Danish Eldercare Research Articles

Tooth Shame - An Ethnographic Study of the Choreographies of Tooth Shame in Danish Elderly Care (SSM-D-24-02581)

This study suggests the term tooth shame and explores it as a phenomenon encompassing deep entanglements between emotional experiences, social interactions, and care work practices. Drawing on shame research concerning the body, health, and class, juxtaposed with odontological research on the social implications of oral health issues, it investigates how tooth shame appears in Danish elderly care. In Denmark, oral health is notably impaired among older people depending on professional care, with significant repercussions for general health and social life. The study stems from the Lifelong Oral Health project, which identifies barriers to oral health and examines the potential to improve it in Danish elderly care. It is based on ethnographic fieldwork in nursing homes, home care units, and a rehabilitation center in two Danish municipalities. As self-derogative statements and self-limiting behaviors regarding oral health issues stood out as a general finding in interviews with older people, the focus on tooth shame emerged from this fieldwork. The study contributes to recent shame discussions with a social-material understanding of tooth shame, emphasizing that it is more than an individual feature. It is a collectively distributed phenomenon that expands among people and situations, and that interferes with vital caring practices. The study suggests that tooth shame appears through the performance of tooth shame choreographies, highlighting its implications in a socio-material setting. First, it demonstrates that tooth shame can make older people adapt to oral health issues, for example, by avoiding social interactions, dental care, and oral treatments. Second, it identifies tooth shame as a collectively distributed and expanding phenomenon, as it draws, for example, care workers into sensitive shame situations. Third, it explores how tooth shame interferes with daily dental care practices, professional considerations, and ethical dilemmas within elderly care systems.

Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up.

To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers. We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders. Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users). Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.

Ward-level leadership quality and prospective low-back pain of eldercare workers: do resident handlings mediate the association?

ObjectiveWe investigated the extent to which ward-level leadership quality was associated with prospective low-back pain among eldercare workers, and how this association was mediated by observed resident handlings.Methods530 Danish eldercare workers, employed in 121 wards, distributed across 20 nursing homes were evaluated. At baseline, leadership quality was measured using the Copenhagen Psychosocial Questionnaire, and resident handlings [handlings per shift, handlings not using assistive devices, handlings done alone, interruptions to handlings, impediments to handlings] were assessed using observations. Frequency and intensity of low-back pain was assessed monthly during the following year. All variables were averaged for each ward. We used ordinary least squares regressions to examine direct effects of leadership on low-back pain and indirect effects through handlings, using PROCESS-macro for SPSS.ResultsAfter adjustments for low-back pain at baseline, type of ward, staff ratio (i.e., number of workers divided by number of residents) and proportion of devices not in place, leadership quality showed no effect on prospective low-back pain frequency (β = 0.01 [− 0.05:0.07]) and a small beneficial effect on pain intensity (β = − 0.02 [− 0.04:0.00]). Resident handlings did not mediate the association between leadership quality and frequency or intensity of low-back pain.ConclusionsGood leadership quality was associated with a small decrease in prospective low-back pain intensity, but resident handlings did not seem to play a mediating role, although better ward-level leadership quality contributed to fewer workplace-observed resident handlings without assistance. Potentially, organizational factors, such as type of ward and staff ratio, may have a greater influence on handlings and low-back pain than leadership quality per se among eldercare workers.

Proactive Control for Online Individual User Adaptation in a Welfare Robot Guidance Scenario: Toward Supporting Elderly People

Due to demographic change, health and elderly care systems are facing a shortage of qualified caregivers. This issue can be addressed by introducing welfare robots into people’s homes, hospitals, and care institutions. To provide useful support, such robots must adapt to individual users and smoothly interact with them. From this perspective, we present advances on the development of proactive control for online individual user adaptation in a welfare robot guidance scenario, with the integration of three main modules: 1) navigation control; 2) visual human detection; and 3) temporal error correlation-based neural learning. The proposed control approach can drive a mobile robot to autonomously navigate in relevant indoor environments. At the same time, it can predict human walking speed based on visual information without prior knowledge of personality and preferences (i.e., walking speed). The robot then uses this prediction to continuously adapt its speed to individual users in a proactive online manner. We validate the performance of the proposed proactive robot control in different real-world environments with various users, including an elderly resident of a Danish elderly care center. The results show that the robot successfully and smoothly guided various users of different ages and average walking speeds (e.g., 0.2 m/s, 0.7 m/s, and 1.1 m/s) to target locations over distances of 25–60 m. All in all, this study captures a wide range of research from robot control technology development to technological validity in a relevant environment and system prototype demonstration in an operational environment (i.e., an elderly care center).

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively.Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Organizational narratives in rehabilitation-focused dementia care - Negotiating identities, interventions and personhood.

Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations. The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018-2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories. Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self. Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance.

Tinkering with (in)visibilities: Caring for older people with surveillance technologies.

New surveillance technologies have in later years been introduced in care for older people as part of a broader policy agenda of 'sustainable' welfare state retrenchment, promoting ideals of self-sufficiency and empowerment of older people 'ageing in place'. Drawing on newer approaches to surveillance studies, this article explores care workers' active labour in creating (in)visibility in a complex and ongoing process of tinkering, while negotiating political rationales of empowerment and professional accountability. Hence, visibilities are conceived as coded, reflecting different ideals and rationales. Based on extensive fieldwork in Danish eldercare, we analyse two forms of surveillance: virtual homecare and sensor-flooring, where clients are involved and positioned in different ways in accomplishing surveillance. We illuminate how the process of accomplishing (in)visibility does not only involve tinkering with technology, but also with spatial arrangements in the client's home, and with clients' behaviour. Consequently, we underscore how tinkering may turn out to be a difficult and even conflictual task of negotiating professional authority and accountability in ways that resonate with clients' sense of autonomy and policy ideals of empowerment. Our studies underline how the power dynamics of surveillance in care should not be overlooked, even though they are continuously negotiated in care practices.

Silence Agreements in Danish Elderly Care: Phantasmatic Asymmetry between Care Managers and Self-Appointed Helpers with a Muslim Immigrant Background

This paper explores the composite of elderly immigrants, self-appointed helpers (selvudpegede hjælpere) and care managers (visitatorer) in Danish municipalities. Free elderly care is a common good in the Danish welfare state. Instead of using the homecare service provided by the municipality, many elderly citizens with a Muslim immigrant background prefer to have a family member contracted as their self-appointed helper. The self-appointed helper is often a spouse, daughter or daughter-in-law, who ends up having the dual role as both a caring, loving family member and a professional care worker. Due to the special setup with self-appointed helpers working in their private homes, it is difficult for the care managers to follow standard rules and procedures. Instead, it seems to be a public secret that there is a gap between what we are supposed to do (according to the law) and what we actually do. We suggest seeing this gap as a silence agreement, where care managers, self-appointed helpers and elderly citizens refrain from asking all the critical questions (regarding the provision of care, the quality of care, working conditions, etc.) that no one wants to know the answers to. However, when the silence agreement from time to time breaks down, the relationship between the self-appointed helper and the care manager is haunted by a widespread phantasm where Muslim immigrants are cast as welfare scroungers. Basically, we argue that care managers and self-appointed helpers share a silent agreement but when it is neglected or violated, the latter end up in a vulnerable and marginalized position. The dynamic highlights the ambiguous intimate belonging of Muslim immigrant families and questions to what extent they were seen as legitimate subjects under the state in the first place.

Lost in the diffusion chasm: Lessons learned from a failed robot project in the public sector

Public sector organizations increasingly engage in robotic innovation projects to assist or substitute for humans in service delivery. However, transitioning small-scale development projects into a large-scale context is a notoriously difficult task that often fails, with many promising robotic projects becoming lost in the diffusion “chasm.” We investigate a failed robotic diffusion project to analyze what went wrong and what can be learned from it. Despite an increased interest in learning from public sector digitalization failure, little attention has been paid to how and why seemingly successful service robot initiatives fail to move beyond the pilot stage. We identify three types of explanations for diffusion failure using an in-depth case study of a service robot initiative in the Danish eldercare sector that had a high degree of management support and commitment from key stakeholders. Our analysis demonstrates how the failure was caused by interrelated and context-specific reasons regarding the lack of technological maturity of the service robot (technology-oriented explanations), inadequate problem-solution fit in the conceptual design (scope-oriented explanations), and misalignment between the robot company and public sector organization mindsets (competing logic-oriented explanations). We outline the lessons learned for public sector digitalization and discuss the paradox between the hype surrounding robot innovations and their slow diffusion.

Manager characteristics and early innovation adoption during crises: the case of COVID-19 preventive measures in Danish Eldercare

ABSTRACT Reacting rapidly and adequately in the early stages of a crisis is crucial to effective crisis management. This study analyses the relationship between key first-line manager characteristics, early innovation adoption and crisis scenarios in the context of Danish eldercare during the early stages of the COVID-19 crisis. Our findings show that manager characteristics such as education level, eldercare job tenure and previous similar experience are important to early innovation adoption in crises. The study contributes to the crisis management literature by emphasizing the importance of first-line manager characteristics in effective crisis management.

From efficient service provision to co-production: the diffusion of a new governance paradigm in Danish eldercare

From 2008 to 2017, a public sector innovation termed reablement diffused among Danish municipalities. We show how this transition is an example of New Public Governance (NPG) strategies supplementing and to some extent replacing New Public Management (NPM) strategies. Further, we analyze the diffusion pattern based on hypotheses derived from the diffusion-of-innovation literature. We find a surprising relationship between fiscal stress and time of adoption. Those municipalities with high levels of fiscal stress adopt early relative to municipalities with lower levels of fiscal stress. Thus, innovation seems to be the politics of ‘hard times’ and as a tool to overcome economic austerity.

Ældrepleje i forandring – fra pleje og omsorg til ansvarliggørelse og hjælp til selvhjælp

Since the start of the millennium, significant changes have been seen in Danish eldercare. Central is the political ambition of a paradigm shift from »help« to »help to self-self« in home care, which is envisioned to happen through reablement. Reablement refers to short-duration home-based training programmes through which applicants of publicly funded home care are sought re-enabled to manage practical housework and/or personal hygiene. This article is based on an empirical case and discusses the ethical dilemmas that arise in the practical encounter between health care professionals and older people, including professionals’ balancing of different care logics, the shift in responsibilities from welfare society to older people and their relatives, and the more general implications of changed conceptions of how ‘good eldercare’ is defined and practiced for the possibility of achieving a good late life in the modern welfare society (Less)

Nation-Wide Dissemination of a Digital Checklist to Improve Work Environment in the Eldercare Sector in Denmark.

In this study, we evaluated the dissemination of a digital checklist for improving implementation of work environment initiatives in the Danish eldercare sector. We evaluated the impact of the checklist using the RE-AIM framework. Initiated in 2016, researchers and relevant stakeholders were responsible for disseminating the checklist to all workplaces in the eldercare sector in Denmark through a national campaign. The checklist guided the user to define an action plan to implement, and the checklist covered 11 implementation concept points that should be addressed to reach full implementation of the action in focus. One year after the launch of the campaign almost all municipalities in Denmark had visited the website hosting the checklist (96%), 17% of individual workers within the eldercare responding to a union survey was reached, 4% (n = 199) of all eligible eldercare workplaces in Denmark and 8% of all nursing homes had adopted the checklist. Of the workplaces that used the checklist, 46% typed an action in the checklist. There were 13% of the first time users that used the checklist twice and 29% of the actions were revised (maintenance) after working with the implementation. Finally, the workplaces that had used the checklist showed a higher prioritization of work environment compared to workplaces not using the checklist both at baseline and at follow up. In conclusion, this study employing various strategies, including a 1-year national campaign to disseminate a checklist shows potential to impact implementation of work environment initiatives in the Danish eldercare sector. While dissemination is satisfactory and likely to increase further with time, more efforts is needed to ensure maintenance.

Evaluation and Dissemination of a Checklist to Improve Implementation of Work Environment Initiatives in the Eldercare Sector: Protocol for a Prospective Observational Study.

BackgroundTo measure sustainable improvements in the work environment, a flexible and highly responsive tool is needed that will give important focus to the implementation process. A digital checklist was developed in collaboration with key stakeholders to document the implementation of changes in eldercare sector workplaces.ObjectiveThis paper describes the study protocol of a dissemination study that aims to examine when, why, and how the digital checklist is spread to the Danish eldercare sector following a national campaign particularly targeting nursing homes and home care.MethodsThis prospective observational study will use quantitative data from Google Analytics describing use of the checklist as documented website engagement, a survey among members in the largest union in the sector, information from a central business register, and monitoring of campaign activities. The evaluation will be guided by the five elements of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance.ResultsThe study was approved in June 2016 and began in October 2018. The campaign that is the foundation for the evaluation began in 2017 and ended in 2018. However, the webpage where we collect data is still running. Results are expected in 2020.ConclusionsThis protocol provides a working example of how to evaluate dissemination of a checklist to improve implementation of work environment initiatives in the eldercare sector in Denmark. To our knowledge, implementation in a nationwide Danish work environment has not been previously undertaken. Given that the checklist is sector-specific for work environment initiatives and developed through systematic collaboration between research and practice, it is likely to have high utility and impact; however, the proposed evaluation will determine this. This study will advance dissemination research and, in particular, the evaluation of the impact of these types of studies. Finally, this study advances the field through digital tools that can be used for evaluation of dissemination efforts (eg, Google Analytics associated with website) in the context of a rigorous research design activity.International Registered Report Identifier (IRRID)DERR1-10.2196/16039

Do organisational and ward-level factors explain the variance in multi-site musculoskeletal pain in eldercare workers? A multi-level cross-sectional study.

Multi-site musculoskeletal pain (MSP) is highly prevalent among eldercare workers, leading to increased incidence of sickness absence and early retirement. Most research on MSP in eldercare workers has focused on individual-level factors reported by the employees, with limited focus at the organisation and ward level. To address this gap, the aim of this study was to investigate whether organisation and ward-level factors explain the variance in MSP among Danish eldercare workers. A multi-level cross-sectional study was conducted among 20 Danish nursing homes, containing 126 wards, and 418 workers who participated in measurements of organisational factors, working environment factors, and MSP (classified as reporting pain in 2 or more body regions). Data were collected at the level of the organisation, ward, and individual. The proportion of variance in MSP explained by each level was estimated using variance components analysis. The association between factors at each level of the organisation and MSP was investigated using generalised linear mixed-effects regression. Sixty seven percent of participants reported having MSP. The organisational and ward-level factors explained 0% of the variance in MSP, while the individual-level factors explained 100% of the variance in MSP. Moreover, no factors at the organisational and ward levels showed statistically significant associations with MSP. Individual-level perceived physical exertion and quantitative demands had a statistically significant association with a higher prevalence of MSP. The organisation and ward levels did not contribute to explaining any of the variance in MSP. All variance in MSP was explained at the individual level.

Integrative Social Robotics Hands-on

Abstract In this paper, we discuss the development of robot use cases in an elderly care facility in the context of exploring the method of Integrative Social Robotics (ISR) when used on top of a user-centered design approach. Integrative Social Robotics is a new proposal for how to generate responsible, i.e. culturally and ethically sustainable, social robotics applications. Starting point for the discussion are the five principles that characterize an ISR approach, which are discussed in application to the three use cases for robot support in a Danish elderly care facility developed within the smooth project. The discussion by an interdisciplinary design team explores what attention to the five principles of ISR can offer for use case development. We report on the consequences of this short-time exposure to the basic ideas of ISR for use case development and discuss the value of approaching robot development from an ISR perspective.

Occupational Identities and Physical Exertion in (re)configurations of New Technologies in Eldercare

New technologies are perceived as a solution to the rising proportion of people requiring elderly care across the Nordic countries. Implementing technologies has unforeseen consequences for the content of work and the working environment. This interview-based study within Danish elderly care investigates the consequences of physical exertion for the work and occupational identities of care workers. Through analytical framework integrating positioning theory and agential realism, the study shows that new technologies in certain constellations may further synergies between the reduction of physical exertion and occupational identities, and in others may harm this relation. The study contributes to empirical knowledge about implementing technologies and to discussions of moral literacy and workarounds within care work by suggesting that the ability to openly judge and question physical and ethical consequences of employing technologies is a valuable competence for care workers and, in addition, that furthering these competences is a challenge for managers and legislators.

Objectively measured versus self-reported occupational physical activity and multisite musculoskeletal pain: a prospective follow-up study at 20 nursing homes in Denmark

PurposeTo explore the prospective association of objectively measured and self-reported occupational physical activity (OPA) with multisite musculoskeletal pain (MSP) among Danish eldercare workers.MethodsThe study population consisted of eldercare workers in 20 Danish nursing homes (N = 553, response rate 59%, 525 female). Baseline data were collected in 2013–2014 and the 1-year follow-up was completed in 2016. At baseline, we measured objective OPA by a thigh-worn ActiGraph GT3X + accelerometer during work and self-reported OPA by a questionnaire survey. Information on musculoskeletal pain during the past four weeks in seven different body sites was reported by a structured questionnaire at baseline (n = 389) and by SMS and telephone interview during follow-up (n = 284). MSP was defined as having pain in two or more body sites. Using log-binomial models we calculated risk ratios (RRs) with their 95% confidence intervals (CIs) to estimate the association between objectively measured and self-reported OPA and MSP.ResultsWe found statistically significant positive associations between self-reported OPA (RR for high OPA 1.24, 95% CI 1.05–1.46) and MSP while there was no significant association found between objective OPA and MSP.ConclusionOur study indicates that self-reported, but not objectively measured OPA is positively associated with MSP. This finding highlights the need for better understanding, use, and interpretation of self-reported and objectively measured OPA in the study of MSP.

Studying robots outside the lab: HRI as ethnography

AbstractAs more and more robots enter our social world, there is a strong need for further field studies of humanrobot interaction. Based on a two-year ethnographic study of the implementation of a South Korean socially assistive robot in Danish elderly care, this paper argues that empirical and ethnographic studies will enhance the understanding of the adaptation of robots in real-life settings. Furthermore, the paper emphasizes how users and the context of use matters to this adaptation, as it is shown that roboticists are unable to control how their designs are implemented and how the sociality of social robots is inscribed by its users in practice. This paper can be seen as a contribution to long-term studies of HRI. It presents the challenges of robot adaptation in practice and discusses the limitations of the present conceptual understanding of human-robot relations. The ethnographic data presented herein encourage a move away from static and linear descriptions of the implementation process toward more contextual and relational accounts of HRI.

Collaboration among eldercare workers: barriers, facilitators and supporting processes.

To retain qualified care workers and to ensure high-quality care for residents in eldercare homes, well-functioning collaboration among care workers is pivotal. This study aims to identify barriers and facilitators of collaboration among eldercare workers and to describe the processes leading to well-functioning collaboration. We collected focus group data from 33 eldercare workers from seven Danish eldercare homes. We found that collaboration was hampered by a number of formal and informal divisions among care workers. To ensure well-functioning collaboration, social and professional relations among care workers needed to be dealt with actively by care workers and by managers. The analysis showed that managers are essential for creating a well-functioning framework around the collaboration between care workers by providing guidelines and procedures for working across various divisions, by being attentive to care workers and taking decisive action when needed and by dealing with conflicts in the workgroups.