Abstract
How are we to care for the elders of our society? This is a question faced by governments and citizens across the world, amidst fears that growing demand far outstrips the resources available. Attempts to find answers must address not only funding but also concerns about service coverage and quality, staff recruitment and retention and clients’ experiences of care.
The ‘Nordic model of care’ is often held up as an exemplar. In contrast to many other welfare states, services for older people across Scandinavia are fully funded through taxation, regulated by the state and universally available to those who need them. Professionalization and unionization enhance the profile of care work, ensure that care workers enjoy appropriate educational and professional development opportunities and protect their wages, working conditions and employment rights.
However, Scandinavian countries have not remained immune to the demographic, social and economic changes that threaten the sustainability of the elderly care sector. In fact, since the 1990s, this sector has become a testing ground for the introduction of neoliberal management techniques, such as new public management (NPM), in the name of achieving greater efficiency, effectiveness and consumer choice.
Investigating these trends in the Scandinavian elderly care sector, Elderly Care in Transition sheds valuable light on the pressing question posed above. The chapters in this edited volume explore the issues from the ‘bottom up’, honing in on the challenges and dilemmas experienced by care workers and managers as they navigate their daily work. The problems of resignation and burnout are highlighted, but the authors also identify pockets of resistance and transformation.
Several of the chapters cover the changing meaning of work in the elderly care sector, through both historical analysis and case studies (Kamp; Dyybroe). Other chapters investigate the paradoxes that are created when neoliberal management principles are introduced into the Nordic model of care, for example between standardization and care workers’ autonomy (Dahl and Rasmussen) or between managers’ care ethos and their commitment to the new economic rationale (Rasmussen). Another chapter explores the significance of the discursive positioning of different types of knowledge, namely emotional versus scientific knowledge, in elderly care policy and practice (Fejes).
A useful counterpoint to dominant narratives about changes in the care sector is offered by Bottrup and Bruhn in their chapter on dementia care. These authors suggest that the emergence of dementia services as an evidence-based medical field has provided new opportunities for care staff to ‘re-professionalize’ as dementia care specialists. However, developing such specialist skills requires systematic engagement in collaborative, interdisciplinary learning which, they argue, is not always promoted by existing structures and communication practices within dementia care settings.
Together, the chapters in this volume offer a range of pertinent analyses on continuity and change across the Scandinavian elderly care sector, although with some variation in the quality of the research and argument among them. Their collective contribution could have been considerably strengthened, I would argue, through better conceptual clarity and structuring. For example, in the introduction, it would have been helpful for the editors to provide explicit definitions of the key concepts, policy instruments and service delivery tools which appear throughout the text – such as NPM, neo-Taylorism, mutual language software and so on – in order to avoid the inconsistency and repetition that can beset multi-authored collections. Further coherence might have been achieved by grouping the chapters around key themes and by ensuring a limited degree of standardization in the presentation of theoretical approach, methods and research focus (such as country, participants) across each chapter.
Furthermore, it is quite challenging to place the arguments presented in this volume into a comparative framework. On the one hand, there is some corroboration of traditional assumptions about the universal, protected, professionalized Scandinavian elderly care sector. On the other hand, there are references to the all too familiar problems of abuse and neglect, poor working conditions, inadequate recruitment and high rates of sick leave and turnover. The ambiguity caused by these conflicting characterizations – which beg the question of how unique or exceptional the Nordic model of care actually is – might have been resolved by the inclusion of some basic comparative statistics on this sector across a selection of welfare regimes.
This book concludes on a cautiously optimistic note about the future of elderly care services in Scandinavia. Drawing on specific examples of recent changes and innovations, the editors suggest that, just as elderly care has been at the forefront of neoliberal interventions across Scandinavian welfare systems, so it may be the first sector to move beyond them, into a new era characterized by different priorities and fresh opportunities for employee autonomy, competence and meaning. Overall, for those of us that are concerned about sustaining and improving elderly care in changing times, Elderly Care in Transition provides a timely and compelling collection of lessons learned and ideas for the way forward.