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Assessment meetings between care managers and persons living with dementia: Citizenship as practice
Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Behovsbedömningssamtal mellan biståndshandläggare och personer med demenssjukdom : Medborgarskap i praktiken (Swedish)
Abstract [en]

This thesis deals with encounters between persons living with dementia and care managers. Dementia often results in progressive care needs that must be met by different social care services. The person’s care needs are assessed in an assessment meeting where the person and their relatives meet with a care manager to negotiate needs and social care services. The assessment is conducted through one or several conversations where the person with dementia meets the care manager; relatives are often present in the meetings. Dementia is a syndrome that involves a cognitive decline and a decreased ability to communicate and interact with others. It may therefore be difficult for a person with dementia to take part in discussions about their care needs and social care services. 15 audio recorded meetings have been studied to explore and understand how persons with dementia use their remaining communicative, cognitive and linguistic resources to invoke, negotiate, and use their rights as citizens in the institutional context where their care needs are assessed. The analysis concerns the organization of talk as a joint activity; the production of social actors in talk-in-interaction; the relation to institutional features of discourse. This dissertation concludes that the practice of citizenship is situation based and varies depending on the participants present. Care managers can facilitate for persons with dementia to overcome communication problems by using different discursive strategies and to make it possible for them to participate or at least be included in the negotiation. Persons with dementia are positioned as less competent than other persons participating in the assessment meeting. This might have an impact on the participation of people with dementia in negotiations regarding their future care. Furthermore, stories told in assessment meetings often position the person as dependent on others, which could undermine the identity and sense of self of the person with dementia.

Abstract [sv]

Den här avhandlingen berör möten mellan personer med demenssjukdom och biståndshandläggare. Demenssjukdomar medför ofta komplexa omsorgsbehov, vilka kan mötas med hjälp av olika stödinsatser. Personens omsorgsbehov bedöms i ett biståndshandläggningssamtal där personen och dennes anhöriga träffar en biståndshandläggare för att förhandla dennes behov och eventuella insatser. Konversation är centralt i dessa möten. Demenssjukdomar medför kognitiva nedsättningar och nedsatt förmåga att kommunicera och interagera med andra. Det kan därför vara svårt för personer med demenssjukdom att deltaga i diskussioner om behov och insatser. 15 ljudinspelade samtal har studerats för att förstå hur personer med demens använder sina kvarvarande kommunikativa, kognitiva och språkliga resurser för att åberopa, förhandla och använda sina rättigheter som medborgare i den institutionella kontext där deras omsorgsbehov bedöms. I samtalet medverkar personen med demens, handläggaren samt ofta någon familjemedlem. Analysen fokuserar på organiseringen av samtal som en gemensam aktivitet; hur sociala aktörer skapas i samtal; hur det institutionella samtalets särdrag påverkar konversationen. Sammanfattningsvis visar denna avhandling på att hur medborgarskap praktiseras är situationsbaserat och varierar beroende på vilka som deltar i mötet. Biståndshandläggare kan underlätta för personer med demenssjukdom att övervinna kommunikativa problem genom att använda olika samtalsstrategier och göra det möjlig för dem att delta eller att åtminstone inkluderas i förhandlingen angående olika stödinsatser. Personer med demenssjukdom positioneras ofta som mindre kompetenta än andra personer som deltar i behovsbedömningssamtal, vilket kan medföra konsekvenser på personens delaktighet i planerandet av framtida insatser. Berättelser i dessa samtal positionerar ofta personen med demenssjukdom som beroende av andra, vilket kan underminera deras identitet och uppfattning av sig själva.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 71 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 684
Keyword [en]
Ageism, decision-making, elderspeak, institutional discourse, malignant positioning, narrative, needs assessment, social work, storytelling
Keyword [sv]
Behovsbedömning, berättande, berättelser, beslutsfattande, institutionella samtal, malign positionering, socialt arbete, ålderism, äldreriktat tal
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing Neurosciences Social Sciences Interdisciplinary
Identifiers
URN: urn:nbn:se:liu:diva-127392DOI: 10.3384/diss.diva-127392ISBN: 978-91-7685-759-5 (print)OAI: oai:DiVA.org:liu-127392DiVA: diva2:923240
Public defence
2016-06-03, K1, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (Swedish)
Supervisors
Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2016-05-13Bibliographically approved
List of papers
1. Citizenship as practice: Handling communication problems in encounters between persons with dementia and social workers
Open this publication in new window or tab >>Citizenship as practice: Handling communication problems in encounters between persons with dementia and social workers
2016 (English)In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 6, 1457-1473 p.Article in journal (Refereed) Published
Abstract [en]

The overall aim of the study was to investigate if and how persons with dementia were able to take part in negotiations for formal support, as cases of citizenship as practice. The transcripts used for analysis were from 11 assessment meetings conducted in Sweden, in which the formal applicant was a person with dementia. The findings suggest that the actual participation of persons with dementia in assessment meetings varies. Communication problems were found in the meetings to different degrees and were dealt with differently and with various consequences. For those persons with dementia contributing at the same levels as the other participants, there was an attempt at mutual understanding. For those making fewer contributions, the other interlocutors took over the initiative and thus affected the practice of citizenship by persons with dementia in a negative way. The practice of citizenship is situation based and varies depending on all participants. When the person with dementia is able to participate in the conversation, social workers can facilitate for them to overcome communication problems by giving them more time and signaling acceptance. If the person with dementia has great problems in participating, the other participants can find different strategies to at least involve her or him in the conversation

Place, publisher, year, edition, pages
Sage Publications, 2016
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-119105 (URN)10.1177/1471301214563959 (DOI)000387007700009 ()25525075 (PubMedID)
Note

Funding agencies: Solstickan Foundation; Swedish Riksbankens Jubileumsfond [M10-0187:1]

Available from: 2015-06-09 Created: 2015-06-09 Last updated: 2017-12-04
2. Handling the dilemma of self-determination and dementia: A study of case managers’ discursive strategies in assessment meetings.
Open this publication in new window or tab >>Handling the dilemma of self-determination and dementia: A study of case managers’ discursive strategies in assessment meetings.
2015 (English)In: Journal of Gerontological Social Work, ISSN 0163-4372, Vol. 58, no 6, 613-636 p.Article in journal (Refereed) Published
Abstract [en]

In assessment meetings concerning care services for people with dementia, Swedish case managers face a dilemma. On the one hand, according to the law, the right to self-determination of every adult citizen must be respected, but on the other hand cognitive disabilities make it difficult to fulfill obligations of being a full-fledged citizen. In this article, we examine 15 assessment meetings to identify discursive strategies used by case managers to handle this dilemma. We also examine how these affect the participation of persons with dementia, and indicate implications of our study for social work practice and research.

Place, publisher, year, edition, pages
Routledge, 2015
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-122384 (URN)10.1080/01634372.2015.1067851 (DOI)26207822 (PubMedID)
Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2016-04-26
3. Orally positioning persons with dementia in assessment meetings
Open this publication in new window or tab >>Orally positioning persons with dementia in assessment meetings
2015 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 35, no 2, 367-388 p.Article in journal (Refereed) Published
Abstract [en]

In this paper the authors study if and how persons with dementia are orally positioned by others, and how they position themselves while participating in assessment meetings held in order to discuss access to supportive services. We analysed five assessment meetings where two older persons (one diagnosed with dementia and one without a dementia diagnosis) participated to investigate whether the person with dementia is positioned differently than the other old person. Interactional phenomena used to position the person with dementia were identified by interactional analysis.

The paperidentifies six phenomena that positioned the person with dementia as an individual with less interactional competence than the other participants: ignoring the person with dementia; voicing the feelings, capacity or opinion of the person with dementia; posing questions implying lack of competence; others' use of diagnosis; self-(re)positioning; and elderspeak. Persons with dementia are often orally positioned as less competent, indicating that they suffer further from discrimination than other older persons. We suggest that this has an impact on the participation of people with dementia in negotiations regarding their future care. The results indicate that social workers should be made aware that negative positioning exists and how it may affect the ability of people with dementia to contribute to discussions about their everyday life. Social workers should be encouraged to find strategies to reduce negative positioning in interaction.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2015
Keyword
Äldreriktat tal positionerna biståndshandläggarsamtal demens
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-103361 (URN)10.1017/S0144686X13000755 (DOI)000357881000007 ()
Available from: 2014-01-17 Created: 2014-01-17 Last updated: 2017-12-06

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