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This paper explores how dignity is articulated and pursued by care workers in two currently prominent policy initiatives seeking to reform Danish care services for older people. Based on ethnographic case studies of 'reablement' practices and the use of 'welfare technologies', the paper shows how these attempts to create dignified care services transform interactions between care recipients and care workers. The analysis is inspired by a socio-material perspective on dignity as 'crafted' and 'co-laboured' in daily practices, in an interplay between multiple human and non-human actors. In the cases studied, dignity is articulated as closely related to older people's increasing autonomy and independence of formal care, and is pursued through enhancing care recipients' self-care ability, and through technological automation of care tasks. However, these articulations and pursuits of dignity do not stand alone. When everyday care practices are closely examined, dignity is also pursued by care workers as increased co-operation and equality between care workers and care recipients, as de-objectification, and as promotion of enjoyment and quality of life. In these practices, care is ambivalently positioned as both a potential threat to dignity, and as a prerequisite to achieving it. The paper concludes by discussing the risks of policy agendas pursuing a narrow understanding of dignity as simply independence of care. [ABSTRACT FROM AUTHOR]

This paper is dedicated to the research presented at the 26th Nordic Congress of Gerontology in Odense, Denmark, in June 2022, which was organized by the Danish Gerontological Society and the Danish Society for Geriatrics. The overall topics of the congress were change and continuity. Participants were invited to explore questions on change and continuity from the perspective of ageing and later life within the following congress themes: digitisation and technology; housing, generations and mobility; lifestyle, engagement and transition; education and competences in ageing societies; morbidity, medical treatment and ageing processes; and a good life and a good death. Life is about change and continuity. We experience ourselves and our surroundings differently throughout our lives. For most people, later life is characterized by major transitions, moving towards frailty and multiple losses. But it may also be a part of life with more time to engage in preferred activities, explore new possibilities, and to cope and come to terms with new challenges. The COVID-19 pandemic proved to be a challenge to the world beyond imagination, particularly for frail and vulnerable people and societies. However, it also provided valuable new insights and reminded us of the values in life. We, therefore, also welcomed presentations and discussions on societal perspectives such as citizen perspective, ethnicity, inequality, sustainability and ecology, the pandemic and lockdown. We thank the organizers, scientific committees and all participants for a great congress with high-quality presentations and discussions. [ABSTRACT FROM AUTHOR]

Background: This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. Aim: This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. Approach and Methods: Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. Findings: The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of 'at‐homeness' through trusting 'the other', experiencing continuity as caring and prioritising the time to care. Conclusion: Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence. [ABSTRACT FROM AUTHOR]

In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3‐year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal‐oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide. [ABSTRACT FROM AUTHOR]

Aim: To investigate the challenges and barriers in Danish care professionals' work in relation to elderly citizens who use substances. Method: The study draws on data from a "going along" study of care professionals' encounters with citizens as well as interviews with professionals. This was conducted in two smaller, rural municipalities in Denmark. Findings: Providing adequate care for elderly citizens who use substances can be highly challenging. This is due to a multitude of factors, especially (1) the complexity of their health conditions, (2) contradictory logics of care (autonomy vs. healthy living), (3) citizens often unpredictable behaviours, (4) lack of cooperation between welfare systems and, not least, (5) lack of knowledge and education among healthcare professionals. Conclusions: There is a need for more specialised procedures locally, the appointment of local "experts", better cooperation between sectors and easier accessible training and information on the group on a national level. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care programmes (ICPs) for community-dwelling frail older people work for some, but not for others. Why and how ICPs work, is rather unknown because the 'mechanisms' and the 'context' often remain underexposed. The study objectives are 1) to identify the relationships between the context in which ICPs are applied, the mechanisms by which ICPs do (not) work, and the outcomes resulting from this interaction, and 2) to analyse to what extent the World Health Organization (WHO) framework on integrated people-centred health services (IPCHS) is applied in ICPs. Methods: A rapid realist review was conducted to identify the mechanisms of ICPs that operate in particular contexts to generate outcomes. Peer-reviewed (reviews and meta-analyses) and nonpeer-reviewed literature reporting on integrated care for community-dwelling frail older people (= 60 years) was included. Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-Narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms, and outcomes were extracted. Per source publication, context-mechanism-outcome configuration(s) (CMOc(s)) were aimed to be identified. Factors were categorized into the five strategies of the WHO-IPCHS framework. Results: 27 papers were included. The most prevalent WHO-IPCHS strategies as part of ICPs are "creating an enabling environment", followed by "strengthening governance and accountability". For ICPs to demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and healthcare providers (HCPs), and a delayed placement in a nursing home, it is essential to establish multidisciplinary teams of competent HCPs (by means of education and training) providing person-centred care, closely working together and communicating effectively with other stakeholders. Heterogenous effects were however found for hospital-related outcomes, quality of life, healthcare costs, and use of healthcare services. Older people and informal caregivers should be involved in the care process in order to get a better picture of the patient's wishes and needs, and shared decision-making should be established. Financial support, efficient use of information technology, and organisational alignment were found essential. Conclusion and discussion: ICPs for older people are still in development, as most ICPs do not address all WHO-IPCHS strategies. To optimize ICPs for frail older people the comprehensiveness of the WHO-IPCHS framework and the interaction between items should be taken into account from different perspectives (system, organisation, service delivery, HCP, and patient). Within this study, data on context, mechanisms, and outcomes may show overlap, which is often considered an interpretative challenge within realist research. Additional realist research is needed to establish more comprehensive and detailed relationships of items related to ICPs for frail older people. [ABSTRACT FROM AUTHOR]

To explore the Nordic municipal health and care services' ability to promote principal goals within care for older people during the COVID-19 pandemic. Two surveys were conducted among managers of municipal health care services for older people in Denmark, Finland, Norway and Sweden; the first around 6 months into the pandemic (survey 1), and the second around 12 months later (survey 2). Data were analysed through descriptive statistics, and multiple regression (OLS). 1470 (survey 1, 2020) and 745 (survey 2, 2021) managers. 32% in home care, 51% in nursing homes, 17% combined. In all countries the pandemic seems to have had more negative impact on eldercare services' ability to promote an active and social life, than on the ability to promote or enhance older people's mental and physical health. The regression analysis indicates that different factors influence the ability to promote these goals. Managers within nursing homes reported reduced ability to promote mental and physical health and an active social life to a significantly lower degree than managers of home care. The effect of three prevention strategies (lock down, testing, and/or organisational change), were explored. Organisational change (reorganize staff and practice, restrict use of substitutes) tended to impact the units' ability to promote a social life in a positive direction, while lock down (areas, buffets etc) tended to impact both the ability to promote mental/physical health and a social life in a negative direction. Measures that can improve opportunities for an active and social life during a pandemic should have high priority, particularily within home care. It is important to learn from how the COVID-19 outbreak in 2020 affected the municipal health and care services' ability to achieve principal goals within care for older people. The pandemic had a more negative impact on the services' ability to promote an active and social life, than on their ability to promote or enhance mental and physical health. Measures that can improve opportunities for an active and social life during a pandemic situation should have high priority, particularily within home-based care. [ABSTRACT FROM AUTHOR]

This article draws on two in-depth stories of an Arab-Danish Muslim woman and an Arab-Danish Muslim man to explore how they 'do gender' when 'doing care' for their elderly parents in their everyday lives. Analysis of ethnographic material reveals that for the Arab-Danish Muslim woman, 'doing care' is regarded as a right which provides her with the opportunity to become irreplaceable and enables her to realize herself. In her self-realization, it is argued, lies a reproduction of gendered understanding of caregiving that seems to prevent the Muslim man from performing the desired role as caregiver, leaving him to struggle with the entrenched gender norms and structured ideals of masculinity. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations. Methods: The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018–2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories. Findings: Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self. Conclusion: Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance. [ABSTRACT FROM AUTHOR]

Summary: This article considers ways in which a nursing home can come to serve as a hub for community health promotion. Inspired by the term 'boundary crossing' (Akkerman and Bakker. Boundary crossing and boundary objects. Rev Educ Res 2011;81:132–69), we suggest the notion of 'boundary work' to illustrate how a nursing home arranges community activities and includes a wide range of participants. In health research, a 'hub' refers to a space in which activities and expertise are 'bound together' over time. The concept of the hub indicates that health organizations have the power to become centres for health promotion by initiating new collaborations and opening up initiatives in two-way processes with the local community. The term 'boundary work' supports a perspective that dissolves organizational, professional and conceptual boundaries and directs attention towards social inclusion as a key to community health promotion in and beyond institutionalized elderly care. The article is based on a 4-year-long practice-based study of social innovation in elderly care in Norway and Denmark. Empirical illustrations show boundary work in which a nursing home comes to serve as a hub. We discuss a flexible framework for understanding, mapping and planning participatory approaches for health and wellbeing (South et al. An evidence-based framework on community-centred approaches for health: England, UK. Health Promot Int 2019;34:356–66) and briefly connect these approaches to the concept of social innovation as a possible future research path. [ABSTRACT FROM AUTHOR]

Introduction Perceived quantitative demands at work have been associated with poor mental and physical health, long-term sickness absence and subsequent early retirement. Identifying modifiable determinants of perceived quantitative demands at different levels of the organization is key to developing effective interventions. The aim of the study was to identify determinants of perceived quantitative demands at work and examine the extent to which they occur at different levels of the eldercare organisation (i.e. the worker, ward and nursing home levels). Methods We collected data on 383 eldercare workers in 95 wards at 20 nursing homes in Denmark using workplace observations and questionnaires to workers and their managers. Perceived quantitative work demands were assessed using two items from the Copenhagen Psychosocial Questionnaire, II. We identified contributions to overall variability from the three organisational levels using variance components analysis, and examined associations between determinants at these three levels and quantitative demands. Results Almost all (90.9%) the variability in perceived quantitative demands occurred between eldercare workers (within wards). Determinants significantly associated with lower quantitative demands were: having a job as a care helper, working fixed evening shifts, being born outside Denmark, having lower influence at work, higher quality of leadership and lower emotional demands. None of the investigated physical factors (e.g. resident handlings, push/pull tasks, step-count) were associated with perceived quantitative demands. Conclusion We found that the variability in perceived quantitative demands occurred primarily between eldercare workers within wards. Our study indicates that psychosocial work environment factors are the strongest modifiable determinants of perceived quantitative demands in eldercare, while organisational factors related to job position, shift, and resident-staff ratio also play a role. Interventions should test if changes in these determinants can reduce perceived quantitative demands at work in eldercare. [ABSTRACT FROM AUTHOR]

Welfare governance in elder care has undergone significant changes, but we know less about the processes and actors of making welfare governance. This is problematic, as the concern for process is a key strength of the welfare governance perspective. Based on a case study of elder care in Denmark, and drawing on studies of professions, the aim is to analyse how welfare professions contribute to the making of welfare governance. Our analysis shows that welfare professions bring unique resources into play. They have strong professional agency, drawing on both broader institutional roles and more specific professional projects. The institutional work itself is highly complex and the welfare professions combine not only formal and informal coordination, but also do so in ways that are closely tailored to specific contexts. The analysis makes important empirical and theoretical contributions to the study of welfare governance in elder care. [ABSTRACT FROM AUTHOR]

Purpose: Eldercare work is characterised by high quantitative work demands and high occurrence of musculoskeletal pain and sickness absence. Our aim was to investigate the association between quantitative demands aggregated at the different organizational levels of eldercare and low back pain (LBP) and sickness absence due to pain among workers. Methods: This study was conducted in 527 eldercare workers from 105 wards across 20 nursing homes in Denmark. We collected workers' perceived quantitative demands at baseline and workers' LBP and sickness absence repeatedly over the following year. We aggregated worker-level quantitative demands to the ward and nursing home-levels, and used mixed-effects regression models to investigate the associations between quantitative demands at different organizational levels and LBP and sickness absence over 1 year. Results: Across all models, increased quantitative demands (0–100 scale) at the worker-level was associated with an increased likelihood (OR 1.02) and intensity of LBP (β = 0.01). We did not identify any associations between quantitative demands at the ward-level and either of our outcomes. Across all models, increased quantitative demands at the nursing home-level was associated with increased days with sickness absence due to pain (β = 0.03 to 0.06). Conclusion: In eldercare, workers' perceived quantitative demands are associated with the presence and intensity of LBP. Further, quantitative demands across the overall nursing home-level are associated with sickness absence due to pain among eldercare workers. These results are of relevance to developing organisational interventions targeting quantitative demands to reduce sickness absence in eldercare. [ABSTRACT FROM AUTHOR]

Objectives Current knowledge on the determinants of step-rate at different organizational levels is limited. Thus, our aim was to identify, in eldercare, at what workplace level differences in step-rate occur and to identify determinants of workers' step-rate at these levels. Methods Participants were 420 eldercare workers from 17 nursing homes (126 wards) in Denmark. Accelerometry was used to assess step-rate (steps per hour) of workers over multiple shifts. We assessed various determinants at different levels of the workplace, i.e. at the (i) shift, (ii) worker, (iii) ward, and (iv) nursing home levels. Variance components analysis identified the percentage contribution to total variance in step-rate from each respective level. Multi-level linear regression modelling was used to investigate the association between candidate determinants at each level and step-rate. Results Differences in eldercare workers' step-rate occurred primarily between shifts (within workers; 44.9%) and between workers (within wards; 49.1%). A higher step-rate was associated with: (i) weekend and evening shifts (versus weekday/day); (ii) job as a care helper (versus care aide) and an increased proportion of time spent on direct care tasks; (iii) working in a somatic ward (versus dementia), an increased resident–staff ratio and permission to take unscheduled breaks; and (iv) lack of elevators. Conclusions We found that nearly all variability in step-rate in eldercare work occurs between shifts (within workers) and between workers (within wards). The main determinants of step-rate were related to the type of shift, type of work tasks, staffing ratio, break policy, and availability of elevators. [ABSTRACT FROM AUTHOR]

Purpose Population aging - an increase in the proportion of older people in a population - is predicted to affect all sectors that form the backbone of modern democratic societies. In the attempt to ensure the social and economic sustainability of the welfare state, digital technologies have become essential components in the delivery of care for older adults. Departing in situated care practices among older adults in Denmark, the purpose of this presentation is to contribute to the studies and discussions of the role and effects of digitally mediated care solutions in care practices. Method This presentation is based on 4 months of ethnographic fieldwork (qualitative research). The researchers participated in- and observed 10 digitally mediated health/home care visits and 10 digitally mediated rehabilitation programs in homes and in training centers. Furthermore we attended several cultural activities and participated in health care and political forums, where the digitalisation of elder care was discussed. Furthermore the researchers conducted interviews with 15 elderly citizens,15 healthcare professionals, 5 public health care managers. The research took place on the island of Ærø, Denmark during the early phases of the corona crisis between June and September 2020. Results and Discussion Our research shows how a group of healthcare professionals perform their care work with and through screens, and how this work is both facilitated and curtailed by the functionalities, materiality and design features of particular screen technologies. We stress that the use of screens to establish a virtual meeting point between citizens and healthcare professionals, is not solely or simply a technological solution, but instead a material, embodied and technical practice that requires health workers to develop new skills and competencies. We thus identify a need to develop new professional competencies when working with the digitally mediated care and an acknowledgement of the extra work performed by both health professionals and elderly citizens, as well as the complexities involved in introducing digital care. [ABSTRACT FROM AUTHOR]