”I händerna på myndigheterna” : Om hur äldre personer förstår och förhåller sig till att bli utskrivna från sjukhusvård för att istället få stöd och vård i det egna hemmet.

Sammanfattning: Background: The report Laga efter Läge (Rapport, 2020: 4) states that there is limited knowledge about the effects of the Act on collaboration for patients and care recipients. The report emphasizes that the discharge process has changed at a rapid pace, which they mean can challenges both coordination and care recipients' participation and security. The law of Sweden contains an intention for legal recognition of human beings. Swedish legislation also regulates various principals (region, primary care and municipality) in the health and care sector and their respective responsibilities for the individual. The study is based on the fact that the individual is a central part but also as an intersection between these various principals in their collaboration and the legislation's intention of recognition and self-determination. The discharge-process itself is a broad and in some case relatively explored field within the health and care sector, but relatively unexplored from a social work perspective. In that sense that earlier studies have contributed with perspectives on how professionals, elderly and relatives experience different moments in how practice is done, it may be valuable to take note of the elderly people´s own experiences to contribute with increased knowledge among healthcare and social-care professionals in their daily work. Purpose: The purpose is to describe and analyse how older people understand and relate to being discharged from hospital care in order to instead receive support and care in their own home. A special focus will be on their ability to influence and participate during this care transition. The analysis will be based on theories of recognition and social psychological role theory. Method: The study was based on a hermeneutic approach and the empirical material was collected by using a qualitative semi-structured telephone-interviews with 12 people with the age of 70-90 years old. The analysis was based on a hermeneutic analytic method with the theoretical approach of recognition by Honneth (2000/2003) and Heidegren (2009) and concepts from Erving Goffman's dramaturgical perspective. Results and conclusion: The study indicates that elderly people are heterogeneous in terms on how they experience participation and self-determination in the discharge process from hospital to home and in their own home with home-care. The study resulted in four different themes; the role as individual, patient and care recipient; Recognition from other as individual, patient and care recipient; Recognition in practice and Compliance or struggle for recognition. One main finding in the study was that the elderly had different ways of considering their own role as part in the discharge process, the view of being included as active part or put their trust in the hands of professionals and relatives to plan for their continued support and help at home. It appeared that the elderly themselves not alone sets the terms of participation and autonomy in the discharge process without this being something that is also assured to the individual from others (professionals and relatives). Finally, it emerged that for the participating individuals in the study who did not experience participation, recognition and self-determination in the discharge process, ended up with a choice of how to handle the experience of lack of self-determination and recognition. Either compliance or the choice to go to battle to ensure a desired recognition. The overall conclusion is that the elderly are not involved and experience self-determination in the care transition as the intention is in legislation.