Mia Vabø

Job stress, sickness absence and sickness presenteeism in Nordic elderly care

Aims: Nordic elderly care has been restructured to obtain more efficiency. Among workers caring for the elderly, levels of perceived job stress could vary, due to understaffing and resource scarcity. This study examines how sickness absence and sickness presenteeism are associated with perceived job stress. Methods: Data were obtained by posting questionnaires to lower-level care staff in Sweden (n=483), Denmark (n=704), Finland (n=597), and Norway (n=663). Self-reports about job stress (four items), sickness absence and sickness presenteeism were analysed by cross-tabulations and logistic regression. Results: Each item of job stress was associated with sickness absence and sickness presenteeism in the samples from all four countries. With low levels of job stress, levels of reported sickness absence and sickness presenteeism were relatively moderate. With increasing levels of job stress, the level of sickness presenteeism rose more sharply than that of sickness absence. Conclusions: The results can be interpreted in the light of features inherent in care work. Owing to professional norms and moral obligations, care workers could lower their thresholds for taking sick leave when care organizations are understaffed, because absences will be particularly critical for care recipients in such circumstances. Thus, while increasing job stress tends to be accompanied both by more sickness absence and by more sickness presenteeism, sickness presenteeism rises particularly in cases of high levels of job stress. Owing to cross-sectional data and self-reported information, conclusions are tentative.

CARING FOR PEOPLE OR CARING FOR PROXY CONSUMERS

ABSTRACT Reforms that aim at empowering recipients as ‘consumers’ are often seen as self-evidently favourable and unavoidable. Current narratives on public-sector change describe the previous service regimes as rigid, uniform and inhumane, whereas reforms are regarded as offering a flexible and responsive future. Accordingly, consumerism has become a major driving force behind Nordic welfare reforms. This paper presents a more nuanced analysis of the suppositions about the past systems for home care services and offers a critical view on current reforms and the assumptions underlying them. Empirical examples are drawn from field research and personal interviews undertaken before (1995) and after (2000) the Norwegian home care service was caught in the wave of New Public Management reforms. The paper demonstrates how contractual arrangements implemented in the name of the consumer run counter to established practices based on personal trust and continuous dialogue on needs.

Norwegian home care in transition – heading for accountability, off‐loading responsibilities

In Norway, home-based care forms part of the universal welfare model in that services are offered to and used by all groups of citizens. An infrastructure of in-home services has evolved within a multi-level government characterised by a combination of local autonomy and strong integration between central and local levels. In the mid-1980s and early 1990s, home care was typically organised in teams characterised by collegiality and flexible organisation. Over the past two decades, this framework has been challenged by new modes of governance introduced under the banner of transparency and accountability. This paper focuses on how this new trend in governance has been justified and put into practice. Against the backdrop of the institutional history of home care, the paper demonstrates how accountability arrangements became entangled with ongoing effort of local authorities to control costs. Drawing on existing case studies conducted at different points in time, the paper reveals how these arrangements have reshaped home care organisations in a way that also contributes to splitting up and curtailing responsibilities. It is argued that steps taken to make home care services more transparent and reliable have made them less sensitive to the particular needs of individual service recipients. Although no firm conclusion can be drawn from a limited number of case studies, the paper concludes by arguing that accountability arrangements in home care have enhanced the predictability and reliability of service delivery. However, as off-loading responsibilities may be disempowering for those who do not have additional coping resources, institutional changes may also serve to undermine the enabling role of home care services. These findings suggest a need to address the dilemma inherent in the rationing of home care services and to rethink how a contextual and situated approach to care can be better balanced against the requirement of due process.

A caring state for all older people

The Nordic Welfare states are frequently designated with labels like ‘social service states’ (Anttonen 1990) or ‘caring states’ (Leira 1994 ) as they offer a wide variety of services, including care services for children and elderly, to citizens of all socioeconomic groups. In this chapter, attention will be directed toward the Nordic home care service, a service which is often regarded an icon of the caring states. Home care is neither the most comprehensive or costly part of Nordic elder care, but we believe that this service institution may serve as an illuminating case to display some of the preconditions of and challenges confronting the Nordic universalist welfare policy.

Changing governance, changing needs interpretations: implications for universalism

Purpose – The paper seeks to explore how universal welfare arrangements based on needs testing may change and assume different institutional forms. Drawing attention to Norwegian home care, the paper explores how established interpretations of needs and associated notions of equity among needs have been challenged by shifting modes of governance.Design/methodology/approach – The study draws on policy documents, interviews and observation from three different case studies undertaken at different points in time representing different eras of governance. From this perspective, the study examines the role of professionals taking part in needs assessment.Findings – The studies indicate that routines for needs assessment in home care are contingent on shifting logics of governance. A shift in policy of needs testing may be described as a shift from a personal situated approach encouraging “creative justice” towards a detached and impartial approach better equipped to ensure “proportional justice”. The latter ap...

Shaping social situations: A hidden aspect of care work in nursing homes.

A significant aspect of care work in nursing homes involves dealing with emotional responses such as anxiety, fear, pain, depression and anger on the part of residents and their families. Previous care and nursing research on this topic centers around dyadic relationships and does not provide useful conceptualizations of how care workers actively deal with the social situations they encounter as part of their work. Drawing on ethnographic field work and interviews conducted in two Norwegian nursing homes, this article aims to describe and conceptualize a previously neglected aspect of good care work: the active shaping of social situations in order to lessen uneasy feelings of residents and their families. Three episodes of good work are described to illustrate how social situations can be shaped. Strategies include such actions as timing events, regulating ones presence, and composing social groups. The concluding section discusses some implications for nursing home management.

The Case Studies

Chapters 3 to 8 have described the social care each of the six countries provides for older people at the ‘system’ level of family, public, voluntary and private institutions. This chapter turns to what this means for individual older people who need assistance with activities of daily living because of ill-health or disability.