Do national guidelines have any impact? A comparison of nine Swedish municipalities and the Dementia care

Abstract

The aim of this article is to find out what impact national guidelines have on municipality dementia care. Furthermore, the aim is to compare organization of social care to the local adaptation of nationally invoked values. This article is connected to Living with dementia, care and social care systems, an interdisciplinary project between Health Sciences at Lund University and Social Sciences at Linnaeus University. The national guidelines for care and services to people with dementia recommend specialized units, and professional specialization in dementia care. Based on values of self-determination, integrity, accessibility, equity, rights and safety, they are meant to guide the dementia care in the community. In this article the organization of care is compared to how nationally invoked values are discussed in local policy documents in nine municipalities. These two aspects of dementia care are central to the national guidelines. The organization of care was explored by a mapping study of 19 municipality services. Type of organization was determined based on when, throughout the progression of the disease, services were made available, the existence of specialized dementia care units, and level of professional specialization. Information about values in local policies was examined by utilizing policy as discourse analysis of local policy documents. Four types of relationships between organization and value implementation were found. Eight out of nine municipalities failed to adapt to both aspects of the national guidelines.

Care Ethics for Supported Decision-making. A Narrative Policy Analysis Regarding Social Work in Cases of Dementia and Self-neglect

“…The policy narrative examined in this article invokes an insufficient and unstable workforce as well as inappropriate management and leadership as possible explanations for lack of a care-ethics approach among care managers. This kind of explanation is supported by for example Vingare, Giertz, and Melin Emilsson (2020), which shows a weak connection between national guidelines and regulations and routines at the local policy level in Swedish elder care. In an elder care system that is less generous on an individual level (Szebehely and Meagher 2018) and that is staffed with an inadequate and unstable workforce, it is less likely that care managers (and their managers) will find time to search for and process a fragmented national policy narrative about how they are to work.…”

People living with dementia using eldercare in Sweden

“…On the other hand, informal care is generally involving help with household chores, errands, transportation, social visits, social get together, or emotional guidance (Verbakel, 2018). This type of care is often provided by spouses, parents, adult children, family-in-laws, friends or neighbour, whose work is not compensated by public funding (Vingare et al, 2020).…”

“…That means people diagnosed with dementia may have challenges performing everyday tasks during the course of the disease. With the individual diversity at different stages of the disease, the care supports for this group of people will confront with a complex combination of needs (Vingare et al, 2020). Consequently, the need for eldercare services, both homecare, and care in residential facilities, among older adults living with dementia may increase (Odzakovic et al, 2019;Wimo et al, 2016).…”

“…Two recent studies investigated the professional care organization for PlwD in nine different Swedish municipalities (Lethin, Scandali, et al, 2018;Vingare et al, 2020) and found four available care services for PlwD: (1) Support to family caregivers in the form of supportive units for family caregivers, respite care, education in dementia, and consulting and guiding services. PlwD with moderate or severe stages of dementia and their caregivers generally utilize more services.…”

Online representations of nursing-home life in Sweden: perspectives from staff on content, purpose and audience

“…Unlike many other countries, Swedish care providers have no formal right to overrule an adult's self-determination, even when that person has dementia (Nedlund and Taghizadeh Larsson, 2016). Equally, relatives have no legal obligation to provide care for adult persons (Vingare et al ., in press). The official guidelines issued by the National Board of Health and Welfare (Socialstyrelsen, 2013) state that relatives and next of kin ‘have no legal authority to act as deputy for the individual’, and indeed ‘no right to make an application on behalf of the individual’.…”