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Uppsatsen syftade till att undersöka faktorer kring hemtjänstpersonalens kvarvarande i yrket samt personalens arbetsvillkor. Datainsamlingen utfördes genom en kvalitativ intervjustudie med fyra enhetschefer inom både privat och kommunal hemtjänst. Bidragande orsaker till att personal lämnar yrket framgick som upplevelser av otillräcklighet, bristande påverkans- och utvecklingsmöjligheter samt arbetstidsförläggningen. Faktorer för kvarvarande uppmärksammades som betydelsen av det relationsnära arbetet, kollegialt utbyte, utvecklingsmöjligheter och stöd i arbetet. Resultatet indikerade på att bristande resurser var skäl till att personal lämnar yrket och betydelsen för personalens kvarvarande har diskuterats utifrån äldreomsorgens kvalité. Äldreomsorgen har likt andra välfärdsverksamheter skyldigheter i att bedrivas på ett sätt som tillgodogör målgruppens behov varför personalens kompetens och erfarenhet blir av stor betydelse. The study aimed to examine home care workers’ intentions to remain within their profession and working conditions. Data collection was conducted through qualitative interviews with four first-line managers within private and municipal home care. The first-line managers described experiences of inadequacy, lack of influence and development opportunities, and the working hours as reasons for the care workers’ turnover intentions. Factors regarding remaining in the profession were noted as the importance of relational work, collegiate exchange, development opportunities, and support. The results indicated lack of resources as the main reason for home care workers leaving their profession, and the importance of remaining has been discussed based on the quality of elderly care. Elderly care has obligations to be conducted in a manner that meets the needs of the targeted group, which is why the home care workers’ competence and experience are of significant importance.

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.

This article seeks to understand a puzzling finding: that workers in publicly funded home care for older people in Australia, compared to those in Sweden, feel that they are better able to meet their clients’ needs, that their workplaces are less pressed, and that their work is less burdensome and more compatible with their family and social commitments. This finding seems to challenge expectations fostered by comparative sociological research that job quality and care services are inferior in Australia compared to Sweden. Informed by comparative institutionalist theory and care research, the structures and dynamics of the care systems in the two countries are analysed, along with findings from the NORDCARE survey of home care workers conducted in Sweden in 2005 ( n=166) and Australia in 2010 ( n=318). Differences in the work and working conditions in the two countries are explained by the dynamic interaction of national institutional and highly gendered sector-level effects.

La contribution se centre sur le travail de care aux personnes âgées dépendantes en institutions gériatriques et à domicile. Elle se propose de réflechir à la présence et à l’absence de collectifs de travail dans différents espaces d’aide aux personnes âgées, et comment celles-ci pèsent sur la relation subjective au travail, un travail qui se caractérse par la relation intime à la déchéance humaine. Nous nous proposons, partant d’études portant sur le sens du travail, les relations de travail, l’importance du collectif et les stratégies défensives déployées par les auxiliaires en institution, d’analyser le cas des aides qui travaillent à demeure. Dans ces situations, l’engagement et la temporalité du care prennent de l’importance, là-même où l’isolement peut s’avérer tout à la fois fortement nocif et autoriser le déploiement d’un travail qui pourra être valorisé par la travailleuse. Mots clés: travail de care ; collectifs de travail; travailleur isolé, sens du travail, institutions gériatriques, travail à domicile. &nbsp, The present contribution focuses on the care of the elderly dependents in geriatric institutions and at home. Based on existing studies of the meaning of work, the importance of the collective and the defenses strategies deployed by the workers in the institutions, our study is particularly interested on the kind of resources which mobilized home caregivers who are deprived of the possibilities of relying on colleagues and groups use to deal with the problems they meet in their activities. In the extreme case of “live in” elderly home care the dedication and the temporality of care are important because the isolation can be both very harmful and authorize the deployment of the work that could be valued by the worker herself. Key words: care work; work collectives; isolated worker; sense of work; geriatric institutions; home care work. &nbsp, A presente contribuição tem como foco o trabalho de cuidado de idosos em instituições geriátricas e em domicílio. Propõe-se refletir sobre a presença e ausência de coletivos de trabalho nos diferentes espaços de cuidado de idosos dependentes e como isso influencia na relação subjetiva com o trabalho, o qual se caracteriza pela íntima relação com o declive humano. Retomam-se os estudos existentes sobre o sentido do trabalho, as relações laborais, a importância do coletivo e as estratégias defensivas geradas pelas trabalhadoras em instituições geriátricas, para pensar no caso das cuidadoras que trabalham a domicílio, e inclusive “sem aposentadoria”. Nestes casos, cobram importância a dedicação e temporalidade do cuidado, ali aonde o isolamento pode igualmente ser muito nocivo. Refletir sobre o cuidado dos idosos nos tempos atuais resulta, assim, um imperativo necessário para a academia. Palavras chave: trabalho de cuidado; coletivos de trabalho; trabalhador isolado; sentido do trabalho; instituições geriátricas; trabalho domiciliar., La presente contribución se centra en el trabajo de cuidado de adultos mayores, en instituciones geriátricas y a domicilio. Se propone reflexionar sobre la presencia y ausencia de colectivos laborales en diferentes espacios de cuidado de adultos mayores dependientes y cómo éstas influyen en la relación subjetiva con el trabajo, el cual se caracteriza por la íntima relación con el declive humano. Se parte de los estudios existentes sobre el sentido del trabajo, las relaciones laborales, la importancia del colectivo y las estrategias defensivas desplegadas por las trabajadoras en instituciones geriátricas, para pensar en el caso de las cuidadoras que trabajan a domicilio e inclusive “sin retiro”. En estos casos, cobran importancia la dedicación y temporalidad del cuidado, allí donde el aislamiento puede ser igualmente muy nocivo. Reflexionar sobre el cuidado de adultos mayores en los tiempos actuales resulta, así, un imperativo necesario para la academia. Palabras clave: trabajo de cuidado; colectivos de trabajo; trabajador aislado; sentido del trabajo, instituciones geriátricas, trabajo domiciliario.

Background: Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. Objectives: This study aims to examine home care workers’ perceptions of health, risks, working conditions, and risk management within their organization. Method: The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides (n = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Results: Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. Conclusion: There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

Objectives: The present study aims to augment the network of home care around elderly. We investigate the nature of cooperative work between relatives and home care workers around elderly persons; present the CareCoor system developed to support that work; and report experiences from two pilot tests of CareCoor. Methods: We employed ethnographic fieldwork methods and conducted participatory design workshops to throw light on the nature of cooperative home care work, and to elicit implications for the design of an IT system that would support the work of relatives and home care workers around elderly persons. The design implications led to the development of a prototype, called CareCoor,which is accessible via a tablet computer and on the Internet. CareCoor was subsequently evaluated in two pilot tests. The first lasted a week and included three elderly, their next of kin and the affiliated home care workers, while the second test lasted for six weeks and involved five elderly people, their next of kin and relevant home care workers. Results: In the paper we make three major points, namely, (1) home care work is highly cooperative in nature and involves substantial coordinative efforts on the part of the actors involved, (2) the network of care around elderly can be augmented with new technology without elements of control and monitoring of elderly or home care workers, nor elements of remote care, (3) CareCoor, the prototype introduced in this study, shows promise as it was well received during test and evaluation. Conclusion: Home care work is increasingly important due to the aging populationsof Europe, the USA and large parts of Asia.Home care work between relatives and home care workers is inherently cooperative nature, and can be facilitatedand augmentedby new information technology such as CareCoor. The pilot tests of CareCoor revealed promising results and will be further developed andevaluated in a larger test. ObjectivesThe present study aims to augment the network of home care around elderly. We investigate the nature of cooperative work between relatives and home care workers around elderly persons; present the CareCoor system developed to support that work; and report experiences from two pilot tests of CareCoor.MethodsWe employed ethnographic fieldwork methods and conducted participatory design workshops to throw light on the nature of cooperative home care work, and to elicit implications for the design of an IT system that would support the work of relatives and home care workers around elderly persons. The design implications led to the development of a prototype, called CareCoor, which is accessible via a tablet PC and on the Internet. CareCoor was subsequently evaluated in two pilot tests. The first lasted a week and included three elderly, their next of kin and the affiliated home care workers, while the second test lasted for six weeks and involved five elderly people, their next of kin and relevant home care workers.ResultsIn the paper we make three major points, namely, (1) home care work is highly cooperative in nature and involves substantial coordinative efforts on the part of the actors involved, (2) the network of care around elderly can be augmented with new technology that allows all members of the network to follow, influence and be a part of the cooperative care of the elderly, and (3) CareCoor, the prototype introduced in this study, shows promise as it was well received during test and evaluation.ConclusionHome care work is increasingly important due to the ageing populations of Europe, the USA and large parts of Asia. Home care work between relatives and home care workers is inherently a cooperative effort, and can be facilitated and augmented by new information technology such as CareCoor. The pilot tests of CareCoor revealed promising results and will be further developed and evaluated in a larger test.

Tutkimuksen tarkoituksena on kuvata tiimityön kehittymistä kotipalvelun ja kotisairaanhoidon yhdistyessä kotihoidoksi. Tutkimuksessa pyrittiin selvittämään, minkälaiseksi tiimityö kotihoidossa kehittyy kotipalvelun ja kotisairaanhoidon yhdistymisprosessin aikana. Tutkimus toteutettiin kunnallisessa kotihoidossa vuosina 2000-2003, jolloin organisaatiossa toteutettiin yhdistymiseen liittyvä kehittämishanke. Kehittämishankkeen tavoitteena oli luoda kotihoitoon yhteinen arvoperusta ja yhteiset toimintatavat. Tutkimusaineisto kerättiin sekä kehittämishankkeen aikana että sen jälkeen. Tutkimusmusaineisto koostui henkilöstön haastatteluista ja arvioinneista kehittämistyön eri vaiheissa sekä ohjausryhmän muistioista. Tutkimuksen tuloksena syntyi uusi kotihoidon kehittämismalli. Kotihoidon kehittäminen edellyttää organisaation sisällä tapahtuvaa yhteistä ja avointa keskustelua kehittämistyön etenemisestä, tavoitteista ja sisällöstä, johon jokaisen henkilöstön edustajan pitäisi päästä osallistumaan. Merkittävää kehittämistyön onnistumisen kannalta on kotihoidon johtamisen kehittäminen sekä jatkuva arviointi- ja palauteprosessi kehittämisen etenemisestä. Kotihoidon kehittäminen edellyttää huolellista suunnittelua ja tavoitteiden asettelua sekä verkostoitumista ja yhteistyötä muiden vastaavien organisaatioiden kanssa. Alan opiskelijoiden opiskeluprosesseja voidaan kytkeä kotihoitotyön kehittämiseen eri muodoissa. Tiimityön kehittyminen kotihoidossa edellyttää henkilöstön jatkuvaa oppimista ja kehittymistä. Johtopäätöksenä voidaan todeta, että tiimityö näyttää olevan toimiva toimintamalli kotihoidossa. Kehittämistyön tuloksena tiimityöllä voidaan saada monipuolista osaamista, joustavuutta ja tehokkuutta asiakkaan hoitoon ja palveluihin. Lisäksi tiimityö mahdollistaa yksilöllisempää hoitotyötä, ennalta ehkäisevää toimintaa ja vapauttaa uusia resursseja kotihoitotyöhön. Purpose of the study is to describe fusion of a home care work organisation and a home health care organisation. Together they form Home care organisation. Development and learning of team work during the development project is also described. Aim of the study is to produce a model of development of the home care with help of teamwork and in this way to produce new information and tools to developing the home care. In this study it was tried to find out how the home care developes when two different organizations are combined. The main result of this study is a new model for developing the home care work. The study was done as an action research in a communal home care organisation during 2000-2003. The home care work organisation and home health care organisation were combined in 2000. At that time personnel in the home care was 38. Aim of development in the process was to develop a team organization and a shared model of work via methods of co-operative development. Frame of reference of the development work was participatory action research in which development areas, problems and solutions were defined by the employees. Empirical research data was collected by theme interviews of the personnel during the development interventions and after the project. Data collection and analysis were performed simultaneously because the data affected planning of interventions. The research data was analyzed with inductive content analysis. As result of the research new model of home care was developed. Development model of the home care consists of several processes. Basic processes are continuous common discussion forum, improvement of management and continuous evaluation and feedback process. Supporting processes are continuously working steering and planning group, networking and improving of learning process of the students. Development work advances via development cycles, which consist of five phases; diagnosis, planning, implementation, evaluation and learning. Phases of a cycle may occur simultaneously. Development of a team and learning of teamwork advance during the development work. Learning process of a home care team includes of following phases: eployees' experience, reflection and common evaluation of operations, creation of internal model that steers operations, and planning the operations together. Development of home care is target-oriented action, which implements in home care context.