Weeks 5-7: Empirics & theory

Interview with home care staff in northern Moldova.

The last couple of weeks have been intense and full of fascinating input. This blog update will try to highlight some of them. The picture shows an interview with three home care workers in a village in Northern Moldova; for pandemic-related reasons the interview was performed outdoors.

While carrying out a number of interviews and observations, one thing has become a lot clearer: Elderly care workers in Moldova do spend considerable time supporting care-takers emotionally. As previously stated, talks (“convoribiri”) amount to the most commonly performed intervention during care work, but this is also regarded the most important of them all, both from care-takers and staff’s perspective. They may have considerable duration in time and occur every second day. This contrasts sharply with Swedish home care practice, characterized by short but frequent interventions.

As a Moldovan care-taker is admitted home care, a number of hours is assigned and a schedule established. Typically, the schedule (“grafic”) allows for a two-hour visit every second day, by one care-giver. Together, the care receiver (“beneficiar/a”) and the staff agrees on what needs to be done. While shopping for food, taking care of the house, helping out with preparing food, and making errands at the postal office or the pharmacy are frequently occuring task; talks & consultation takes place at almost every visit. In case a care receiver needs more time on a specific day, staff may call to the person next on the list to announce a later arrival. It’s however not feasible, or at least not sustainable, to reoccuringly spend more than the assigned number of hours, or to come at a more frequent pace – like every day or several times per day (although some staff admit to that they occasionally step out of their work schedule to make additional visits at care receivers who are in especially dire need).

This order of things differs radically from how Swedish home care is designed. There, the normality could be described as consisting of a number of very short visits per day. Care takers may be admitted help with getting out of bed, making breakfast, performing intimate care, etc – all of which may be divided into a number of short interventions. Since actions related to food, intimate hygiene, movement, and getting dressed and undressed occur in large numbers in Sweden, one may wonder why they are not mentioned in the Moldovan home care. Interviewees have given two explanations:

  1. Few people have this sort of needs. Most can get out of bed, put coffee on the table, or take care of their intime hygiene by themselves.
  2. Those that are in such an advanced state of ageing that they can not manage this any more, will anyway not have too many more months left to live, so that when those things occur, this type of interventions will not have to last for very long.

Alternatively, it may be possible that a lot of people feel uncomfortable to ask for this kind of help, because they know it’s unusual, or they’re too proud to admit to incapabilities of this kind, or out of knowledge that it may anyway not be provided.
Whichever comes closer to the truth – or if they all have some truth in them – a theory coined by James Holstein (1992; full reference below) may here be employed. Holstein applies a micro perspectiv to social interaction in public sector organisations and finds that whenever an instituion, authority or welfare organisation sets up formal criteria, such as diagnoses, it tends to “squeeze” its clients/patients into that scheme. It “produces” the clients/patients it is set up to deal with. Out of a person with certain conditions, it produces a patient with a specific diagnose – or a care receiver with a number of needs, neatly lined up in a list, corresponding with interventions lined up equally neatly.

In Swedish elderly care, the possible conditions for which an elderly person may receive home care are listed in a code guide consisting of almost 200 pages, an international functionality standard called ICF. Every possible vulnerability, urgent human need, every requirement has to be linked to one or several of the codes in the ICF. The assistance officer, investigating the conditions for home service admittance, performs an assessment interview and is required by the National Bureau of Social and Medical Services to tic all the boxes corresponding to the catalogue of codes in the ICF. Following Holstein, we may observe how the care receiver is reformed into fitting the form – the “care-taker” is thus produced. If reocurring help requirements such as getting out of bed, getting dressed or putting food on the table are expected to turn up during the interview, they’re much more likely to be asked for by the care receiver – compared to if they are not mentioned and barely possible to even pronounce. In short, while Moldova may be “producing” care-takers that are in apparent need of having a longer talk every time the care giver shows up, Sweden may be producing care receivers who require frequent visits in order to just survive each day.

The empirical study is, however, not coming to an end quite yet, and new findings may put Holstein down the list of theory providers. Please return for updates, and please do leave comments below.

Holstein, J.A. 1992. “Producing People: Descriptive Practice in Human Service Work.” Current Research on Occupations and Professions 6:23-39.

Fourth week: Corona-restrictions… but the work gets done

Social workers' office in a Moldovan village.

Halfways into the project, covid-infection rates start reaching alarming levels. Among others have all of my colleagues/informants in Chisinau city administration been ordered to self-quarantine (and many of them are ill with covid, but currently recovering). The impact is quite noticeble from the point of view of my research, since it’s impossible to collect empirical data without meeting people. Hence I decided to go to outlying villages with lower infection levels where restrictions and quarantine is not (yet) in function.

Thus I came to interview care staff and assistance officers in a village in northern Moldova. I met with them in their work office, appearing at the photo. Interviews were carried out individually and recorded, resulting in audio files that will further on be transcribed and translated into English. Following previous findings, my questions this time focused on how decision making about service provision takes the needs of each individual into consideration, since it appeared to me as if decision texts were rather vague and tended to end in a paragraph stating the admission of home service of a certain number of hours per week, without too many details as of which kind of help, how often and for how long per day had been agreed upon.

Interviewees explained that needs would typically vary from day to day, and that it’s therefore more fair, and better for everyone, to set a number hours of home service as an outcome of the assessment – without stating too detailedly exactly what sort of service or help would be provided at each visit. Thereby, money would be allocated from the regional healt & social care board to the assigned social worker in the village, and they could start working almost instantly. From that moment on, the interventions would be decided by the care-taker and the home care worker together, with a priority to what the beneficiary wishes for at each visit. As the interventions would commence, the social worker would report in a summary what had been performed at each visit, based on a 15-point-scheme of possible intervention. Of all the possible interventions, the two most common ones referred to 1) bringing groceries to the beneficiary, and 2) carrying out small talk and listen to what the beneficiary wanted to say, an activity named convorbiri. From a Swedish point of view, this last intervention appear almost unthinkable, since Swedish care staff seldomly have any time for talking to the care-taker. Reflecting on this, both interviewees stated that the need for convorbiri was more or less the corner stone of elderly care in Moldova, since beneficiearies are all too often very lonely. Looking at reports from recent weeks’ work, it was beyond doubt that the code for convorbiri appeared at almost every visit, whereas other interventions, such as bringing groceries or water, cleaning the living areas, performing personal care, or securing house heating, appeared sporadically.