"Man håller ju lite koll" - en kvalitativ studie om hemtjänstpersonals arbete med äldre med alkoholproblem

Sammanfattning: The aim of this study was to examine how home care workers are reasoning about and using their discretion in their work with elder people with alcohol problems. The two concepts responsibility and respect was used to understand the difficulty and dilemmas they encounter in their work with elderly with alcohol problems. The study was based on semi-structured interviews, combined with two vignettes, with six home care workers in three different municipalities in southern Sweden. The difficulties identified during the interviews were lack of time, guidelines and education about abuse and dependency. The analysis was based on Michael Lipsky’s theory about discretion and Rosmari Eliasson’s perspective of balancing between omission and abuse, i.e. both looking at the individual as a subject and an object. The result of this study showed that the home care workers discretion are minimized through manual based instructions and that the lack of both time and knowledge about abuse and dependency makes their work with elder people with alcohol problems complex and physically and mentally demanding. Without any guidelines the care workers have developed their own approach and response to the problems they meet but due to the organizations inflexible demarcation there’s a risk that deviant user of home care work are marginalized and that a holistic view of the individual is overlooked.