Uppsatsens syfte är att ur ett personalperspektiv undersöka och beskriva kunskapsläget i äldreomsorgsarbete inom hemtjänsten med brukare som har alkoholproblematik. Syftet belyses via följande frågeställningar; 1) Hur beskrivs arbete med vård och omsorg hos brukaren generellt i forskningen? 2) Hur påverkas brukarens självbestämmande och livskvalitet generellt vid behov av vård och omsorg från äldreomsorgen? 3) Hur beskrivs arbete med vård och omsorg hos brukaren med alkoholproblematik i forskningen? 4) Hur påverkas brukarens självbestämmande och livskvalitet generellt vid behov av vård och omsorg från äldreomsorgen om brukaren har alkoholproblematik? För att besvara frågeställningarna valdes selektiv kunskapsöversikt som består av 11 utvalda primärdokument. Syfte och frågor i vår uppsats analyserades och besvarades via socialkonstruktionistisk och DBO-teorin, en handlingsteori. Resultatet av uppsatsen visar att: relationen mellan personal och brukare är avgörande för brukarens självbestämmande och livskvalitet. Är relationen dålig påverkas självbestämmandet negativt då brukaren alltid kan ses vara i beroendeställning, har brukaren även alkoholproblematik kan relationen försämras då personalen i vissa fall inte vet hur de skall förhålla sig till dessa brukare. Relation byggs upp genom tid, kontinuitet och lojalitet. I ett föränderligt och flexibelt arbete som hemtjänstarbetet är, kan tid, kontinuitet och lojalitet vara en bristvara beroende på hur verksamheten styrs och är organiserad. Arbetet hos äldre med alkoholproblematik kan bli en växande problematik som äldreomsorgen inom varje kommun måste ta ställning till hur de skall hantera. Skall man acceptera olika livsstilar hos olika brukare eller skall de som är i behov av äldreomsorg dras över samma kam och alla får samma typ av insats? Hur skall framtidens äldreomsorg se ut? / Purpose of this thesis is that from a personnel perspective, examine and describe the state of knowledge in the home care work with elderly clients who have alcohol problems. The purpose is highlighted by the following questions: 1) How is work with health and care of elderly clients in generally described in the research? 2) How is the elderly client’s autonomy and quality of life in general affected when in need of home care from the eldercare? 3) How is work with health and care of clients with alcohol problems described in the research? 4) How is the elderly client’s autonomy and quality of life in general affected when in need of care from the eldercare if the patient has an alcohol problem? In order to answer the questions a selective knowledge review consisting of 11 selected primary documents was chosen. The purpose and questions in this thesis were analyzed and answered by social construction theory and DBO theory, an action theory. The result of the knowledge review shows that: the relationship between caregivers and elderly clients is crucial for the client’s autonomy and quality of life. If the relationship is bad it will affect the patient’s autonomy negatively as the client can be seen to be the dependent part, and have the client also a alcohol-related problem the relationship may deteriorate when the caregivers in some cases do not know how to respond to these clients. Relationships are built through time, continuity and loyalty. In a changing and flexible work as home care work is, time, continuity and loyalty could be scarce, much depending on how the eldercare is managed and organized. Work with clients with alcohol problems may be a growing problem that the eldercare in each community must decide how to deal with. Should different lifestyles be accepted among various clients or shall all clients who are in need of eldercare just get the same kind of help as everybody else with no acceptance of different needs? How shall the future eldercare be organized?

Enligt forskning ökar alkoholkonsumtionen bland personer som är 65 år och äldre. Detta antas innebära att hemtjänstpersonal kommer att stöta på alkoholberoende allt oftare i arbetet. Syftet med denna studie är att bidra till en ökad kunskap om hur arbetet kring äldre vårdtagare med problematisk alkoholkonsumtion bedrivs inom hemtjänsten. Som teoretisk grund för studien användes makt, ålderism, synen på människan som objekt/subjekt samt synsätt på alkoholmissbruk. En kvalitativ metod bestående av åtta intervjuer med hemtjänstpersonal genomfördes. Resultatet visar att respondenterna tycker det är viktigt att vara värderingsfri i arbetet. De beaktar även vårdtagarnas rätt till privatliv. Enligt socialtjänstlagen ska verksamheter inom socialt arbete bygga på respekt för människors självbestämmanderätt och integritet, något som respondenterna beaktar i sitt arbete. Svårigheter som respondenterna stöter på i arbetet löser de bland annat genom att diskutera med kollegor, något som nämndes som strategier. Det framkom också att respondenterna anser att de ibland inte har de förutsättningar som krävs för att möta den berörda gruppen. / According to research, alcohol consumption among people aged 65 and over increases. This is supposed to mean that homecare staff will encounter alcohol addiction more and more frequently at work. The purpose of this study is to contribute to an increased knowledge of how work on elderly patients with problematic alcohol consumption is conducted within homecare. As a theoretical basis for the study, power, ageism, the view of man as object / subject, and approach to alcohol abuse were used. A qualitative method consisting of eight interviews with homecare staff was conducted. The result shows that the respondents find it important to be value-free at work. They also take into account the patients’ right to privacy. According to the Social Services Act, activities within social work must be based on respect for people's self-determination and integrity, something that the respondents consider in their work. Difficulties encountered by the respondents in the work are solved, among other things, by discussing with colleagues, something that was mentioned as strategies. It also emerged that the respondents believe that they sometimes don’t have the conditions required to meet the relevant group.

<p>The overall purpose with this study was to examine the influence elderly people have over their granted home help. Specifically, the aim was to examine in what extent the image of the elderly as a <em>unique individual</em> emerges in the plans where the home help is described [“genomförandeplaner”]. A plan which is personally designed is used as an indicator of personal influence. A text analysis inspired by Michel Foucault’s discourse concept, was carried out and the study adopts the concepts <em>standardization</em> and <em>categorization</em> as well as the theory of “Sense of coherence”. The result showed that the content of the plans mainly lacks a personal imprint, which is to be understood as a form of standardization. Furthermore, the analysis reveals that the content that is excluded and included creates an image of the elderly as someone who is not a unique individual. This study highlights the value of establishing more salutogenic infused plans. Also other studies, emphasize that elderly in need of care wants to be able to predict and influence the help they receive, which in turn is a condition for the elderly to achieve a Sense of coherence.</p>

The overall purpose with this study was to examine the influence elderly people have over their granted home help. Specifically, the aim was to examine in what extent the image of the elderly as a unique individual emerges in the plans where the home help is described [“genomförandeplaner”]. A plan which is personally designed is used as an indicator of personal influence. A text analysis inspired by Michel Foucault’s discourse concept, was carried out and the study adopts the concepts standardization and categorization as well as the theory of “Sense of coherence”. The result showed that the content of the plans mainly lacks a personal imprint, which is to be understood as a form of standardization. Furthermore, the analysis reveals that the content that is excluded and included creates an image of the elderly as someone who is not a unique individual. This study highlights the value of establishing more salutogenic infused plans. Also other studies, emphasize that elderly in need of care wants to be able to predict and influence the help they receive, which in turn is a condition for the elderly to achieve a Sense of coherence.

Hur kan medbestämmande och inflytande i hemtjänsten komma till stånd? Syftet med denna uppsats var att ta reda på vad som upplevs ge medbestämmande och inflytande i hemtjänsten. Den övergripande frågeställningen formulerades utifrån om det finns skillnad i uppfattning hos personer som har erfarenhet och de som inte har erfarenhet av att ta emot hemtjänst? Det sociala synsättets tankar (Westlund, 2002), teorier om salutogenes (Antonowsky, 1991), (Sjöberg &amp; Westlund, 2005) samt ett socialkonstruktivistiska synsätt om synen på äldre (Jönsson, 2001) utgör de huvudsakliga teorierna. Metoden utformades som en fallstudie och genomfördes i Alvesta kommun. Fyra grupper intervjuades med vardera tre till fem slumpmässigt utvalda respondenter. Två av intervju-grupperna bestod av personer som har personlig erfarenhet av att ta emot hemtjänst och deltagarna i de två andra intervjugrupperna saknade denna erfarenhet. Resultatet visar att de flesta av intervjugruppernas deltagare ansett oavsett tidigare erfarenhet att hemtjänstens och äldreomsorgens kvalitet? i Alvesta överlag är bra eller mycket bra. Viss skillnad i vad som de olika grupperna betecknar vara ett gott liv kommer fram. Frågor om att få byta insats, bestämma om när den ska utföras, ha möjlighet till insats utan biståndsbeslut efter viss ålder, byte till timtaxa, servicecheckar eller ej, engagerar de flesta deltagarna i intervjugrupperna med personer som inte har egen erfarenhet av hemtjänst. Dessa frågor engagerar dock inte deltagarna nämnvärt i grupperna som redan har erfarenhet av hemtjänst. Vidare pekar studien på att nästan alla gruppdeltagare, oavsett erfarenhet eller ej, anser att beslutsgången vid ansökan om insats känns oklar, en fråga som framförallt framhålls som angelägen för respondenterna. En annan betydelsefull fråga för respondenterna är frågan om personalkontinuiteten. Det uttrycks angeläget att få till stånd en kommunikation omkring frågan om ombyggnad av det gamla sjukhemmet ”Högåsen”. Avslutningsvis visar resultatet på att ett stort intresse finns från de deltagare som inte har egen erfarenhet av hemtjänst för att socialt uppsökande verksamhet erbjuds alla vid en viss ålder. / How can co-determination and influence within the home-help service sector come about? The aim of this paper is to find out what is considered to give co-determination and influence within the home-help service sector. The overall question was formulated from the The social workers have a lot of authority, I think; I should like to have some authority too. - On co-determination and influence in Alvesta´s home-help service - anticipation that there is a difference in opinion between people who have experience and those who have no experience in receiving home-help service. Det sociala synsättets tankar (Westlund 2003), Theories about Salutogenes (Atonowski 1991), Sjöberg &amp; Westlund 2005) and Ett socilakonstruktivistiskt synsätt om synen på äldre (Jönsson, 2001) form the main theories. The method was constructed as a case study and was carried out in the town of Alvesta. Four groups were interviewed with three to five randomly chosen respondents in each group. Two of the interview groups consisted of persons who have personal experience of receiving home-help service and the participants in the two other interview groups lacked this experience. The result shows that most of the participants in the interview groups, disregarded earlier experience, are of the opinion that the quality of old age care in Alvesta overall is good or very good. A certain difference in what the different groups consider to be a good life is shown. Questions about be allowed to change service, decide when it is to be done, have possibility for services without formal authority decisions after a certain age, service cheques or not, engage most participants in the interview groups that have no personal experience of home-help service. These questions do not much engage the participants in the groups that already have experience from home-help service. Further, the study shows that nearly all group members, experience or no experience of home-help service, are of the opinion that the line of decision is unclear, a question that above all is regarded as urgent. Another important question for the respondent is the continuity in staffing. There is also a strong opinion about starting a communication regarding the reconstruction of the old nursing home “Högåsen”. Finally, the result shows that there is a great interest from the participants, who have no personal experience of home-help service, that everybody is offered an outreach programme from a certain age.

<p>Hur kan medbestämmande och inflytande i hemtjänsten komma till stånd?</p><p>Syftet med denna uppsats var att ta reda på vad som upplevs ge medbestämmande och inflytande i hemtjänsten. Den övergripande frågeställningen formulerades utifrån om det finns skillnad i uppfattning hos personer som har erfarenhet och de som inte har erfarenhet av att ta emot hemtjänst?</p><p>Det sociala synsättets tankar (Westlund, 2002), teorier om salutogenes (Antonowsky, 1991), (Sjöberg & Westlund, 2005) samt ett socialkonstruktivistiska synsätt om synen på äldre (Jönsson, 2001) utgör de huvudsakliga teorierna.</p><p>Metoden utformades som en fallstudie och genomfördes i Alvesta kommun. Fyra grupper intervjuades med vardera tre till fem slumpmässigt utvalda respondenter. Två av intervju-grupperna bestod av personer som har personlig erfarenhet av att ta emot hemtjänst och deltagarna i de två andra intervjugrupperna saknade denna erfarenhet.</p><p>Resultatet visar att de flesta av intervjugruppernas deltagare ansett oavsett tidigare erfarenhet att hemtjänstens och äldreomsorgens kvalitet? i Alvesta överlag är bra eller mycket bra. Viss skillnad i vad som de olika grupperna betecknar vara ett gott liv kommer fram. Frågor om att få byta insats, bestämma om när den ska utföras, ha möjlighet till insats utan biståndsbeslut efter viss ålder, byte till timtaxa, servicecheckar eller ej, engagerar de flesta deltagarna i intervjugrupperna med personer som inte har egen erfarenhet av hemtjänst. Dessa frågor engagerar dock inte deltagarna nämnvärt i grupperna som redan har erfarenhet av hemtjänst.</p><p>Vidare pekar studien på att nästan alla gruppdeltagare, oavsett erfarenhet eller ej, anser att beslutsgången vid ansökan om insats känns oklar, en fråga som framförallt framhålls som angelägen för respondenterna. En annan betydelsefull fråga för respondenterna är frågan om personalkontinuiteten. Det uttrycks angeläget att få till stånd en kommunikation omkring frågan om ombyggnad av det gamla sjukhemmet ”Högåsen”.</p><p>Avslutningsvis visar resultatet på att ett stort intresse finns från de deltagare som inte har egen erfarenhet av hemtjänst för att socialt uppsökande verksamhet erbjuds alla vid en viss ålder.</p> / <p>How can co-determination and influence within the home-help service sector come about?</p><p>The aim of this paper is to find out what is considered to give co-determination and influence within the home-help service sector. The overall question was formulated from the The social workers have a lot of authority, I think; I should like to have some authority too.</p><p>- On co-determination and influence in Alvesta´s home-help service -</p><p>anticipation that there is a difference in opinion between people who have experience and those who have no experience in receiving home-help service.</p><p>Det sociala synsättets tankar (Westlund 2003), Theories about Salutogenes (Atonowski 1991), Sjöberg & Westlund 2005) and Ett socilakonstruktivistiskt synsätt om synen på äldre (Jönsson, 2001) form the main theories.</p><p>The method was constructed as a case study and was carried out in the town of Alvesta. Four groups were interviewed with three to five randomly chosen respondents in each group. Two of the interview groups consisted of persons who have personal experience of receiving home-help service and the participants in the two other interview groups lacked this experience.</p><p>The result shows that most of the participants in the interview groups, disregarded earlier experience, are of the opinion that the quality of old age care in Alvesta overall is good or very good. A certain difference in what the different groups consider to be a good life is shown. Questions about be allowed to change service, decide when it is to be done, have possibility for services without formal authority decisions after a certain age, service cheques or not, engage most participants in the interview groups that have no personal experience of home-help service. These questions do not much engage the participants in the groups that already have experience from home-help service.</p><p>Further, the study shows that nearly all group members, experience or no experience of home-help service, are of the opinion that the line of decision is unclear, a question that above all is regarded as urgent. Another important question for the respondent is the continuity in staffing. There is also a strong opinion about starting a communication regarding the reconstruction of the old nursing home “Högåsen”.</p><p>Finally, the result shows that there is a great interest from the participants, who have no personal experience of home-help service, that everybody is offered an outreach programme from a certain age.</p>

Hensikten med denne undersøkelsen var å belyse et lite studert område, nemlig: Stemmer enkeltvedtak overens med hjelpen hjemmeboende personer med demens får, og om tap av ferdigheter påvirker vedtakene og hjelpen som gis. Materiale: I alt 460 hjemmeboende personer med demens fra 24 kommuner i alle landets fem helseregioner ble inkludert i undersøkelsen. Alle fikk hjelp fra hjemmebaserte tjenester og hadde en demenssykdom diagnostisert av lege og/eller hjemmesykepleien antok at det forelå demens på grunnlag av en Klinisk Demensvurdering I alt 489 pasienter ble rekruttert, 249 med demensdiagnose og 240 uten. Blant de 240 med antatt demens hadde 211 en KDV skåre 1 eller høyere. Disse ble inkludert, mens de 29 med lavere skåre ble ekskludert. Metode: Pasienten ble vurdert med Klinisk Demensvurdering og et skjema som måler funksjoner i dagliglivet, Rapid Disability Rating Scale-2. Enkeltvedtak for pasientene ble samlet inn og kategorisert ved hjelp av kvalitativ innholdsanalyse slik at kategoriene stemte overens med hjelpetiltakene som ble tilbudt. Hjelp til pasientene ble registret i en sju dagers periode. Resultater: Vi fant liten sammenheng mellom vedtakene og utført hjelp, og liten sammenheng mellom behov for hjelp og utført hjelp. Åttiseks prosent av vedtakene ble fulgt opp av hjemmetjenesten, men svært mange får hjelp uten vedtak. Undersøkelsen viser at mange som har behov for hjelp, ikke får hjelp. Undersøkelsen viser at det ikke er lovverket som svikter, men håndhevelsen av gjeldende lover og forskrifter. / he purpose of this study was to look more closely at a previously neglected area namely: Do administrative decisions for provisions of care correspond to the actual care given to persons with dementia living at home, and does the loss of skills effect the decision and care provided?The method used was collection of data, which was than categorised by a qualitative analysis of content. Although individual administrative decisions are governed by law, and most local authorities have passed guidelines on how these decisions should be formulated, and how the care should be provided, our study showed a large variation in the quality of provisions and professional practice. Four hundred and sixty persons with dementia, from all health regions, were included in the study. Inclusion criteria were patients with known dementia, diagnosed by a doctor and/or assumed to be demented by the community nurse. In total, 489 patients were recruited, 249 with a confirmed diagnosis of dementia, and 240 without. Of these 240 patients, with assumed dementia, 211 had a KDV score of one or greater. These were included, whilst the 29 with lower scores were excluded from the study. Data for the study was thus collected from 460 patients. The results show little relationship between the administrative decisions for care, the need for care, and actual care provided. Eighty-six percent of administrative decisions were followed up by the home services, but many receive help without formal decisions. The study also found many in need of help who did not receive it. Routines for arriving at and formalising administrative decisions were incomplete. The study shows a failure of implementation of existing laws, regulations and patient rights, rather than a failure of the laws and regulations themselves / <p>ISBN 91-7997-148-2</p>

<p>The aim of the study has been to gain an increased understanding of the sense of participation and influence that the enrolled nurses, working with home-help services within the purchaser – provider model, feel and how this participation and influence affect them. Five enrolled nurses in three of Stockholm's districts related their experiences of participation and influence at work in the qualitative interviews that were conducted. The result was then analyzed with the help of two theories, Karasek's and Theorell´s Demand- Control Model and Antonovsky's theory regarding ”a Sense of Coherence (SOC)”. The analyzes show that the enrolled nurses have a low sense of participation and influence regarding decisions relating to their work situation. Decisions that affect the enrolled nurses are made by politicians, directors, and care managers of the city districts (biståndshandläggare). On the other hand, the enrolled nurses felt strong support from their peers at work. They could socialize and discuss issues with them. The analyzes show that without their peer support, they would have a lower sense of participation and influence. Furthermore the analyzes show that the interview subjects possess knowledge and competence that they are unable to make use of in their work.</p>

<p>This paper studies, from a client perspective, how three Swedish municipalities work with information about a voucher system in homecare. The paper is a qualitative study using structured informant interviews and analysis of documents. The interviewees are responsible of information about the voucher system in the municipalities. The studied documents describe and clarify the voucher system of the municipality. Neo-institutional organization theory is used to analyse the result. Existing research has showed how pensioners find information on the voucher systems lacking. The research also shows how care managers have difficulties relating to their new roles as information coordinators on the voucher system. With this background, the study focuses on examining how the municipalities work with and organises the information on the voucher system as well as how the responsibiliy of the information is handled. The result shows that the studied municipalities mainly deal with the issue from a market point of view, where the care providers are to be presented in a neutral way. However, one of the municipalities has reconsidered the principle of neutrality and works to clarify the information to the elders. All three municipalities place the responsibility of information on the care managers in their interaction with the elder. There is no further communication between the municipality and the elderly people in the form of client studies or fora of discussion and review of the information on the voucher system.</p>

The aim of the study has been to gain an increased understanding of the sense of participation and influence that the enrolled nurses, working with home-help services within the purchaser – provider model, feel and how this participation and influence affect them. Five enrolled nurses in three of Stockholm's districts related their experiences of participation and influence at work in the qualitative interviews that were conducted. The result was then analyzed with the help of two theories, Karasek's and Theorell´s Demand- Control Model and Antonovsky's theory regarding ”a Sense of Coherence (SOC)”. The analyzes show that the enrolled nurses have a low sense of participation and influence regarding decisions relating to their work situation. Decisions that affect the enrolled nurses are made by politicians, directors, and care managers of the city districts (biståndshandläggare). On the other hand, the enrolled nurses felt strong support from their peers at work. They could socialize and discuss issues with them. The analyzes show that without their peer support, they would have a lower sense of participation and influence. Furthermore the analyzes show that the interview subjects possess knowledge and competence that they are unable to make use of in their work.