Care Work in Crisis. Reclaiming the Nordic Ethos of Care EDITED BY SIRPA WREDE LEA HENRIKSSON HAKON H0ST STINA JOHANSSON BETINA DYBBROE

Transcription

1 Care Work in Crisis Reclaiming the Nordic Ethos of Care EDITED BY SIRPA WREDE LEA HENRIKSSON HAKON H0ST STINA JOHANSSON BETINA DYBBROE t^j Studentlitteratur

2 Contents LIST OF TABLES 9 CONTRIBUTORS 11 FOREWORD 13 INTRODUCTION 15 Care Work and the Competing Rationalities of Public Policy Sirpa Wrecle, Lea Henriksson, Hakon Host, Stina Johansson and Betina Dybbroe Historical and structural affinity: the Nordic context 17 A Nordic ethos of care: an ambiguous history 23 The rationality of efficiency 25 Education as a strategy for regulating care 28 Care work in crisis 30 Aim and scope 31 References 33 PART I DENMARK INTRODUCTION TO PART I 41 Crisis of Care in a Learning Perspective Betina Dybbroe Changes in politics of care 42 Professionalisation and deprofessionalisation in care work 44 Crisis of quality and the declining interest in care work 45 Learning in care 46 References 48 ONE 49 A Crisis of Learning, Professional Knowledge and Welfare in Care Betina Dybbroe Recruitment crisis a symptom 51 A qualification strategy for welfare? 54 Learning to be professional 56 Subjective and shared experience of dequalification 68 References 71

3 TWO 75 Neglected Opportunities for Personal Development: Care Work in a Perspective of Lifelong Learning. Helle Krogh Hansen Learning processes in care work 78 The tensions of care work in a pedagogical perspective 83 Lifelong exemplary learning 87 Conclusion 92 References 94 THREE 97 A Crisis of Recognition in Care Work for Elderly People? Looking at Professional, Bodily and Gendered Hierarchies for Explanations Anne Liveng Care work for elderly people as low ranked in three hierarchies 100 Social and health care helper work as inscribed in a professional hierarchy 101 Care work for elderly people in a 'dirt' hierarchy: working with decaying and dying bodies 105 Care work for elderly in a gender hierarchy: devaluation of the care orientation 110 Conclusion 113 References 116 PART II FINLAND INTRODUCTION TO PART II 121 Care Work in the Context of a Transforming Welfare State Lea Henriksson and Sirpa Wrede The neoliberal turn in Finland 122 Tension in workplaces: professionals and care recipients 125 References 128 FOUR 131 The Making of Medico-Managerial Care Work Culture in Public Home Care for the Elderly Lea Henriksson and Sirpa Wrede The rise of socially defined care: from home help to home care 134 Neoliberal policies boosting the medical culture in elderly home care 136 The rise of the medico-managerial culture 141

4 Impoverishment of care work culture in elderly home care 146 References 150 FIVE 153 Staffing Levels and Well-being of the Residents with Dementia Pa'ivi Topo and Saila Sornnmen Elderly care policy and institutional conditions of care provision in Finland 156 Research design 158 The care units and the residents 160 Well-being, behaviour and activities of the residents 163 Conclusion 170 References 174 SIX 177 Practical Nurses' Work Role and Workplace Ethos in an Era of Austerity Laura Tainio and Sirpa Wrede The dynamics of vagueness 180 Organisation-centred or patient-centred care? 187 Conclusion 193 References 197 SEVEN 199 Immigrant Nurses in Finland: Political Negotiations on Occupational Membership Suvi Nieminen and Lea Henriksson The perspective of migrant care workers in European welfare states 202 Political agencies: regulating the entry to the occupational fields 205 Choosing from the margins: are immigrant nurses needed? 209 Categories of the respectable nurses 211 Conclusion 214 References to the data 216 References 217 PART III NORWAY INTRODUCTION TO PART III 221 Care Work and Care Work Education in Norway: Problems of Modernisation Hdkon H0st The Norwegian contributions 224 References 226

5 EIGHT 227 Reforming Auxiliary Nurse Education in Norway A Story of Failed Modernisation Hakon Host Theoretical framework 228 Care and nursing during restricted, liberal modernity 230 Auxiliary nurse education: a child of organised modernity 231 The second stage of organised modernity 235 Adult reform between organised and liberal modernity 238 A cross-national comparison 240 Denmark: modernisation and autonomy 241 Conclusion 244 References 247 NINE 249 Social Capital in Public Home Care Services (1) Karen Christensen Social capital, power and gender 251 Modernisation of public home based care services 254 The unheard voices of the care sector 262 Listening to the voices of social capital 265 Legislation 269 References 269 PART IV SWEDEN INTRODUCTION TO PART IV 275 Focus on Knowledge Formation and Care Work Organisation Stina Johansson The public image of care work 278 Tensions in the work place arena 279 References 281 TEN 283 Academic Strength and Boundary Work: Contextualising Elderly Care Stina Johansson Academic strength and boundary work 285 Care work and the link to the organisation of knowledge 287 Sector/administrative boundaries 288 Three borderlines to negotiate 289 Academic strength. System of professions 292 Boundaries of knowledge/academic disciplines 294 Professional structure in relation to intellectual jurisdictions 296 The authors and Studenthtteratur

6 Two contradictory strategies 298 Conclusion 299 References 301 ELEVEN 303 To Organise for Care Work Work Environment and Relational Aspects of Care Work in Sweden Petra Ahnlund The working environment: some definitions 305 Care work: a relational job 307 Methodological considerations and ideal types 308 Ideal types: the care recipient controlled, the organisational abandoned and the environmentally supported 311 Conclusion 318 References 321 TWELVE 323 Upper Secondary Health Care Programme as Means or Measure? On the Problem of Legitimacy and the View of Knowledge Petra Ahnlund and Stina Johansson Training as a professionalisation strategy 326 Quality assurance via training? 328 The administrative structure 329 The material: nursing assistants and auxiliary nurses 331 Middle managers in elderly care formal training versus personal suitability 332 Personnel in direct care work in the elderly care sector 334 Conclusion 336 References 339 THIRTEEN 341 The Neglect of Time as an Aspect of Organising Care Work Katarina Andersson Public elderly care in transformation 343 Care beyond time and space 346 Time and routines 348 Is care work still a question of personal chemistry and a given time space? 355 The consequences of the neglect of time 358 References 360

7 EPILOGUE 363 The Unheard Voices of Care Workers and Care Researchers Kari Woerness The 1950s and the 1960s: homemaking as a new ideology in public care for the elderly 364 The 1970s and thel980s: increasing bureaucratisation, standardisation, professionalisation and institutionalisation of the home care services 367 The 1990s and beyond: the pace of organisational changes increases and 'new public management' is introduced 371 References 374