MFS research project: Needs assessment in Moldovan elderly care

What happens when an old person in need of social care gets in touch with society’s institutions? What is the nature of the assessment interview, where the old person expresses their needs, and the assistance officer carries out an inquiry and decides upon provision of help?

These are the questions that originated a trip to Moldova in the autumn of 2021. As the research unfolds, this blog will report on some of the impressions. This, the first chapter, will provide a summary of the background and the setting of the scene for the eight following weeks.

1 The study
This research originated in a bachelor’s thesis in 2019 (Möllergren: Ålderism i riktlinjer för äldreomsorgen, link below) where care provision in Swedish elderly care was explored through an analysis of guideline documents from the municipal level. The main finding was that care provision is influenced by ageist prejudice about old peope. It is therefore much easier to receive help covering basic needs, like food, hygiene, security and home service, than to obtain support for “non-old-related” problems connected to psychical suffering, substance abuse, violence, and sexuality. The municipal guidelines explicitly state things like “going for a walk” as examples of what old persons are expected to need society’s help with. The crucial point is the assessment interview, where the assistance officer talks the applicant into accepting a certain set of care interventions, rather than openly listening to every expression of need that the old person might communicate. A “reversed assessment” evolves, where the care provision aligned with municipal guidelines replaces the actual needs, and the applicant is convinced to apply only for the type of care that the guidlines actually state.

But is this a purely Swedish phenomena? How would the assessment interview function in a less-ageist, less-guideline-oriented society? These reflections led to the establishment of a research plan for a master’s thesis in social work. As the MFS scholarship listed Moldova among eligible countries, this country became the location of choice. While Sweden has a decades-old tradition of manual-based assessment processes, this is a novelty in Moldova. And while the general Swedish perception of “old age” is among the most negative in the world, Moldovan culture is more appreciative.
The application for an MFS scholarship was handed in. A positive decision was concluded in the spring of 2021, but the Ministry of Foreign Affairs didn’t put Moldova off the corona restricted list until July 2021, meaning the research could take place only in the autumn of 2021.

2 The preparation
Initial discussions involving the mentor Linda Lill at MaU and the local Moldavian supervisor professor Tatiana Gribincea at the The Free International University of Moldova, ULIM, started out in the autumn of 2020. It was therefore possible to fast-forward the pracitalities once the scholarship was granted. In order to maximize flexibility during the research, I chose to use a car to get to Moldova. Departure date was September 29 from Malmö and the trip went through Poland and Ukraine entering Moldova in the north-west. The 1750 kilometers took four days to complete and today, October 3, I arrived in the capital of Moldova – Chisinau.

Chisinau is a city of 700 000 people, counting a number of universities as well as an array of economical, educational and political institutions. Official language is Moldovan, which is practically identical to Romanian, but broad layers of the population – especially in Chisinau – speak Russian. The territory currently known as the Republic of Moldova was under Russian and Soviet rule for the lion part of the last two centuries, and in Soviet time, russians were encouraged to relocate to Moldova. The country also has a significant Ukrainian minority as well as Roma and a number of smaller nationalities. Up until the Holocaust, it was also home to a large Jewish population, most of which was murdered by Romanian and German fascists.
After independence following the demise of the Soviet Union in 1991, Moldova has encountered a dramatic decline in living standards, resulting in migration to both Western Europe and Russia. Combined with a drastic decline in nativity, Moldova is, after 30 years of independence, a country that, to some estimates, has lost half its population while the remaining half is considerably older, compared to 1991. In other words, the present-day Moldovan state struggles with finding a way to support its increasingly larger old-age-population, with less working people around to contribute. The situation is challenging. As if this was not enough, a significant part of the contry’s territory is a de-facto independant state over which the central gouvernment exercises no control – Transnistria. It is a frozen conflict, where the Transnistrian leadership in its capital Tiraspol enjoys Russian support, meaning that Moldova is unable to win a military show-off. Lacking control over parts of its territory effectively blocks Moldova from entering the EU. In 2020/21 the Moldovan electorate, however, vote for a pro-EU, liberal leadership, throwing out the former communist gouvernment.

Since Moldova has primarily been ruled by pro-communists since 1991, it has defied the introduction of neo-liberal mechanisms that characterizes most Western states. At the same time, funding of welfare services is painfully insufficient. It therefore offers an interesting research environment for studies in social work, and the logic along which welfare services are provided – which brings us to the present moment, where this research is about to begin.

I’m looking forward to sharing findings along the way. I also welcome feedback and questions.

Glenn Möllergren, master student of social work at MaU

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