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.