Outi Jolanki

Moral argumentation in talk about health and old age.

This study examines the ways in which people aged 90 or over construct and negotiate meanings of health in research interviews. Detailed analyses of two interview cases illustrate the flow of these negotiations within interviews, and how the interviewees balance different moral arguments. First, the interviewees try to manage the face-threat posed by the questioning about health. Second, their health accounts move on the axis of advocating good health and activity and conceding impaired health and diminished activity. They apply various rhetorical devices to challenge the traditional discourse of old age as decline. On the other hand, aligning oneself with the category of ‘old’ makes ill-health and inactivity legitimate, but brings along other kinds of moral obligations. Finally, the results are discussed in relation to cultural discourses of old age and health, and their moral implications.

Old age as a choice and as a necessity two interpretative repertoires

Abstract This article applies the method of discourse analysis to look at how older people talk about age and getting old. The data come from biographical interviews with people aged 90 years or over. The picture that emerges from these interviewees is one of ambivalence: old age is constructed through two contrasting repertoires that are described as the choice repertoire and the necessity repertoire. Talk about old age as a necessity produces it as a self-evident fact that the essence of old age is deterioration. Talk about old age as a choice is used to undermine the necessity repertoire and to argue for various and more positive definitions of old age among which one can make a choice. It is important to note that the contrast is not between cultural views and individual experience, but the ambivalence is rooted in peoples minds. Both repertoires are reasonable and justifiable, which turns old age into a dilemma. Our thinking about old age is dilemmatic by nature

To work or to care? Working women's decision-making

Recent changes in older peoples public care services in Nordic countries in particular in Finland and Sweden are based on implicit expectations that family members will increase their involvement in care. In Nordic countries, the care of small children has been acknowledged to be a social matter that concerns gender equality and the work life participation of both men and women, while the situation of working carers of older people is much less acknowledged. This study addressed the question of how Finnish working women who give care to their older parents argue for and against their decisions of working and caring and the meaning of work and care in these decisions. Majority of the interviewees emphasised the importance of work and refuted the idea of leaving work for care. The decision not to leave work for care was justified with worker identity, commitment to work, having no innate skills to be a carer, availability of support services and other carers and financial necessity. On the other hand, a few interviewees brought forward their willingness to leave work which was justified by constructing care as meaningful and valuable activity as opposed to meaningless paid employment, and with the intensification of work, and with ageing. Lengthy argumentation and several discursive tools indicate that women anticipated moral blame for the decision of giving work primacy over care, but also for leaving work. Thus, working carers balance between contrasting expectations to care and to work.

Elderly Parents’ Need for Help and Adult Children's Moving Decisions

Recent changes in Finnish welfare policies have increased the need for family involvement in eldercare. This article uses qualitative interviews to study working adult daughters’ reasons for moving in with their parent(s). Coresidence was linked to the parents’ need for support, but also to the daughters’ life situations, family histories, the availability of welfare services, and cultural norms and values. The interviewees used the “familist” and “independent life” discourses in their speech. The familist discourse was used to argue for coresidence as a natural continuation of family traditions and life history, whereas the independent life discourse was used to legitimize the need for alternative care options and having a home of their own.

The Meaning of a “Sense of Community” in a Finnish Senior Co-Housing Community

In the foreseeable future, alternative housing options will be needed to meet the needs of and answer to the wishes of older people. Co-housing schemes are developed to fulfill the need for a housing type that provides mutual support and social contacts while alleviating the isolation and loneliness often experienced in ordinary neighborhoods. This study on a senior co-housing community in Finland asked what a “sense of community” meant to the residents and how a sense of community becomes visible in daily life. For these residents, a sense of community meant not only living with like-minded people but also communal activities, doing things together, learning from each other, and having reciprocal support, all of which created a sense of togetherness, belonging, and trust. The findings of this study showed that moving in later life can offer a viable option of having a living environment that one likes, which calls for a broader interpretation of housing policy guided by “aging in place” thinking.

Understanding functional ability: Perspectives of nurses and older people living in long-term care

The functional ability of older people has come to play a significant role in their care. Policies and public debate promote active aging and the need to maintain functioning in old age, including among older people living in long-term care. This study explores the meanings given to functional ability in the interview talk of long-term care nurses (n=24) and older people living in long-term care (n=16). The study is based on discourse analysis and positioning theory. In this study, accounts of functioning differed between nurses and older residents. For the nurses, functional ability was about the basic functions of everyday life, and they often used formal and theoretical language, whereas for older long-term care residents, functional ability was a more versatile concept. Being active was promoted, particularly in the nurses talk but also sometimes in residents talk, thereby reflecting the public discourse about functioning. In their talk, the nurses positioned themselves in relation to functional ability as competent professionals and active caregivers. In residents talk, we found three positions: an active individual taking care of him or herself, a recipient of help, and a burden to nurses. To move in a direction that promotes activity and rehabilitative care, a better understanding of older peoples individual needs and their own views of functional ability is needed.

How do health care workers manage a patient with multiple care needs from both health and social care services? – A vignette study

Introduction To assess how health care professionals outline the management of care and explore which health or social care professionals were involved in the patients treatment. Methods A survey with a patient vignette for general practitioners (nu2009=u200931) and registered nurses (nu2009=u200931) working daily in Finnish health centres located in four cities. Respondents answered structural questions and explained in detail the care process that they tailored for the patient. The care process was examined using content analysis. Results A physician–nurse working pair was declared to be in charge of the care process by 27% of respondents, a registered nurse by 9% and a general practitioner by 11%. However, 53% reported that no single person or working pair was in charge of the care process (response rate 72%). The concluding result of the analyses of the presented process was that both treatment practices and the professionals participating in the patients treatment varied. Collaboration with social services was occasional, and few care processes included referrals to social services. Conclusion For the patient who needs both health and social care services, the management of care is a challenge. To improve the chances of patients being actively involved in making treatment plans at least three factors need to be addressed. Firstly, a written treatment plan should explicate the care process. Second, collaboration and interaction between health and social care services should be strengthened, and third, a contact person should be named to avoid care gaps in primary health care. Next-step data from patients need to be collected to get their views on care management and compare these with those from general practitioners and registered nurses.

Primary health care nurses’ views on patients’ abilities and resources to make choices and take decisions on health care

Recent health reforms in many European countries have emphasised patient choice as a tool for patient participation, and for the improved efficiency of services. Little attention has been paid to experiences of the nurses in these reforms, even though the reforms directly concern all health care personnel and cannot be implemented without their contribution. This study looks at patient choice from the perspective of the nurses working in primary health care clinics in Finland. In Finnish primary care, nurses have a central role in coordinating patient care and advising patients. The data come from 31 interviews conducted in 17 health care clinics. The approach adopted in the analysis is data-driven and brings forth nurses experiences in their daily work with patients. A detailed analysis of the nurses responses and views was conducted with discourse analysis. While nurses positioned some patients as knowledgeable, able to search for information and make use of different services without nurses help, some of the patients were positioned as those needing nurses advice and guidance through the complex system of health and social care services. Nurses positions varied from co-actors and gate-keepers to advocates and spokespersons. In order to succeed future health care reforms need to take better into account the realities of health clinics and the grassroots-level knowledge that primary care nurses have on patients and clinical practices.

The Janus face of social innovation in local welfare initiatives

The aim of this chapter is to understand the relationship between local welfare initiatives and social innovation and how it varies across places. Since welfare policies must tackle increasing needs with scarcer resources, the topic of social innovation has become relevant. Social innovation expresses a shared hope for making things better in the future (Evers, 2015). It is a semantic magnet that attracts many different meanings and is charged with many positive connotations (Bergmark et al., 2011). As Martinelli (Chapter 1, in this volume) suggests, social innovation is an important dimension of the restructuring of social services and must be integrated into the analysis. To explore the role of social innovations in the restructuring of social services, we analyse four local welfare initiatives in health and social services. By ‘local welfare initiatives’, we refer to collective practices that arise at the municipal or neighbourhood level for creating or sustaining the welfare of individuals, groups or communities through the provision of services. The local initiatives under study take place in four municipalities in different European countries and aim to renew social policy practices and services in neighbourhoods or for particular groups of people. Our focus is on the variations in the way social innovation is created and sustained in these local welfare systems, which we define as ‘dynamic arrangements in which the specific local socioeconomic and cultural conditions give rise to different mixes of formal and informal actors, public or not, involved in the provision of welfare resources’ (Andreotti et al., 2012, p. 1925). As a result, new local combinations of social activities emerge in the welfare diamond (Martinelli, Chapter 1, as well as Leibetseder et al., in this volume), i.e. among state and municipal services, social entrepreneurs, third sector organisations, and community and family networks (Evers and Ewert, 2015).

Professionals’ views on integrated care

Purpose n n n n nIntegrated care policies have been at the heart of recent health reforms in many European countries. The purpose of this paper is to study the integration from the perspective of health care personnel working in primary health care clinics. n n n n nDesign/methodology/approach n n n n nThe study employs data from interviews collected in a research project examining patient choice and integrated care in primary health care clinics in Finland. The interviews were conducted in five cities in Southern Finland in 17 primary health care clinics in Autumn 2014. Among the interviewees there were both doctors (n=32) and nurses (n=31). n n n n nFindings n n n n nThe typical problems hindering integration were, according to the workers, poor communication and insufficient information exchange between professionals, unclear definition of responsibilities between professionals, and lacking contacts and information exchange between health and social care professionals. To secure availability and continuity of care, doctors and nurses did extra work and exceeded their duties or invented ad hoc solutions to solve the problem at hand. According to professionals, patients were forced to take an active role as coordinator of their own care when responsibilities were not clearly defined between professionals. n n n n nOriginality/value n n n n nThis paper highlights that successful integration requires taking into account the requirements of the day-to-day work of health care clinics, and clarifying what facilitates and what hinders practical collaboration between different actors in health care and between health care and other service providers.