What constitutes ‘good care’ and ‘good carers’? The normative implications of introducing reablement in Danish home care

Abstract

As populations worldwide are ageing, Western welfare states are currently implementing welfare reforms aimed at curbing the rising need for social and healthcare services for ageing populations. A central element in home‐care reforms in several welfare countries is reablement: short‐term home‐based training programmes aimed at re‐enabling older people to live in their own homes independently of care. In this paper, we explore how transitioning from compensatory care to reablement care is not merely a practical process, but also a deeply normative one. Drawing on Annemarie Mol's concept of ‘ontonorms’ we analyse the normative dynamics involved in transitioning from one form of care to another as reflected in reablement professionals' practices and discourses. The paper draws on 10 months of multisited ethnographic fieldwork carried out from April 2015 to February 2016 in a Danish municipality, including participant observations of reablement practices as well as qualitative interviews with 13 professionals working with reablement. We demonstrate that professionals generally consider reablement to represent a desirable shift in home care from ‘bad care’ practices of making people passive through compensatory care, towards ‘good care’ practices of ‘keeping people going’ despite their limitations. Moreover, we demonstrate that while therapists are valued as ‘good carers’ due to their ability to focus on development and training, nurses and in particular home helpers are devalued as ‘bad carers’ due to their ‘caring genes’ and lack of technical and theoretical skills necessary for documentation work. Finally, we discuss the implications of these normative dynamics, which may risk stigmatising compensating care practices, although this form of care to a large extent continues to coexist with reablement practices. In conclusion, we argue for a more nuanced approach to care, recognising compensatory care and reablement as complementary forms of care, each doing good under different circumstances.

Integration of physical activity in reablement for community dwelling older adults: a systematic scoping review

“…After screening 2,304 unique records, of which 236 were examined in full-text, 43 articles met our eligibility criteria and served as the overall data material for the scoping review (illustrated in Figure 1-Prisma Flow Diagram). Among these studies were 12 intervention studies, including ve RCTs (30)(31)(32)(33)(34), ve non-randomized controlled trials (35)(36)(37)(38)(39) and two non-controlled pre-post study (40,41), in addition to one RCT long-term follow up study (42); four studies with mixed design/other (43)(44)(45)(46); three studies based on quantitative research (47)(48)(49); and 23 qualitative studies, of which 15 focused on HCPs' perspectives (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), six on older adults' perspectives (65)(66)(67)(68)(69)(70) and two on family members perspectives (71,72).…”

“…Fifteen qualitative studies and two mixed method/feasibility/implementation studies investigated inquiries based on HCPs experiences or perspectives on reablement (44,46,50,(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)76), but none of these speci cally aimed at investigating or exploring HCPs' experiences related to PA facilitation. However, some of the studies -of which ve were Norwegian (53-55, 58, 60), two were Danish (51, 62), one Australian (44) and one from the USA (46), brought up perspectives from HCPs related to activity training or exercises, which are presented in the following.…”

“…The roles of the allied health personnel were found to be transformed from being carers to become trainers and implied a change of mindset of what it means to be a good carer (76). However, this transformation of mindset could also lead to discrepancies regarding different disciplinary views and norms related to caring and rehabilitation (76).…”

“…The roles of the allied health personnel were found to be transformed from being carers to become trainers and implied a change of mindset of what it means to be a good carer (76). However, this transformation of mindset could also lead to discrepancies regarding different disciplinary views and norms related to caring and rehabilitation (76). Phrases such as keeping your hands behind your back and don't take over for the citizen were reported to be commonly repeated in a Danish reablement setting, and HCPs were reported to increasingly assume a physically passive position, including a more distanced, observational and instructing practice (62).…”

“…However, the family members could also be a barrier to (physical) activity, by taking over the older adults daily activities. Several studies reported that the knowledge and values related to the bene ts of PA and active aging sometimes were met with skepticism or resistance from older adults themselves, family members, HCPs or by habitual traditions of running healthcare services (46,60,64,76).…”