‘More like a daughter than an employee’: the kinning process between migrant care workers,elderly care receivers and their extended families

ABSTRACT

This paper explores the intersections of formal and informal care in the relationships that develop between elderly care receivers and their families and migrant domestic care workers and their families. The domestic migrant care literature has tended to focus on two main ‘hidden costs’ of this ‘care-chain’: the ‘care exploitation’ of paid carers by their employers and the ‘care drain’ impact on the family members left behind by the migrant. In this paper, we employ a care circulation framework to examine the process of becoming kin-like – or ‘kinning’, which remains relatively under-explored and warrants further research. An analysis of this process of kinning helps to highlight how the domestic space of care receiver homes are transformed – through the negotiation of relationships with migrant care workers – into transnational social fields that bring the diaspora worlds of the migrants into the everyday worlds of the locals.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.     

What is a transformative approach to care,and why do we need it?

The meanings of care are contested – the approaches to care in the development and feminist literature have varied greatly. At the same time, care is a common word, loaded with moral meanings concerning notions of duty and love, and care is commonly associated with women. These associations are not innocent; they have concrete effects in shaping different policy agendas and institutional responses to care and care work. While the feminist meanings of care stem from feminist philosophy, feminist economics, and feminist social policy research, these meanings compete with the more conservative and traditional meaning of care in the development discourse. This article provides a conceptual introduction to care, and aims to show how the different understandings of it affect the ways policymakers approach the issue. Depending on the way care is framed, policies and practices can be designed and implemented in transformative ways, in the sense of supporting carers – predominantly women – and lightening their care burdens, while challenging the notion that this work is intrinsically ‘female’ and of lesser importance than work seen as ‘productive’. The article invites development practitioners to reflect on their own views about care, and to identify what can be done to recognise, reduce, and redistribute care at multiple levels.     

Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence

ABSTRACT

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.     

Performative identity regulation in rehabilitative home care work: an analysis of how experts’ embodied mediation of the managerial ideology ‘activates’ new frontline identities

ABSTRACT

This article explores how therapists when introduced as new so-called frontline ‘experts’ in home care work, become both discursive and embodied mediators for the managerial ideology of rehabilitation, and how their presence regulates the care aides’ subjectivities at work. We show how the managerial discourse of rehabilitation mobilizes the care aides to transform their identity from traditional nurturing to rehabilitation, as a result of promoting the latter as more professional. While the traditional managers/nurses promote the identity transfer through more classic discursive regulation at a distance from ‘the office’, the therapists do so through what we label performative regulation. Performative regulation is exercised by the therapists performing the desired role at the frontline and thus embodies the ideal and transfers it by embodied practices, not directives. With this notion of performative regulation, the article emphasizes the material, physical, embodied and performative dimensions of professional identity regulation.     

Stratified structural and epistemic aspects of the care manager's discretion—a theoretical approach to social work related to older people's potential relocation to a residential home

By applying a theoretical point of departure, the overarching aim of this article is to describe, analyze, and try to understand why care managers in their everyday occupational practice normalize the restrictive approach when older people consider relocation to a residential home. While earlier research to a large extent has drawn attention to how the care managers carry out the restrictive approach, this article pays attention to the circumstances paving its way. The focus is on influences from different sociological levels, thereby ‘stratified’, and from two aspects of discretion, where ‘structural aspects’ refer to choices between permitted alternatives and ‘epistemic aspects’ to practical reasoning under conditions of indeterminacy. With this combination, a multitude of circumstances contributing to the restrictive approach is revealed. Thus, the theoretical model includes levels as well as discretionary powers where formulas constitute the foundation at each level, subsequently related to multidisciplinary references in order to get the practice into perspective. The findings show that the priority given to home-based care in contrast to residential care is repeated and confirmed at each level and besides in an interchange between structural and epistemic aspects.     

Health care,social care or both? A qualitative explorative study of different focuses in long-term care of older people in France,Portugal and Sweden

Challenges with an ageing population are increasingly becoming a reality in the Western world. Since cognitive impairment increases with age, we can expect an increasing number of older people in need of care. The aim of this article is to describe, analyse and compare different focuses on care of older people with dementia, using examples from France, Portugal and Sweden. The questions are principally focused on the participants’ view about their tasks, the organisation of work, the professional role and cooperation with other professions. Everyday care was studied through observations and participant observations and the staff's opinion was explored by means of interviews. Twenty-two care settings for older people were included. The findings showed that France provided mainly ‘health care’, Sweden ‘social care’ and Portugal an integrated ‘health care and social care’. In a comparative perspective the Portuguese general care of older people, which focuses on integration of health care, social care and social work, also seems to provide care for older people suffering from dementia which best corresponds to the previously developed group living model.     

Working mothers,injury and embodied care work

In this article, we examine how mothers respond when injury interrupts maternal care, using the lens of embodied care, which we conceptualize as a form of ‘body work’. We draw on findings from a qualitative research project with two organizations in Australia that help people with injuries to return to work, examining the experiences of workers who are also mothers of dependent children. Mothers' inability to care for children during periods of injury was a significant concern for our interviewees; constraints on physical labour and physical affection were particularly troubling, indicating the importance of embodied maternal caregiving to maternal roles. Yet, while these mothers inhabited the spheres of paid work and unpaid care work simultaneously, service providers did not consider embodied care work or its relevance to injured women's ongoing needs for support. While our findings reflect the experiences of injured women, they also suggest the need for a materialist analysis of the ways that both paid work and care activities are deeply enmeshed in and through the bodies of those doing the work. Employers and service organizations still fail to recognize maternal ‘body work’, and this may be typical of social attitudes more widely.     

Bodies of work: skilling at the bottom of the global nursing care chain

ABSTRACT

In the midst of a growing global market for migrant care work, there is a need to investigate not only how such labour is consumed but how ‘ideal’ care workers are also produced. This paper investigates how schools within migrant-sending countries produce nurse labour through body work or the testing and honing of hospital procedures on patients’ bodies. Focusing on the case of the Philippines, this paper shows how the education of nurses for export creates a paradoxical impact on care work within local healthcare institutions. Aspiring nurse migrants provide much-needed manpower to understaffed public hospitals yet, treat poor patients as docile bodies to enhance their skills for future foreign employers. This practice creates an inherent inequality in the actual skilling of aspiring nurse migrants, where the poorest bodies allow nurse migrants to provide better care to more privileged bodies in wealthier nations.     

Becoming-care: reframing care work as flesh work not body work

ABSTRACT

This paper highlights the central role of the flesh within care relationships and how this disrupts and progresses existing understandings of care work. It is argued here that care work is a connected and fluid assemblage of diverse and changeable factors and that this relationship is best understood as a form of flesh work. Seeing care work in this way allows the care relationship between the person being cared for and the carer/s to be seen as a process of becoming; framed here as becoming-care. To illustrate this, two examples of a care relationship taken from a previous project are presented and discussed from a deleuzoguattarian standpoint. In this way, care work is assessed and theorised at the ontological level, resulting in the formulation of an alternative way of seeing care work that perhaps better reflects its reality – where the flesh is vital.     

Non‐job work/unpaid caring: Gendered industrial relations in long‐term care

This article explores the operation of gender and industrial relations in long‐term care work or nursing home work, ‘from within’ the experience of the predominantly female workforce in seven unionized facilities in Canada. Drawing on qualitative case study data in non‐profit facilities, the article argues that the main industrial relations challenges facing long‐term care workers are that their workplace priorities do not fit within existing, gendered, industrial relations processes and institutions. This article starts from the experience of women and threads this experience through other layers of social organization such as: global and local policy directions including austerity, New Public Management, and social and healthcare funding; industrial relations mechanisms and policy; and workers’ formal [union] and informal efforts to represent their interests in the workplace. The strongest themes in the reported experience of the women include: manufacturing conditions for unpaid work; increasing management and state dependence on unpaid care work; fostering loose boundaries; and limiting respect and autonomy as aspects of care work. The article extends the feminist political economy by analysing the links between the policies noted above and frontline care work. Building on gendered organizational theory the article also introduces the concept of non‐job work and suggests a fourth industrial relations institution, namely the needs and gendered expectations of residents, families and workers themselves, operating within the liminal spaces in care work.     

Public Social Services’ encounters with irregular migrants in Sweden: amid values of social work and control of migration

This article outlines Public Social Services’ encounters with irregular migrants in Sweden from the perspectives of institutional and street-level bureaucrats. Staff and executive considerations are influenced by a de jure exclusion of irregular migrants, which is an element of the control of migration. Staff face contradictory demands concerning international and national regulations, which leads to legal ambiguities open to discretionary powers. The aim is to explore the handling of such cases, experiences and considerations with an interest in the values that are invoked when enacting discretion and to discuss implications of the unclear legal situation. The material was obtained using web-based questionnaires. A tentative analysis confirms that the Public Social Services encounter irregular migrants and that handling differs greatly. It suggests that different approaches and the contradictory legal framework endanger the rule of law. Differing reference points appear to be invoked when enacting discretion: some related to social work and others to controlled migration. The social work values invoked by some respondents might imply an appreciation of a right to services and control of migration as independent processes and jurisdiction related to human rights that are applicable beyond the nationally framed legal status and not subordinated to policies of migration.     

Interprofessional collaboration in Swedish health and social care from a care manager's perspective

The aim of this study was to study interprofessional collaboration in health and social care for older people and persons with disabilities from a care manager's perspective. The empirical data was collected at a workshop held during a national conference for care managers and through focus group interviews in two Swedish municipalities. The results showed that the care managers collaborated in different ways with many different professionals from different organisations. The care and discharge planning meetings emerged as the most typical situation where care managers collaborated with different health care professionals. Interprofessional collaboration was seen as a means for care managers to fulfil their assignment and carry out their work. The care manager role encompassed role strain, a relatively weak professional identity, and differences in professional status among those involved in interprofessional collaboration.     

Voluntary work in the Norwegian long-term care sector: complementing or substituting formal services?

ABSTRACT

Across Europe, governments call for increased involvement of volunteers to shoulder some of the welfare burden. Nevertheless, there is little research into what kind of work and how much volunteers currently contribute in the long-term care services and whether this has the potential to substitute formal services. Drawing on findings from a survey of employees in Norwegian nursing homes and home care districts, we examine the nature and volume of voluntary, unpaid work in the long-term care services in Norway. Our data suggest that volunteers to a very limited degree carry out work that has traditionally been considered the formal system’s domain: personal care and practical help. Nearly all the voluntary, unpaid contributions in our data takes place within cultural, social and other activities aimed at promoting mental stimulation and well-being, indicating a classic specialisation of tasks between volunteers and professionals. However, there has been an expansion of the formal care system to include activities aimed at promoting well-being in recent decades. This may indicate that there is a certain level of task sharing between voluntary and formal care. Thus, social workers need to consider voluntary service provision when assessing the needs of clients.     

‘Care is not a dirty word!’ Enacting an ethic of care in social work practice

While ‘care’ has been positioned as a core value of the social work profession since its inception, the increasing influence of neoliberal rationalities have placed care on the periphery of social work theory and practice. Social work scholars have promoted the incorporation of ethic of care theory into direct social work practice as a means of countering the effects of a context that is antithetical to caring practice. I present findings from my Australian study, providing an original contribution by presenting concrete understandings of how social workers enact care in everyday direct social work practice. The study was guided by a grounded theory approach. Fifteen social workers were interviewed using a semi-structured interview schedule. The interviews were analysed using constructivist grounded theory techniques. ‘Meeting needs’, ‘just being there for clients’, ‘building relationships with clients’, and ‘going the extra mile’ were some of the ways that participants demonstrated care in their practice. Constraints on care were challenged and resisted by ‘taking a stand’, ‘bending the rules’, ‘picking battles’, ‘justifying care’, and ‘taking risks’.     

Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.     

Developing social work students’ professional identity: the role of England’s Professional Capabilities Framework

ABSTRACT

Developing professional identity is a key aim of social work education. This paper argues that the Professional Capabilities Framework (PCF) – a holistic, capability approach to student assessment used in England’s social work education programmes – is ideally placed to promote the development of students’ professional identities. The paper discusses two research studies, each of which was stimulated by significant policy changes in England’s social work profession. The author draws out the implications of both studies for supporting social work students to develop their professional identities. It is concluded that the PCF is valued by practice educators as an assessment and teaching tool, while acknowledging that its future is uncertain due to the lack of continuity impacting on England’s social work profession. This paper is equally of relevance for social work educators outside the UK who may be developing and evaluating their assessment approaches and also for those experiencing the impact of rapid policy changes in their own countries.     

Interprofessional collaboration between residential child care and mental care practitioners: a cross-country study in six European countries

ABSTRACT

The severe mental health problems of many of the young people living in residential settings pose a great challenge and demand on child protection and mental care (MC) services. Drawing on comparative research and debates from six European countries, this study examines demands for integrated care and interprofessional collaboration practices between residential child care (RCC) and MC. In this article, research data will be brought together from Denmark, Finland, Germany, Lithuania, the UK (Scotland) and Spain. In total, 61 practitioners from RCC and MC were interviewed. Given the complexity of the residential care service context and service system differences across national contexts, the original hypothesis was that this would differentiate the collaboration practices. However, the similarity between the countries is greater than anticipated. The concluding findings are organised by matrix technique into a content-analytic summary table. The main finding was that in spite of encouragement for integrated RCC, obstacles for collaboration and lack of coordination between systems remain, often related to understanding the professional role and tasks, lack of shared knowledge, attitudes and ways of communication. One significant finding in the cross-country comparison was the evident and unrealistic expectations for the ‘other’ provider to help and care.     

High job strain among social work managers and its relation to perceived work situation

The purpose of this study was to examine how middle managers within the personal social services in Sweden perceived demands, control and support at work. The study group included 402 frontline, second tier and third tier managers who have answered questions concerning their work situation and perceptions of their psychosocial work environment. Based on Karasek's demand–control model, a ‘high strain’ group was defined and analysed further. The results showed that this group experienced less support from immediate superiors, but no correlation could be found between high strain and other forms of support, such as courses on leadership, managerial supervision or networks. Organisational factors, such as municipality size, managerial level, number of subordinates and field of social work, seemed to be of little importance. Comparisons between the ‘high strain’ group and other managers showed that the high strain group spent more hours working with administration, that they to a lesser degree regarded budget responsibility as a way to exercise power in the organisation and that they had a more negative view on their organisation, especially concerning the possibility to influence decisions. They also had less confidence in the way the organisation was governed.