process as well as power and knowledge with the help of Magnus Hörnqvists (2012) elaboration of Michel Foucault's original concepts.  The results of the study showed that there is a possibility for care managers to make aid decisions that exceed references in municipal guidelines because of their full delegation which results in autonomy. Furthermore, an individual assessment may result in an aid decision which requires the care managers to exceed references in municipal guidelines in order to meet the individual needs. The results also showed that municipal guidelines affect the care managers work in several ways. The guidelines can be just that, a guide for care managers in their aid decisions in both what the municipality can offer and at what frequency. The results show that municipal guidelines can be both beneficial and inhibitory for care managers. They can be used as support in cases that are complicated for the care managers and they can be used in a way to strengthen the customers position and their rights. Guidelines are also a way for the municipality to organise their organisation. But they can also be inhibitory if they are diffuse and doesn’t clearly describe the meaning of what is stated in the guidelines, which results in the aid officer having to define the guidelines themselves. Guidelines are also inhibitory if they don't correspond to customers specific needs. Lastly, the result of the essay shows that there is no resistance from colleagues or managers if care managers make aid decisions that exceed references in municipal guidelines, however there is resistance from the aid providers if they have to execute an aid decision which exceeds references in guidelines.

Elderly people with a different cultural background than swedish is now a targeted group that is becoming more relevant in elderly care. The swedish elderly care has also focused much of the work to be carried out according to a salutogenic approach and several development projects in this perspective has been practiced in many parts of the country's municipalities. The purpose of this study was to create a greater understanding of the care managers work with foreign-born elderly people from a salutogenic approach. For us to be able to answer the purpose of the study we collected empirical material through semi-structured interviews from five care managers from two different municipalities in central Sweden. The results are presented and analyzed based on the collected empirical data that we then tied together with the key concepts and previous research. The results showed that the challenges that the care managers encounter in their salutogenic approach is the language deficiencies and demands for action because they differ from the Swedish culture. In the discussion we write our thought about the future development concidering the care managers work with foreign-born elderly. / Äldre med en annan kulturell bakgrund än svenskt är idag en målgrupp som blir allt mer aktuell inom äldreomsorgen. Den svenska äldreomsorgen har även på senare år fokuserat mycket på att arbetet ska utföras genom ett salutogent förhållningssätt och flera utvecklingsprojekt inom perspektivet har utövats i flera delar av landets kommuner. Syftet med föreliggande studie var att skapa en ökad förståelse för biståndshandläggarens arbete med utrikesfödda äldre utifrån ett salutogent förhållningssätt. För att besvara studiens syfte inhämtas studiens empiri genom semistrukturerade intervjuer från fem biståndshandläggare från två olika kommuner i Mellansverige. Resultatet presenteras och analyseras utifrån insamlad empiri som binds ihop med centrala begrepp och tidigare forskning. Resultatet visar till att de utmaningar som biståndshandläggare stöter på utifrån sitt salutogena förhållningssätt är språkbrister och krav på insatser som skiljer sig från den svenska kulturen. Slutligen lyfts en diskussion om framtidens utveckling för biståndshandläggarens arbete med utrikesfödda äldre.

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Föreliggande studies syfte var att undersöka biståndsläggarens arbete för att minska ensamhet och social isolering hos äldre personer. En kvalitativ explorativ design användes och materialet till studien samlades in genom semistrukturerade intervjuer med sex biståndshandläggare. Genom en tematisk analys framkom fyra huvudteman: vad är ensamhet och social isolering, identifiering och information, betydelsen av insatser och sociala sammanhang samt biståndshandläggaren och den äldre personen. Sammanfattningsvis beskriver de intervjuade biståndshandläggarna att ensamhet och social isolering kan förebyggas och minskas genom kommunala insatser men att den viktigaste faktorn är närheten till familj och sociala nätverk. Biståndshandläggarna beskriver också att de kan uppleva maktlöshet, både i förhållande till den enskilde och i förhållande till riktlinjer och brist på resurser inom den egna verksamheten. Maktlösheten kopplas i diskussionsavsnittet till Lipskys teori om frontlinjebyråkrater. Trots de utmaningar som finns är biståndshandläggarna överens om att de har en viktig och betydande roll i arbetet för att tillgodose den enskildes behov. / The aim of this study was to investigate the care managers’ work to reduce loneliness and social isolation in older people. A qualitative exploratory design was used and the material for the study was collected through semi-structured interviews with six care managers. Through a thematic analysis, four main themes emerged: "what is loneliness and social isolation", "identification and information", "the importance of activities and the social context" and "the care manager and the older person". In summary, the interviewed care managers describe that loneliness and social isolation can be prevented and reduced through governmental interventions, but the most important factor is proximity to family and social networks. Moreover, the care managers describe that they can experience impotency, both in relation to the individual client and in relation to framework and lack of resources within their own operation. The impotency is discussed in relation to Lipsky's theory of street level bureaucrats. Despite the challenges that exist, the care managers agree on the importance and significance of their role in working to meet the individual’s needs.

This study aims to understand how care managers approach consent and user influence related to older people with dementia. The study was conducted through qualitative interviews with individual care managers and with a hermeneutic approach. We have interviewed ten care managers in smaller municipalities whom are experienced in their profession and have been in contact with older people with dementia. throughout all the interviews, we had a semi-structured interview guide at our disposal, and after all the interviews were conducted, we analyzed them with the hermeneutic circle and theoretically analyzed the material with Lipsky´s theory about street level bureaucracy, acting space and, what we call it, the social service as a last resort and finally with Johansson´s theory of client relationships. Our main conclusions regarding consent is that care managers need to relate to the law simultaneously have the individual needs and wishes in regards. Also, the care managers have a few ways to circumvent the absolute that the individual needs to give his or hers consent to everything. Our main conclusions regarding user influence is that the care managers need to use other professions for information regarding the individual, such as nurses, carers, dependants and so on. They also prefer to get in touch with the individual whom is diagnosed with dementia as early into the disease as possible to get to know them and learn how they want their care to be. As a last conclusion about the whole study is that the care managers find working with older people with dementia is a vastly difficult task, and they need to rely on dependants, other professions and have a lot of knowledge about the individual.

The overall aim of this thesis was to examine how eHomecare affects the daily lives of older users and their relatives, with a focus on safety and communication. A further aim was to explore care managers’ perspectives, expectations and experiences of eHomecare and its implementation. Methods: Participants in study one and two were older people with granted eHomecare and eight relatives and, care managers in study three and four. Data were collected through four qualitative studies, using individual interviews in the first and second studies before the introduction and after six months’ use of eHomecare, by individual vignette-based interviews in the third study, and with focus-group interviews in the fourth study. Data were analysed using different qualitative content analyses. Results: The participants described safety as a part of everyday life. eHomecare was found to facilitate a ‘new safety’ for older people and a ‘re-established safety’ for relatives, yet its use raised concerns about ethical considerations and reduced human contact. Participants could attain feelings of togetherness and affection through communication, although this was also considered a vulnerable activity due to physical changes and loss of other people. Used correctly, eHomecare increased communication and thus closeness and participation for the participants. For older participants unable to use the technology as hoped, eHomecare led to disappointment. Care managers expressed that eHomecare can increase older peoples’ everyday life-quality if they receive the right tools at the right time. Care managers, however, have difficulties with eHomecare’s management process. While they struggle with their own attitudes, lack of time and high workloads, their decisions are also influenced by surrounding organisations and the older people’s relatives. Care managers’ own organisations, work situations, relevant stakeholders and society in general can hinder them in managing eHomecare as a new homecare service. Widespread information about eHomecare and opportunities for relevant stakeholders to participate in its implementation are good preconditions for fulfilling the mission of care managers. Conclusions: The findings describe eHomecare from the perspectives of its older users, their relatives and the care managers responsible for managing the service. Used correctly, eHomecare increases possibilities for communication and provides safety. However, care managers have a complex mission when managing the service and they express a need for support and knowledge. The findings can be used clinically to develop older peoples’ utilization of eHomecare and to develop support for the fulfilment of care managers’ mission. Keywords: care managers, content analysis, communication, eHomecare, experiences, information and communication technology, older people, participation, perceptions, relatives, safety, welfare technology

Title:          Assistance Assessment for Clients with Dementia Disease - The Perceptions and Experiences of Care Managers   Authors:    Fredrik Borg and Helena Wallin Håkansson   The study aimed to examine the experiences, difficulties and ethical positions of care managers in the assistance assessment of dementia clients. The study was based on the themes of self-determination and integrity, ethical approach, security and meaningful existence. Qualitative semi-structured interviews were used as data collection method. Empirical material was analysed based on empowerment and system theory. The result shows that care managers daily deal with ethical dilemmas regarding the client's self-determination and integrity, in relation to the right to security and meaningful existence. The informants conveyed that it’s mainly about being a fellow human with understanding and empathy, adapted to the current situation. Previous research shows ethical dilemmas regarding family caretakers and decision making for elderly with dementia, this was also evident in our study. For future research, we see the relevance in exploring the differences regarding the use of legal kinship privileges. / Titel:          Biståndsbedömning för klienter med demenssjukdom - Biståndshandläggares upplevelser och erfarenheter   Författare: Fredrik Borg och Helena Wallin Håkansson   Studiens syfte var att undersöka biståndshandläggares upplevelser, svårigheter och etiska ställningstaganden vid biståndsbedömning av klienter med demenssjukdom. Studien utgick från temana självbestämmande och integritet, trygghet och meningsfull tillvaro samt etiskt förhållningssätt. Kvalitativa semistrukturerade intervjuer användes som datainsamlingsmetod. Empiriskt material bestående av transkriberade intervjuer, analyserades utifrån teorierna empowerment och systemteori. Som resultat konstateras att biståndshandläggare dagligen hanterar etiska dilemman kring klientens självbestämmande och integritet, i relation till rätten till trygghet och meningsfull tillvaro. Informanterna förmedlade att det i praktiken handlar om att vara medmänniska med förståelse och empati, anpassat till den aktuella situationen. Tidigare forskning visar på bland annat etiska dilemman kring anhörigvårdare och beslutsfattande för äldre människor med demens. Detta framkom även i vår studie. För framtida forskning tror vi det kan vara relevant att kartlägga varför det ser olika ut kring användning av anhörigbehörighet.