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This study explores the medical services based on the ICT technologies such as the wireless network and positioning. The related history of internet and recently developed technologies of localization will be introduced. The literature review and case study approaches will be applied to explore the medical services using high technologies. Combining new technologies and medical industry requires an integrated platform. How to design such a platform and what functionalities required in that are investigated in this thesis. Our data is mainly from Industrial Technology Research Institute (ITRI), including the platform for homecare and eldercare. Moreover, we also study the product samples available on numerous web sites. The services provided in Taiwan are inspected as well. Due to the increasing aging population worldwide, the medical services incorporating high-tech such as homecare and eldercare have attracted interests from both academics and industry. Once a well developed platform can be integrated, there are many advantages can be expected such as saving the medical resource, enhancing the service quality, and so on. Therefore, the government puts emphasis on such medical integrated scheme such as the U-care project in order to meet the future requirements. We will report the platform constructed by ITRI and analyze the problems encountered in the advanced country such as Japan and America. Finally, how the technologies are developed from the engineer perspective will be clarified. The networking and positioning services from Intel and Microsoft are studied in this work and the evolvements are also illustrated

Syftet med studien var att undersöka om det fanns skillnader i uppfattning av feedback (positiv, negativ och kvalité) beroende på om den kom från chef, medarbetare, vårdtagare eller anhörig inom äldreomsorgen. Ett ytterligare syfte var att undersöka vilken feedbackkälla som bäst predicerar generell arbetstillfredsställelse. Studien genomfördes på sju äldreboenden där 87 anställda deltog. De mätinstrument som användes i studien var FES-skalan som mätte de olika aspekterna av feedback, samt Minnesota Satisfaction Questionnaire (MSQ) som mätte arbetstillfredsställelse. Resultatet visade att källan chef predicerade generell arbetstillfredsställelse bäst av de fyra källorna, samt att det var aspekten kvalité som bidrog mest i modellen. Positiv feedback från vårdtagare och negativ feedback från chef skattades högst. Resultatet visade även att den interna reliabiliteten för samtliga feedbackaspekter inom varje källa var god. Avslutningsvis visade resultatet att inre arbetstillfredsställelse skattades högre än yttre arbetstillfredsställelse. / The purpose with this study was to examine whether there were differences in the perceptions of feedback (positive, negative and quality) depending on whether it came from the supervisor, co-workers, patients, or family members in nursing homes. A further aim was to examine which feedback-source that best predicts job satisfaction. The study was conducted on seven nursing homes where 87 employees participated. The instruments used in the study were FES-scale that measured the different scales of feedback, and the Minnesota Satisfaction Questionnaire (MSQ) which measured job satisfaction. The results showed that the source supervisor predicted overall job satisfaction best of the four sources, and that the aspect quality contributed most to the model. Positive feedback from patients and negative feedback from supervisor was rated highest. The results also showed that the internal reliability for all the feedback aspects of each source was good. In conclusion, the results showed that internal job satisfaction was rated higher than external job satisfaction.

The public eldercare is responsible to provide with both resources and safety for the elderlypopulation now and in the future with the challenge of an aging population. Each of the smallmunicipalities in Åland provides with care for the elderly. This is regulated by the Finnishsocial welfare act with the purpose for the elderly to get the social care they are in need of.The goal of this study is to find out the biggest challenges with this implementation accordingto the leaders of the eldercare. The interviews and the analysis in this study are based on theclassic implementation theory by Lundquist (1992) in which the implementation is analyzedby three important elements: the knowledge, the resources and the willingness to implement.The results of this study indicate that there is some challenges in the implementation of thesocial welfare act. Although there is some lack of resources this is the element in which themost development is taking place, and perhaps the easiest element for the eldercare leaders todiscuss. There is a strong willingness among the leaders to implement the social welfare act.Finally the knowledge has many sides since the leaders are sometimes self taught but alsoaffected by the vagueness of the law. The eldercare is in for a change, in which new laws areabout to be implemented in to the eldercare system and a whole new implementation processwill begin during the next year.

Tidigare forskning visar att äldreomsorgspersonal kämpar med två typer av logiker: en ekonomisk logik och en omsorgslogik. Även om båda logikerna behövs för att skapa god omsorg så utmanar de varandra. Dessa utmaningar kommer till uttryck i omsorgspraktiken där personalen ställs in för val och måste göra prioriteringar. Denna avhandling syftar till att förstå hur äldreomsorgspersonal beskriver att de arbetar för att finna balans mellan logikerna och hur de rättfärdigar sina prioriteringar i omsorgen om de äldre personerna. Frågeställningen för avhandlingen är att ta reda på hur personal och enhetschef vid ett kommunalt äldreboende förstår och hanterar interaktionen mellan de två logiker som styr omsorgsarbetet för att främja de äldre personernas välbefinnande. Syftet innehåller tre delsyften: 1) att analysera personalens erfarenheter av och meningsskapande kring de äldre personernas välbefinnande och deras reflektioner kring det omsorgsarbete de utför, 2) att belysa och problematiserade logiker som styr omsorgsarbetet samt 3) att analysera hur personalen rättfärdigar sina prioriteringar i rådande kontext och hur deras förklarbarhet påverkar deras professionella identiteter. Målet är att bidra med socialvetenskaplig kunskap om de överväganden personal gör när de ställs inför att göra prioriteringar i äldreomsorgens praktik. Material samlades in genom 12 individuella intervjuer med personal vid ett kommunalt äldreboende, en intervju med personalens enhetschef och en uppföljande gruppintervju med tre personer ur personalgruppen. Materialet analyserades med tre analysmetoder: fenomenologisk analys, reflexiv analys och positioneringsanalys. Resultatet visar att personalen definierar de äldre personernas välbefinnande som ett behov av att känna sig existentiellt berörd. Denna känsla av existentiell beröring delas in i tre delar: känsla av valfrihet, känsla av njutning och känsla av närhet till någon eller något. Arbetet för att uppnå detta välbefinnande beskrivs innebära ett balanserande av tre tvetydigheter: att vilja värna om de äldre personernas valfrihet och samtidigt hantera institutionella begränsningar, de äldre personernas behov av aktivering å ena sidan och att de inte behöver aktiveras å andra sidan samt att förstå de äldre personernas behov av rutiner samtidigt som det är svårt att veta vilka behov de har. Tvetydigheterna kontextualiserades och de två logikerna som styr omsorgsarbetet analyserades. Analysen visar att enhetschefen skapar en hybrid av den ekonomiska logiken och omsorgslogiken; ekonomi är omsorg och vice versa. Denna hybrid möter motstånd från personalen som skiljer på de båda logikerna genom att tala om ”vård och det där andra”. Personalen upplever att den ekonomiska logiken begränsar deras möjligheter att utföra omsorg i linje med omsorgslogiken. Motsättningar mellan de båda logikerna leder till prioriteringar som rättfärdigas av personalen i syfte att behålla de professionella identiteterna. Den teoretiska analysen bygger på teorier om institutionella logiker, förklarbarhet ochprofessionell identitet. Analyserna visar vikten av att väcka dialog mellan enhetschefer och personal där de diskuterar innebörder av olika värdeord som används på politisk nivå. Sådana diskussioner skulle kunna bidra till mindre motstånd och en högre överensstämmelse mellan verksamhetsmål och praktik. Avhandlingen visar även vikten av att förstå logiker som vertikala istället för horisontellt uppdelade. Alltså, att styrande verksamhetslogiker existerar uppifrån och ned i verksamheter (från politisk nivå till chefsnivå och till praktisk nivå) och att de inte kan delas in i exempelvis en professionslogik och en styrningslogik. Den senare synen kan bidra till potentiella missförstånd eftersom det gör att konflikter kan tolkas existera mellan personal och chef, medan de egentligen existerar mellan olika motstridiga värderingssystem. Slutsatsen är att de båda logikerna behövs för att stödja äldre personers välbefinnande. Ibland är logikerna samspelta och ibland är de i konflikt med varandra. När logikerna ställs mot varandra är det av vikt att komma ihåg att den ekonomiska logiken är lika förhandlingsbar som omsorgslogiken. De två logikerna existerar i samspel och om deras motstridigheter inte belyses finns risk att omsorgspraktiken inte stödjer de äldre personernas välbefinnande. / This dissertation aims at contributing to social scientific knowledge about prevailing prioritizations in eldercare practice by looking at an economic and a caring logic, and how these logics are overlapping, contradictory or come in conflict with each other. A more concrete aim is to understand how the personnel describe their work with or for balance between the logics and their justifications prioritizations made in the care of older persons. The research question is: How do personnel and care unit manager at a public nursing home understand and handle the two logics that govern care work for facilitating wellbeing of the residents. The aim and research question led to three sub-aims: 1) to analyze the personnel’s experiences of and meaning making about the care work they carry out, 2) to illuminate and problematize the two logics above, and 3) to analyze how the personnel justify their prioritizations in prevailing context, and how their accountability have an effect on their professional identities. Empirical material was gathered through 13 individual interviews with care personnel and their care unit manager at a public nursing home in Sweden. These interviews were complemented by a group interview. The material was analyzed by the use of three methods: phenomenology (Paper I and II), reflexive analysis (Paper III), and a positioning analysis (Paper IV). Paper I found that the personnel understands the residents’ well-being as being characterized by feeling of being existentially touched. This essence is constituted by feeling freedom of choice, pleasure, and closeness to someone or something. In Paper II, the work for facilitating this kind of wellbeing was characterized by three ambiguities: (i) freedom of choice for the older persons vs. institutional constraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need for routine vs. the eldercarers' not being able to know what the residents need. Paper III showed that the care unit manager created a hybrid of the two logics (economy is care and vice versa) and that the personnel oppose this hybrid. The opposition is shaped as the personnel divides their work in care and “those other things”. These findings showed how interaction between the logics expresses itself in practice and that it is the personnel who has to handle contradictions between the logics in their everyday care work. The positioning analysis in Paper IV had three levels. The first level showed how the carers align with their peers and that they find the organizational frame, within which they have agency, changed due to increased workload. This change led to an order of priorities. The second level showed that the carers relate to three aspects when making accounts: the care itself, the older persons, and the media. The third level showed that the carers share a view of administration, cleaning, serving meals, and filling up supplies, as not being parts of caring. The dissertation’s theoretical framework focused on theories on logics, accountability, and professional identity. The conclusion is that both logics are needed in order to facilitate the well-being of the older persons. The relationships between the two logics are not always clear and if their contradictions are not illuminated, there is a risk for a care practice that does not facilitate the well-being of their residents. An important theoretical contribution is that logics of activities should be understood vertically (form political, through management, and down to the level of practice) instead of horizontally. The practical implications emphasize the importance of supporting the personnel’s professional identity on the one hand, and discussing the logics on the other. By understanding differences between definitions on management-level and practice level, a homogeneity can be reached.

SAMMANFATTNING BAKGRUND: I och med Ädelreformen flyttades vården av äldre till kommunen och sjuksköterskor började arbeta inom den kommunala äldreomsorgen. Arbetet saknar tydliga riktlinjer och rutiner. Det innebär ett stort ansvar för sina arbetsuppgifter samt patientansvar. Vid konsultarbete ansvarar sjuksköterskan för ett stort antal människor och förmåga att prioritera och snabbt göra bedömningar av arbetsuppgifter och sjukdomstillstånd krävs. SYFTE: Syftet med studien var att utifrån sjuksköterskors berättelser beskriva deras upplevelser av sitt arbete inom den kommunala äldreomsorgen. METOD: Det är en deskriptiv studie. Information samlades in genom semi-strukturerade fokusgruppsintervjuer. Totalt tio sjuksköterskor deltog uppdelade på intervjugrupper. Det insamlade materialet bearbetades sedan genom tematisk kvalitativ innehållsanalys. RESULTAT: Resultatet visar att sjuksköterskorna upplever ett stort ansvar för sina bedömningar och arbetsuppgifter. De upplever att de inte har några tydliga riktlinjer för sin specifika funktion i kommunen vilket innebär att de ofta får ansvar för uppgifter som inte är deras. Det ökade administrativa arbetet leder till minskad tid för patienter och omvårdnadsarbete vilket leder till frustration och en känsla av otillräcklighet. SLUTSATS: Sjuksköterskans funktion i kommunen behöver preciseras så att hon kan minska sina administrativa uppgifter och få mer tid till patienter och omvårdnadsarbete. Även teamarbetet behöver utvecklas för att stärka yrkeskategorierna och göra riktlinjerna tydligare. Nyckelord: registered nurse, eldercare, residential homes, professional role, focus group

The present study analyses the welfare state as employer by studying eldercare workers’ experiences of their work in Sweden and Denmark.  The Nordic welfare states are often described as potentially women-friendly due to the availability of publicly provided services that enable women to combine paid work and caring responsibilities.  Whereas this might be empowering for a large group of women, paid care workers are often neglected in the discussion. The theoretical point of departure is Nancy Fraser’s dualistic model of gender justice, which encompasses redistribution (of material resources) and recognition (in the form of social status). By utilising survey-data (NORDCARE) on Swedish (n=532) and Danish (n=732) eldercare workers, the study shows that care recipients have larger needs and working conditions are more arduous in Sweden. However, in both countries workers report deficiencies with regard to insufficient resources, such as lack of staff, limited opportunities for development and training, and lack of necessary equipment for lifting service users, of support from managers and of reasonable time for the tasks to be performed. The pressure at work makes the care workers feel inadequate in relation to quality of care they are able to offer. The differences in job strain between the countries turn out to be of little importance when the care workers’ experiences of bodily and mental fatigue are compared. The bodies of the care workers are their main working tool and thus the bearer of the working conditions. More than 60 per cent of the respondents state that they often are physically tired after the day's work, and two-fifths of the respondents have seriously considered leaving their job during the past year. In both countries, the experience of physical and mental fatigue and the number of sick days over the past year are important factors behind thoughts about quitting the job. Using a dualistic model of gender justice, where redistribution and recognition are theorised as overlapping analytical dimensions, the results are interpreted as continuous organisational shortcomings which make the care workers’ everyday work invisible, and in the long run imply a risk for their health.

Against the backdrop of successful family planning in China, the aging of the society’s population is increasing. With the increasing number of older adults, the support of the elderly has become a significant issue for society. Filial piety and respect for the elderly are the fundamentals of Chinese society and its long history. One aspect of filial piety focused on the responsibilities of the family in eldercare. It advocates that the elderly need not only material help but also spiritual comfort and emotional support. This culture of filial piety in a traditional Chinese society illustrates a path for responding to problems of the aging population. However, with the advent of an industrialized society, China’s family structure has undergone fundamental changes. There is an increasing trend of families choosing to send the elders to long-term institutional care rather than home or community care. This has led to conflict between traditional filial piety principles and the new model of aging healthcare. As a result, it is important to understand whether the new institutional care in China will meet the material and spiritual needs of the elderly. This paper aims to examine how Chinese values connect with eldercare treatments nowadays with the interplay of filial piety Confucian familism. More specifically, this paper discusses how Confucian values play in the relationship among eldercare locations, accessibility to care, and how filial piety has been expressed in the senior home before and during the COVID-19 pandemic in China. Also, since the available data on service and quality in nursing homes in China is limited, it is important to understand what administrators and caregivers are experiencing as a first step. This paper examines the following issues during the COVID-19 outbreak. 1. To what extent does Filial-piety Confucian familism play a role in young and elder generation’s attitudes regarding elder health care? 2. What challenges do the nursing homes face before and during the pandemic? 3. How was filial-piety expressed in the nursing home before and during the pandemic? Methodology and Methods This project conducted a total of 15 in-depth interviews with selected interviewees, including both selected administrators and caregivers in five nursing homes in Shanghai, China. As the researcher was born and raised in Shanghai, the insights for this research came partially from the real-life experience and a personal understanding of Chinese culture. The researcher conducted this qualitative study in Shanghai during the time when there were restrictions on travel and interaction due to COVID-19. Regarding the location specialty, the researcher was able to conduct interviews in Shanghainese and observe the cultural rituals inherent in the region. The interviews were conducted to observe examples of experiences that administrators and caregivers observed or participated in. As such, the results are based on examples more so that opinions or attitudes. All interviews were recruited through email exchanges and discussions were over WeChat (a Chinese communication app) and phone calls due to the pandemic restrictions. Key Findings This study found that numerous young people in China chose to place their parents in nursing homes due to busy work schedules, house demolitions, and the need for long-term medical care for their parents. However, senior care institutions are still in the stage of exploration and standardization. Inevitably, there are some problems, including a shortage of professional medical staff and a limited level of medical services that can be provided. It was found that this new and flourishing model of elderly care is also facing a series of problems that are prevalent around the world, such as high bed vacancy rate, endless psychological problems of the elderlies, and increased operating costs of nursing homes. This information has led us to question whether the elders are living well and to try to understand views of nursing homes and filial piety. We found that most elders have gradually changed their traditional concept of filial piety to a more modern one. The administrators and caregivers we interviewed said that “filial piety” is a respect from the heart, a mutual emotional exchange and understanding. It possesses equality and democracy between two generations. Their comments suggest that more elderly people living in nursing homes have low attachment to traditional notions of filial piety. In contrast, more children have a solid attachment to traditional filial piety because they struggled mentally before sending their parents to a nursing home. In addition, the study found that filial piety was expressed differently before and during COVID-19. Prior to the pandemic, the administrators and caregivers suggested that individuals were more inclined to fulfill practical obligations and compassionate reverence needs. Whereas, during the pandemic, filial piety was expressed less practically and more emotionally due to the closure of institutions. Future Research Further studies should expand the sample size by including more nursing homes in various districts of Shanghai. It would be helpful if researchers can interview the caregivers and administrators in person and visit some of the care homes to gather other information on the unique needs of clients and families. Further studies could seek to discover how filial piety plays a role in the nursing home after the pandemic has passed. The challenges of the aging models can be further analyzed and recognized through exploring public policies and the needs of China’s overall society. For example, China's future pension system might need to respond to how filial piety evolves. A comprehensive pension security system based on current filial views could be established where children might play different roles in the older adults' material life, care, and spiritual comfort. This research offers suggestions to consider in future research relating to finding a role for elderly care homes in society in reducing some of the negative perceptions of these homes, developing a model that meets the needs of elderly and children, and training and developing staff. Firstly, research might seek to understand how to address some of the negative perceptions of the nursing homes and, possibly, change the view that nursing homes do not mean an abandonment of the elderly. Rather, research might seek to illustrate ways that nursing homes might implement a modern version of filial piety which provides a way that elderly can live in a care home as well as participating with their children in their family homes. Secondly, the study might get input into a template or model for designing nursing homes to recognize the evolving changes and pressures on traditional views of filial piety. As needs of children and elderly in a society have changed, so have their expectation of filial piety and, given these changes, how do we develop elderly institutions to respond to the economic needs of children and society at large? Thirdly, the research might investigate the response to the concerns raised from administrators about the shortage of trained staff. This might involve identifying needs of qualified care professional and encouraging their training and developing in colleges, vocational and technical colleges, secondary vocational schools, and county vocational education centers. / Graduate

Studies of Ghanaians who have immigrated to the United States indicate that both economic and emotional support continue to be provided to non-migrant families in Ghana. However support to “family relatives” has been studied generally, without specifying age. Thus, relationships between immigrants and their elderly relatives, particularly those who may be frail and vulnerable, have not been the focus of previous research. In addition, it is necessary to examine the dynamics that shape attitudes towards elderly people, and which in turn influence eldercare patterns among Ghanaian immigrants. Based on the literature, the researcher identified four factors relevant to international long-distance eldercare: (1) support caregivers receive (or previously received) from elderly relatives, (2) filial obligation towards elderly relatives, (3) perceived vulnerability of the elderly people in Ghana, and (4) vulnerabilities that make immigrants unable to provide eldercare. The main objective of this study was to examine the extent to which these four factors shape the provision of eldercare by Ghanaian immigrants in the United States to their elderly relatives in Ghana. To achieve this objective, a convenience sample of 124 Ghanaian immigrants who resided in a large metropolitan area in the southern United States was surveyed. Study results reveal that the dominant type of eldercare provided was emotional care, but special circumstances in elderly people’s lives, such as serious financial problems may significantly increase their chances of receiving financial support. For caregivers, their levels of income significantly determined the level of financial support provided to their elderly relatives and how often they visited them. It was also found that there are always some siblings left in Ghana to take care of the physical needs of elderly parents in the absence of those who have migrated. Elderly people having multiple migrant adult children or relatives were more likely to receive financial support from multiple sources. Factors contributing to immigrants supporting elders in Ghana included feelings of high obligation toward elderly relatives, readiness to show love and appreciation for elderly relatives, and acceptance of eldercare as a moral obligation for all adult children. Overall, there was evidence to conclude that most immigrants provided care to their elderly relatives and that most were influenced by the social and cultural tenets that underlie elder caregiving in Ghanaian society. Implications of the study for social work research include the importance of further exploration of factors that might result in reduction in the care immigrants provide to their non-migrant elderly relatives, and replication of the current study with the view of explaining the inability of both elderly relatives’ and immigrants’ vulnerabilities to predict level of care. Given the possible psychological distress associated with caregiving and its effect on immigrants’ time and financial resources, social work practitioners need to be sensitive to the financial and emotional aspects of long distance caregiving by providing services to caregivers who may need them. Policy implications include maximizing remittances by reducing transaction cost and using remittance as leverage for financial grants for family investments.

Sammanfattning Denna studie syftar till att undersöka hur enhetschefer inom äldreomsorgen resonerar kring begreppet värdighet hos äldre personer som bor på särskilt boende, samt hur de ser till att deras personal omsätter värdighet i det praktiska arbetet. Värdighetsbegreppet diskuteras främst i förhållande till komponenterna bemötande och självbestämmande. Studien genomfördes med en kvalitativ forskningsmetod i form av semisstrukturerade intervjuer med fem enhetschefer inom äldreomsorgen. I analysen användes fyra olika teorier om värdighet, nämligen (I) meritvärdighet, (II) värdighet som moralisk resning, (III) identitetsvärdighet samt (IV) människovärde. Studien visar att begreppet värdighet rymmer en mängd olika beståndsdelar enligt enhetschefer för äldreomsorgen. Bland annat nämns individualitet, god omvårdnad, respektfullhet och gott bemötande som viktiga delar av värdigheten. Enhetschefer inom äldreomsorgen lägger också mycket vikt vid sin personal och huruvida de uppfyller dessa komponenter i sitt praktiska arbete kring äldre. Studien indikerar även att begreppet identitetsvärdighet bör uppmärksammas och lämnas mer utrymme inom verksamheter som rör äldre. / Abstract This study aims to examine how unit managers in eldercare reason about the concept of the dignity of older people living in residential care, and how they ensure that their staff turnover of dignity in the practical work. Dignity concept is discussed mainly in relation to the components of treatment and self-determination. The study was a qualitative research in the form of semi-structured interviews with five heads of units in elderly care. The analysis used four different theories of dignity, namely (I) merit dignity, (II) dignity as moral stature, (III) the identity and dignity and (IV) human dignity. The study shows that the concept of dignity can accommodate a variety of ingredients according to unit managers for their care. Among others mentioned individuality, good care, respectfulness and good treatment as essential elements of dignity. Heads of Unit in elderly care also places much emphasis on their staff and their compliance with these components in the practical work around the elderly. The study also indicates that the concept of dignity as identity should be recognized and given more space in the activities related to the elderly.