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

Abstract

ABSTRACT Sweden has been held up as one of the most advanced states when it comes to legal realisation of human rights for older persons with dementia, and there are national policies that propose how welfare professionals are to fulfil these rights. However, previous research has repeatedly shown that care managers in Sweden make decisions that leave these persons and their families without suitable interventions, which is especially problematic in cases of self-neglect (an inability to care for oneself combined with resistance to receiving care from others) when basic living standards for health and well-being are jeopardised. This problem is increasing around the world as dementia becomes more common, but there has been little national or international research on policies affecting this matter. This article examines how national policies in Sweden guide care managers to work ethically in cases of self-neglect among older persons with dementia. Through a policy narrative approach, the findings specify care ethical standards that aim to support decision-making abilities in such cases. The discussion dwells on how weaknesses in the identified narrative, in the context of dementia-associated self-neglect, can explain why these standards seem to have little impact on practice.