Abstract
Age is a commonly used criterion in social work, whether for entry and exit or for decisions about the appropriate measures for clients. This study introduces the concept of age logics in social work and investigates the use of age in ‘wet’ eldercare facilities. Wet eldercare facilities are harm reduction arrangements open to people over the age of 50 with long-term substance misuse. No treatment is provided, and residents can continue to consume alcohol and other substances for the rest of their lives. At wet eldercare facilities, age is used to mark a shift in ambition: earlier efforts to treat are replaced by attempts to provide care and dignity. The article uses wet eldercare facilities as the example with which to (i) introduce age logics as an analytical tool for critical studies of age in social work; (ii) understand how age logics are used in harm reduction arrangements for older people; and (iii) propose a method to increase age awareness and identify and challenge problematic uses of age in social work. The empirical data consists of interviews with 31 residents, 11 caseworkers and 12 staff members at two Swedish wet eldercare facilities. The analysis identifies four types of age logics linking chronological age with its meanings: (a) the logic of changeability; (b) the logic of lifestyle; (c) the logic of function; and (d) the logic of administrative fit. Together they construct an ideal type of the ‘older addict’, which justified existing arrangements.
Introduction
Age in many social work institutions is a criterion for entry and exit and is used to accord rights and judge what actions can be considered normal or deviant (Hultman et al., 2020; Smith et al., 2005). Age is used to decide on retirement as well as public transport concessions and winter fuel payments. It is also a criterion for exclusion from several types of disability benefits (Breda and Schoenmaekers, 2006; Harnett, 2019; Jönson and Norberg, 2023; Mattsson, 2018). In social case work, age is used to determine the choice of treatment when providing support for homeless people, for example, and for people with substance use disorder (Canham et al., 2018; Semborski et al., 2021). Younger people are typically perceived to have a greater potential to change and recover, and age restrictions may be applied to practices that shift the focus away from treatment to the reduction of harm (Watson et al., 2015). For example, in most countries people under 18 are excluded from access to methadone treatment (Ndimbii et al., 2021; Van Beusekom and Iguchi, 2001) and supervised injection facilities (Watson 2015). It is also the case that characteristics associated with age categories are invoked differently in support for different arrangement in social work. Age and age categorizations can be used as an explanation for why people cannot quit a particular lifestyle and why people ‘mature out’ of the lifestyle (Valdez et al., 2019).
While social work categorizations relating to gender, race and ethnicity have been theorized and studied using critical approaches, less attention has been paid to age, and in particular to adults’ age. Ageism has been increasingly studied and theorized, but controversy surrounds the character and prevalence of this problem. There is often consensus in society on the relevance of age-based policies – for example, banning the sale of alcohol to minors. Some scholars have argued that seemingly natural differences make age categorization difficult to challenge as cases of ageism (Bytheway, 1994, 2005). Other scholars have argued that ageism is overgeneralized since it is applied to all sorts of circumstances and levels as a way of explaining nearly all the negative situations and consequences associated with old age’ (Higgs and Gilleard, 2021: 1). In social work, there is also reason to be cautious of approaches that aim to eliminate all forms of ageism, where ageism is defined as ‘stereotypes, prejudice and discriminatory behaviours against older adults’ (Ben-Harush et al., 2017: 39). The eradication approach to ageism (positive and negative), that has been proposed by prominent scholars such as Palmore (1990, 2005), may fail to acknowledge instances when vulnerable populations stand to gain from age stereotypes. Calls to disregard age and only take notice of individual features as function and needs may also turn out to be ableist (Jönson and Taghizadeh Larsson, 2022). An approach which is more open to the uses of age and age categorizations is needed (Holstein and Gubrium, 2007).
With this study we introduce the concept of age logics, defined as age-related reasoning that is culturally established and used to explain or justify particular arrangements. In ageing studies, the concept may be applied to cases where age is used as a ‘proxy’ for something (frailty, habits and interests) and where arrangements appear to have a degree of ‘rationality’ or ‘reasonableness’ (Neugarten, 1981: 823). This reasonableness is, as Neugarten points out, context dependent.
The concept of age logics is inspired by the gender logics used to highlight structural, organizational and interactional gender practices and the division between men and women (Chang, 2000; Kelan, 2010). The dictionary definition of logic is ‘a particular mode of reasoning viewed as valid or faulty’. The concept has been theorized in several research traditions, focusing on cultural constructions as well as decision-making by individuals and organizations (Valentino, 2021). Mills (1939: 674) argues that the generalized other – a term that could be translated as collective attitudes or discourse – provides ‘a logical apparatus’ that governs the individual’s direction of thought. Mills (1940) develops this position in his study on motives as a form of socially situated justifications for past, present and future action. The concept has also been a core feature in neo-institutional theory, where an institutional logic has been defined as a system of cultural elements such as values and beliefs that individuals, groups and organizations use to evaluate and organize their everyday activities (Haveman and Gualtieri, 2017). Society, according to Friedland and Alford (1991), is made up of logics of institutions such as the market, the family, religion and science, which are available to individuals and organizations as the basis for action.
The governing and constraining character of cultural logics has been the subject of much attention (Rao and Giorgi, 2006; Valentino, 2021). Following Swidler (1986) on the influence of culture, we see age logics as part of a ‘tool kit’ that individuals and organizations may use for different purposes. This is similar to how life course and age categorizations have been theorized in critical gerontology (Holstein and Gubrium, 2000, 2007), where they are defined as a culturally established resource, to be invoked and applied in different contexts.
Proponents of critical gerontology argue that age should be studied as an organizing societal principle, interpreted and accomplished in different contexts (Krekula and Johansson, 2017; Laz, 1998). The goal of critical gerontology is not just ‘to understand the social construction of ageing, but to change it’ (Phillipson and Walker, 1987: 12). Like critical approaches in gender and ethnicity, critical gerontology has the potential to reveal arrangements that use stereotypical images and age to justify public policies that affect individuals negatively (Bodily, 1994; Harnett and Jönson, 2017; Torres and Donnelly, 2022). By understanding such logics, we can lay bare the accepted principles that organize social work based on age.
In this article, we use the example of ‘wet’ eldercare facilities to show how age logics can operate in social work.
Older people’s substance use problems and wet eldercare facilities
There are considerable variations in alcohol-related studies when it comes to the definition of ‘older people’. The age considered ‘older’ in the substance use literature ranges from 45 and to 75 years and above. The literature suggests that treatment responses in adults aged 60 and over may be substantially better than adults in their forties (Oslin et al., 2002, 2005). A comparative study of adults aged 55–77 showed they had more favourable outcomes and greater attendance at therapy sessions than their younger counterparts. These differences may be accounted for by variables such as the nature of the substance dependence, social networks and gender (Satre et al., 2004). It has also been shown that stereotypical beliefs in the inability of older people to change have been used as justification for decisions not to suggest treatment (Cummings et al., 2006; Duru et al., 2010; Gunnarsson and Karlsson, 2018). This said, there are indications that older people may lack long-term engagement and be less likely to engage in formal aftercare (Lemke and Moos, 2003). The relevance of age in predicting treatment response is contested, and the literature suggests that both gender (Tait et al., 2012) and substance use trajectory over the life course are more important factors (Boeri, 2011).
This article focuses on a specific type of solution for older adults judged to be unwilling or unable to stop using alcohol or drugs. These facilities are referred to as ‘wet’ eldercare facilities, ‘specialized’ or ‘alternative’ nursing homes and exist in countries as Denmark, Germany, Norway, Sweden, the UK and the Netherlands (EMCDDA, 2010; Jönson et al., 2021; McCann et al., 2017; Thiesen, 2007; Vossius et al., 2013). Wet care facilities constitute a type of harm reduction alternative that provide accommodation, care and food, but no treatment. Instead of efforts to achieve abstinence, the focus is on providing safety, stability and care. Facilities operate on the basis that some older people ‘are unable or unwilling to stop drinking’ (McCann et al., 2017). The term ‘wet’ refers to residents being allowed to consume alcohol on the premises. In the Swedish facilities in this study, residents may use alcohol and drugs in the privacy of their rooms but not in communal areas. The fact that alcohol, drugs and drinking buddies are always close at hand makes it very difficult for residents to become sober if they have that urge. This is a deviation from official Swedish policy, and in particular the zero tolerance approach on drug use that has made harm reduction efforts controversial (Goldberg, 2004). Wet eldercare facilities are the non-preferred solution in the Swedish system. They fall under the Social Services Act, which clearly states the responsibility to ‘actively see to that the person with substance use problems get the help and treatment that he or she needs in order to get free from the addiction’ (Chapter 5 §9). Placement in a wet eldercare facility has been justified as an alternative that should be used only when all other alternatives have failed and qualifies for the non-preferred solution that Emerson (1981) calls a last resort.
Age logics are most visible where there might be reason for individuals to account for these arrangements. This makes wet eldercare facilities a useful object of study. Not only do they apply a policy that could be framed in terms of ‘giving up’ on people by not providing treatment. The typical resident in a standard care facility for older people in Sweden is over 80, but wet eldercare facilities can welcome people from the age of 50. This apparent deviation from what is statistically normal makes it likely that social workers, care staff and residents themselves provide different accounts (Scott and Lyman, 1968) for the age limit in use. As Bytheway (2005) suggests, it is around age limits that differences in age categorization are likely to be questioned, explained and defended.
The aim of this article is threefold: (1) to introduce age logics as an analytical tool for critical studies of age in social work; (2) to understand how age logics are used in harm reduction arrangements for people over the age of 50; and (3) to propose a method for understanding and evaluating age logics in social work.
Method
The study is part of a larger project investigating eldercare arrangements for people with substance misuse and complex needs.
The context where data was collected
The data is based on interviews in several Swedish facilities; the article uses data from two facilities in the same city which have a lower age limit of 50. The two facilities are formally regarded as part of the eldercare sector, and eligibility for admission is based on an individual needs assessment process. Care staff are always available, and the actual cost for to the local authority is about EUR 6000 a month for each resident (premises, food and care). Residents pay a fee for their rent and food. Care services in Sweden are heavily subsidized so residents pay a maximum of EUR 200 a month, whatever their care needs. The total fee for care, rent and food (full board) is typically about EUR 10-1200 a month but is lower for some residents. Some refuse to pay anything but are allowed to remain because the facility is the only option.
Data and procedures for data collection
The data consists of interviews with 31 residents, 12 managers and staff members and 11 caseworkers. The Mountainview facility then had 129 rooms and its sister facility, Cloverdale, 72 rooms. Data was collected between 2018 and 2020 in face-to-face interviews with residents, staff and managers and phone interviews with caseworkers. Various strategies were used to recruit interviewees. Managers were contacted by phone and asked to participate, but other staff members – nurses and nursing assistants – were recruited via managers. The recruitment of residents was adapted to the situation, depending on what was considered appropriate in the context. Staff put up notices in the facility to announce our first visit in advance, and we asked staff for guidance as to which residents were competent to give informed consent, being not too intoxicated or cognitively impaired. As we got to know the facilities better, we recruited interviewees without staff involvement, both by approaching residents in communal areas (such as the TV lounge) or by visiting their rooms to ask if they were interested in participating in the study. All but three interviews took place in the residents’ own rooms. Interviews with residents lasted about 40 min, varying from 13 to 65 min. Of the 31 residents, 25 were men and 6 were women. They were aged between 50 and 81, the majority being between 60 and 70. Some had lived at the facility for over a decade, others had moved in more recently. The recruitment of caseworkers to interview was a multi-step process. First, a counsellor helped us identify residents who had lived at Cloverdale or Mountainview for no more than 5 years. Second, we approached residents individually in their rooms and asked for permission to contact the caseworker in charge of the decision to allocate them to the wet eldercare facility where they were currently living. Third, we obtained the name of the caseworker from the counsellor and contacted them by phone to explain the research project and ask them for informed consent to participate in a phone interview.
The interview guide contained a number of questions ranging from aims and policy of the facility to the problems and quality of life of residents. One set of questions concerned existing age limits and residents’ ages.
Research ethics
All interviewees were provided with written and verbal information about the purpose of the project and were informed that participation was voluntary and that data would be coded for anonymity. Written and verbal consent was obtained from all participants, but the caseworkers who were phone interviewed gave consent by phone. The project was approved by the Ethical Review Authority (Dnr 2019-04404). All interviews were digitally recorded and transcribed verbatim (except from four interviews with residents excluded for ethical reasons, as they were considered too incoherent due to cognitive problems or intoxication). The names of the facilities and the names of those interviewed are pseudonyms.
Coding and analysis
The analysis of data was inspired by the approach within discourse analysis that investigates the ordering and making of meaning that people engage in through talk, and that has been used in critical gerontology (Holstein and Gubrium, 2000, 2007). Ways of describing age in relation to a specific context was the object of knowledge in the study. The analysis thus focused on reasoning on age among participants in relation to culturally established understandings of age. The analysis was carried out as a three-step process, starting with the construction of the interview guide. Given general expectations of the different stages of life, it was anticipated that interviewees would provide reasons for providing eldercare, but no treatment, to over-50s with substance misuse issues. Interviewees were also asked if it should be possible for younger people to move in, for example, people in their 30s. In a second step, the transcribed interviews were read in their entirety by both authors of the team and all references to age were coded. Categories were identified through repeated references among respondents. In a third step, categories were discussed between the authors of the team and during a workshop, in order to proceed in the analysis of culturally established aspects that made it relevant to refer to meanings as age logics.
Results
The analysis resulted in the identification of four meanings that residents, staff and caseworkers ascribed to age in relation to existing policies. Age was considered a marker for lifestyle, a marker for ability to change, a marker for function and an administrative principle. From this, we posit four age logics: the logic of lifestyle difference; the logic of changeability; the logic of function; and the logic of administrative fit. Of these four, the administrative category consisted of references to a simple match between the age of the individual and the facility’s target group. Several interviewees gave no reason for the existing age limits, claiming they were unaware of the limit or had no opinion about it.
The logic of lifestyle difference
When interviewees reasoned about the eldercare facility’s lower age limit and whether younger people could move in, age-related differences in lifestyle were a recurring theme. One common response referred to people’s energy, based on a binary division between the general categories of ‘younger’ and ‘older’ people.
Whenever residents invoked the logic of age as a lifestyle marker, it was to comment on the higher energy and agility of ‘young’ people in contrast to the slow pace of people of the present age group. The negative version of this age difference was evident in their suggestion that younger people would create disorder. Several residents told stories of shelters where they previously stayed and how younger people had made them terrifying places. Statements such as ‘It would be disturbing if they were to live here among the old, you know [laughter]. They would knock on doors and shout’ were followed by ‘Here is for the old people you know, alcoholics, they handle themselves, they are calm’. Categorizations such as ‘the old’ and ‘old people’ were not defined as people above the general retirement age but rather were based on a division between young and old, where ‘older’ could refer to anyone over 50 – the administratively set age limit for entry.
While caseworkers and staff members identified residents’ health problems as the main reason for the calm atmosphere at the eldercare facilities, other age-typical aspects were also mentioned. Those who were older were not only seen as more vulnerable but also as having a different kind of lifestyle because of their age: No, but I think younger people are active in another way, perhaps more criminal. I shouldn’t put it like that, but perhaps they sell… I mean perhaps, yes, I think that those who are older are more exposed in some way. Yes I have seen how those who are older get robbed in places like this because they may have a greater ability not to spend all their money, perhaps they live a slightly quieter life even if they have a dependency problem. Perhaps they are better at hanging onto their money. Those who are younger can push and demand money, those are the things I think about, that it would make it unsafe, that’s my spontaneous thinking (Caseworker Hannah).
The age logic served as an interpretive resource that gave meaning to why the people over the age of 50 should be provided with their own facilities. None of the staff members or caseworkers favoured a lower age limit. Some residents said they would welcome younger people at the facility, and once again the difference in energy and agility was mentioned: ‘Of course, it would be fun with some youngsters here too’. Life at the facilities could be boring, and a mix of ages could be a way of livening up residents and the facility. Statements about the calmness of older people did not invoke younger people in general as comparisons, but younger people with substance misuse, a category associated with activity, but not the activities – working, raising a family – traditionally linked to middle age. The life stages that were constructed by interviewees differentiated between younger people as agile and more aggressive in their substance use and criminal behaviour on the one hand, and older people, who could be in their 50s and 60s, who were characterized as calm, slow and vulnerable and suitable residents of an eldercare facility on the other.
The logic of changeability
Several interviewees took age as a mark of the ability to change, with the number of years residents had lived counted as years of living with substance misuse. Staff and caseworkers justified admission to a wet eldercare facility by associating chronological age with a history that established residents as chronic substance users. One caseworker said the people living at Mountainview had been subject to ‘an infinite number’ of treatment efforts, which she linked to their chronological age: So, but you have, you could do it like this, like a CV [a long list of previous treatment episodes], there would be pages and pages for many of these people. Because so much has been done and finally you kind of reach the end of the road, you feel, when you meet these people. As I said, they are over 65 and have been active for 40 years, 50, and there has not been that much improvement (Caseworker Heather).
To justify and explain why no treatment was provided at Mountainview, the caseworker invoked a logic linking old age with an inability to change. The history of residents’ failed treatments was mentioned as a response to whether younger people could be admitted to the facility. What made age limits something that caseworkers and staff members wanted to account for was the shift in focus at the facilities – wet eldercare facilities were labelled as the ‘end station’. This is also how residents have been described in the media (Jönson and Harnett, 2019). Whenever the interviewer asked whether a 30-year-old should be allowed to move into the facility, it was taken to mean that attempts to make them sober would be abandoned. The response among staff and caseworkers was in some cases that the proper approach would be ‘normalizing and motivating’ efforts with the aim of rehabilitating them as part of the provision of treatment for people under the age of 50. When terms such as normalizing are linked with younger people with substance misuse, it reflects an understanding of younger people as ‘on time’ for life change and older people as ‘off time’ (cf. Holstein and Gubrium, 2000). When residents in wet eldercare facilities are cast as being beyond the age when they could change, it is natural not to provide any treatment.
Interviewees struggled with ways to label the facilities’ policy on alcohol and drugs in relation to age, as when staff member Annie responded to the question about the existing age limit: What a difficult question… but sure, that [different goals for different ages] is the way it is. That those who are younger, in facilities for younger people, you really would not think in this way. They work with slightly different methods… I can’t pick any particular age for when you should… and I would not call it giving up either. I would call it a shift of focus instead. You stop focusing on the substance misuse and focus on the functioning aspects. I don’t know where to draw the line for that, but somewhere… (Staff member Annie).
Calling the issue ‘difficult’, Annie showed her awareness of the problems in justifying any particular age as the lower limit for admission, in particular when social workers could be accused of ‘giving up’ on their clients. The ‘shift of focus’ was part of a repertoire of justifications for the provision of care rather than treatment, where a long history of failed attempts to address substance misuse backed the claim: ‘They have had so many chances, been in so many treatment facilities’. Residents’ history mapped out their future, as seen in references to their established habits, routines and ways of thinking. As the counsellor at the two facilities put it, ‘No, I think that it’s… the pattern… that the actual pattern of life is so entrenched that it’s very difficult to go in a new direction’. Residents were set in their ways; they were unlikely to change.
Residents too referred to the link between ‘old’ age and a set lifestyle. One example was when a 61-year-old resident at Cloverdale responded to a question about the possibility of having a stricter alcohol policy: No, you can’t govern these old addicts, you just have to accept it. You can’t govern them, then all hell breaks loose, so it’s better to have soft regulations. Because damn, they’ve been obstinate all their lives (Resident Henry).
A version of this position was taken by Dean, a 72-year-old man with a long history of homelessness and prison, who said he would never take orders from staff who had not lived half as long as him or experienced a fraction of the humiliations he had survived.
A somewhat surprising finding was that only one resident commented on treatment ambitions as varying according to age. Terry, a 70-year-old resident at Mountainview, supported the existence of the current age limit with reference to younger people’s ability to change: There is a greater chance of saving a younger person compared to someone who is 70 or 75 and has been boozing their whole life or whatever they’ve done. You can try to change a younger person… or it is easier to change (Resident Terry).
When asked to characterize Mountainview, Resident Terry described it as his ‘end station’. He said it was a waiting room for death and the only way out was in a coffin. 1 Although those who lived in wet eldercare facilities were categorized as incapable of becoming sober, this was not necessarily considered a problem by residents. Being able to live in a facility without having to change was described by many as something very positive, which had improved their quality of life and given them their dignity.
The logic of function
If it is not expected that people in their 50s and 60s might move into an eldercare facility, what reasons are given for this being the case for people at Mountainview and Cloverdale? The answer lies in the separation between chronological and functional age. Functional age, according to the APA Dictionary of Psychology, is ‘determined by measures of functional capability indexed by age-normed standards’, and these standards are defined as variables that relate closely to chronological age. 2 In media reports about Mountainview, representatives of the facility have explained that the reason why the lower age limit is 50 is that substance misuse and a hard life result in premature ageing. Residents are ‘ageing faster than others’ (Strandberg, 2000), and chronic alcoholism ‘adds 20 years’ to their age (Fahlgren, 2014). The logic of linking age and function was used to emphasize that residents of Mountainview and Cloverdale were notably ‘off track’ from a normative life course (Gubrium and Holstein, 2000). This deviation from the standard stages of life was mentioned in several interviews, in comments about how residents’ lifestyles had resulted in health problems typical of the ageing process.
According to the logic of function, wearing out their bodies at a higher speed made residents old: I mean old age is one thing in itself physically that the body… the longer you live the more perhaps the body is worn out, but the people who live here, their bodies are likely to be worn out faster because of their substance abuse (staff member Patricia).
A few residents spoke of anomalies between chronological age and the general appearance of other residents at the facility. This was the case when a 59-year-old man at Mountainview explained why he did not socialize with others at the facility: I don’t hang out with… many are not in the mental condition so that it… for example I never eat in the dining room because there is never anyone who says anything there. They just sit there staring at each other, yes so it’s very tragic. And I just think ‘I really hope I will not end up like that’. And many of them are not particularly old either. Many, they are considerably younger than they seem to be (Resident Gary).
Several age-related health problems were mentioned by caseworkers and staff: diabetes, dementia (Wernicke–Korsakoff syndrome), incontinence and difficulties walking. Residents themselves described ageing and age-related health problems as the main reason (along with a lack of money) for cutting back on alcohol and drugs. Some joked about their walking difficulties or incontinence in ways that signalled their awareness that they had deviated from the general timetable.
Still, some residents were in their 70s and 80s. Caseworkers speculated that the absence of a tiring work life had balanced out some residents’ hard lives, and one 72-year-old resident described still being alive as a ‘personal mystery’. With their very different timetable, residents who lived beyond 70 could be described as living unnaturally long lives.
The logic of administrative fit
The final age logic was different to the other three because it was based on administrative practicalities rather than reasoning. The two wet eldercare facilities were labelled as being for ‘older people’ and applied the ethical code – providing wellbeing and dignity – set down for eldercare in Chapter 5 §4 of the Swedish Social Services Act. At the same time, many residents were in their 50s and 60s and few had the special care needs typically associated with older people in care homes. Several staff members we interviewed commented on the lower age limit as an anomaly in relation to eldercare, stating that old age did not start at 50 but at 65 years.
Residents were asked to comment on the relevance of the existing age limit. While some referred to differences in lifestyle, others claimed to be unaware of any age limit or found it difficult to reflect on general topics. In several cases, the residents did not take a position on the age limit and responded ‘I have no opinion about that’ or ‘I don’t care’. Given they were residents of a multiperson facility, we interpreted these answers as virtue signalling that they wanted to mind their own business.
Besides the reasons already mentioned, residents used a type of administrative fit to argue that they belonged to the facility’s target population. When asked to describe Mountainview, one 67-year-old resident answered: Well, it’s sort of a place… well, it is really an old people’s home, but many people on disability pensions live here. But I have lived here for so long that now I became an old age pensioner two years back (Resident Lars).
While the people admitted to eldercare facilities in Sweden are usually in their mid-80s or older, Lars indicated that he now belonged because he was an older person. This administrative fit – taking on the identity of an older person – was stretched even further by Mary, who was only 50 years old: Interviewer: And there is this sign saying ‘Cloverdale Nursing Home’ outside. What do you think of that? Mary: Yes, you do get older. And I am 50 now. So I am only a few years from the grave [laughter].
The prospect of having a few years left to live, as Mary joked, links in the other interviews where staff and residents described the facilities as an end station or as death’s waiting room. Whether the person was 50, 60, 70 or 80 years old, they lived at a facility for older people, with the prospect of dying there.
A more direct use of administrative fitness featured in interviews with caseworkers, in the argument that their clients were in the right place since they met the formal criteria for admission. When using this response, caseworkers did not fit residents into the category of older people but referred directly to the criteria for admission. A typical answer was provided by Mary’s caseworker, who had been responsible for placing her at Cloverdale: Interviewer: Mary is 50 years old. Did her age matter when you decided her placement? Caseworker Judith: Yes, Cloverdale and Mountainview have that target group, people aged 50 and over. That they are mainly aimed at. So of course age is a factor in why she was placed at Cloverdale. She belonged to that target group, so to say.
All caseworkers were asked if the age of their clients affected their decision to offer a placement in a wet eldercare facility, and all related it to the lower age limit when justifying their decisions. One caseworker stressed that the age limit was set by other professionals and he had to adapt to it: The professionals who work with the target group, they have a vision for what clients are suitable. And as is the case with Mountainview and Cloverdale, if they say it is for 50 and up. Yes, then we follow that (Caseworker Matthew).
What we would argue the administrative fit accomplished was a situation where an age logic that could be challenged did not have to be used. It avoided troubling reflections, as one caseworker said of the differences between administrative labelling and the character of the residents: It’s more like when you think about it as a care facility for older people and then you know that some who live there are 45, so of course it’s mindboggling sometimes, and the matter is complex, because we are supposed to still think ‘care facility for older people’ and that, but we know those who live here are not that [older people needing care] (Caseworker Heather).
This shows that on reflection the arrangements were odd and disturbing, and the reference to the youngest person at Mountainview reinforced the impression that there was a misfit between residents and the ‘eldercare facility’ label. Caseworkers avoided the issue by referring the interviewer to others or by simply stating that a client aged 50 (and sometimes even younger) had been placed at a facility for people above that age.
Much like some residents, caseworkers used an additional response to the questions about lower age limits. When answering the question about age, caseworker Uma said that ‘Yes, no, it could… I have no opinions about that actually’ and referred the interviewer to another local authority department. Caseworker Matthew stated that ‘I don’t know, it’s perhaps better if you interview my superiors’. In terms of accounts (Scott and Lyman, 1968) this could be called a type of administrative deflection: social workers who used this response refused to be held accountable for the event the question was about and provided no reasons.
Discussion
Life arrangements that make it easy for people with substance misuse problems to continue with their use of alcohol and drugs constitute a breach of official Swedish policy, since treatment is the preferred solution for this problem. Applying the term ‘eldercare’ to a care facility for people who may be in their fifties, sixties or seventies may also be considered as odd, given that most people who receive such services are in their eighties and nineties. The odd character of the case makes it possible to provide knowledge about how cultural beliefs connected to age and age categorizations are invoked and used to justify different arrangements. In this study we have identified the culturally established reasoning about age that explains or justifies such arrangements, and that we refer to as ‘age logics’. Our proposed forms of age logics serve to link chronological age with four interacting meanings: (1) the logic of lifestyle difference; (2) the logic of changeability: (3) the logic of function; and (4) the logic of administrative fit. The first three have strong links to culturally established beliefs that ‘older people’ are frail and unable to change. The fourth refers to authority and obedience: existing age limits and age categorizations are there to be followed and used.
The four logics that we have identified in this article could all qualify as cases of ageism in the sense that they introduce divisions between younger and older at the age of 50 years and express stereotypical images of old age. Bodily (2005) argues that the use of age as an explanation for activities and arrangements is the bedrock of ageism. Bytheway (1995) makes the point that ageism is concealed by the seemingly natural character of age categorizations and differences among people at different stages of life. Our understanding of these claims is not that all references to age categories and age as explanation should be regarded as ageism to do away with. To focus on the occurrence of ageism using an eradication approach may fail to take into account social work arrangements that actually favour vulnerable individuals. Instead, what is called for is a critical understanding of age logics and a sensitivity to how age and age categorizations interact – and how they are used in the organization of social work. We thus propose an ‘age logic checklist’ to increase age awareness in social work. 1. What age logic is used and how does it relate to culturally established ways of understanding age? 2. What identities are produced by the age logic in this context? 3. What risks and gains are associated with this age logic? 4. Is there a need for change?
Although age logics and the presented checklist may facilitate the identification of ageism, our suggestion is that it is most useful for identifying and challenging problematic uses of age in social work.
Logics, identity, risk and gain – increasing age awareness
The age logics which we have identified appear as logical and ‘reasonable’ because they build upon culturally established understandings. The first logic refers to the general division between the categories of young and old (or younger and older) known from work, sport, family life and other contexts. The ‘young’ category is associated with strength, agility and a lack of control, while ‘old’ is associated with frailty, calmness and maturity. The vague ‘old’ and ‘older’ category in our study consisted of over-50s, 50 being one of the usual age dividers in research on alcohol use among ‘older’ people (Rao and Roche, 2017). In our study, this division associated the young with an active lifestyle as drug users and criminals, but the old were described as slow, calm, vulnerable and sometimes mature. The ‘young’ who were under the age of 50 years were deemed as unsuitable for the facilities, partly because they were lively and dangerous, partly because they were ‘yet treatable,’ and partly because they did not fit the administrative definition.
One of our findings was the identification of a typical stage in life that the care facility residents were supposed to have reached, which was associated with the established image of older people as unable to change (Palmore, 1990). In our study, this ‘old dog’ logic of changeability referred to the assumption that those who had lived for a long time also had lifestyles characterized by repeated failures of treatment that made change difficult or impossible. The third, the logic of function, refers to an understanding of the ageing process, but the body is perceived as ‘worn’ and ‘aged’ in a way that does not match general expectations of chronological age. It is used to justify eldercare services for people who are below the age when such services are typically provided. This identifying of people who age ‘prematurely’ is similar to the treatment of people who have intellectual disabilities (Kåhlin, 2015).
When looking for potential gains, it is evident that the use of several age logics allowed residents to access housing and care without the requirement to become sober or even reduce their consumption of alcohol and drugs, a situation that many appreciated. Suggestions that residents were too old to change their way of living and that they should not be urged to attend treatment could indeed be interpreted as ageism, but this ‘self-ageism’ served as a basis for the right to stay at the facility and avoid a general Swedish policy on drugs that has sometimes been described as inhumane (Goldberg, 2004). A second gain was the provision of the identity as an older person. Given the existence of ageism, it might be expected that ageing adds stigma to any type of problem identity. Our studies of wet eldercare facilities reveal this is not always the case. The media have used labels like ‘older gentlemen’ and ‘good old boys’ when portraying residents (Jönson and Harnett, 2019) and such positive stereotypes of old age may actually offer identities that residents find attractive. Applying a critical approach makes it possible to identify the categorizations which individuals use to reduce stigma. In our findings, the label ‘eldercare facility’ evidently enabled residents to identify as older people. The interview with Lars, one of the residents, provides an example. He described Mountainview as a facility for older people like himself and then mentioned activities such as common gatherings, short trips and entertainment that are typical of regular eldercare facilities that he participated in at Mountainview. Labels such as frailty, vulnerability and maturity enhanced this identity. As we have shown elsewhere, this self-labelling appeared alongside other ways of reducing stigma (Harnett and Jönson, 2021). Being an ‘older person’ receiving eldercare meant residents could avoid or tone down the stigmatizing master category of ‘alcoholic’ or fuse it with features such as maturity and calmness.
The findings of this study point to the risk of what we call ‘age logic expansion’. The point here is not to question the existence of people who display the characteristics described above but rather to reflect on the risk that the categorization becomes too inclusive. Research on treatment for alcohol problems has shown that age in itself is not associated with poorer outcomes, but to have lived for a long time with severe drinking problems gives a bad prognosis for recovery (Oslin et al., 2002; Kuerbis et al., 2014). The obvious risk is that people with substance misuse are presumed to have a history of failed treatments if they have lived a relatively long life. This was not true of several residents we encountered. Some had not been in treatment, as confirmed by caseworkers and staff. Some had stopped drinking but stayed at the facility because they felt secure there, while others were stuck since it was impossible for them to find alternative housing elsewhere. However, according to the logic of administrative fit they belonged to the target group by way of age and substance misuse.
The risk of age logic expansion is present when references to age as an administrative principle justify the admission of people who fit into the target group. Cultural logics are transformed into organizational logics, which become justifications of their own. Wet eldercare facilities have been presented as the last resort for older people with long-term substance use issues who have tried all other options and need the stability that only a wet eldercare facility can offer. It is an end station, a waiting room for death in the words of interviewee Terry. The ideal type of resident is constructed as untreatable, an older person who according to the media has ‘fallen through all protective nets that society has put up’ (Jönson and Harnett, 2019: 335). When an age limit is an administrative principle, what happens is the target group is broadened. People categorized as either ‘unplaceable’ or ‘placeable’ are referred to the facilities: unplaceable clients have few other alternatives, if any; placeable clients are referred to the facility if a room is available, since they meet the formal criteria of the facility – they are over the age of 50, they have problems with substance use and they need care or social support. 3
Age categorizations are common in social work, where they serve to explain and justify the full range of events and arrangements. Reflecting on what part age plays in social work policy and practice is a route to social change (Torres and Donnelly, 2022). This study has adopted a critical approach in order to introduce the analytical concept of age logics. We argue that social workers should gain from using the age logic checklist and reflect on four questions that will help identify age logics in social work. The questions are designed to help scholars and social workers use age and age categorizations more sensitively. And they should make it possible to reveal harmful arrangements and change policies.
Footnotes
Acknowledgements
The authors would like to thank the two anonymous reviewers of Qualitative Social Work for their comments and suggestions. The findings of the study was discussed during a workshop with the ageing group at the School of Social Work, Lund University.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Swedish Research Council for Health, Working Life and Welfare, grant number 2019-01149.
