How does an ageing policy translate into professional practices? An analysis of kitchen table conversations in the Netherlands

ABSTRACT

In the context of the transformation of welfare states into participatory societies, care and welfare professionals are assigned new roles. In the Netherlands, they are tasked with activating and empowering older adults, as well as negotiating customised care. For this purpose, policymakers introduced the kitchen table conversation as a social technology to assess needs and abilities in an informal setting, at home or in public places. The notion of a kitchen table refers to the idea that an informal sphere may increase the professionals’ ability to attune to the needs and abilities of citizens. This paper discusses findings of a qualitative study, in which ethnographic methods were used to examine kitchen table conversations with older adults in practice. Our study demonstrates that, although the tool aims to increase attunement between professionals and citizens, it actually creates tensions between policy, professionals and citizens. Professionals struggle with the issue of how other policy expectations – such as cutting the costs of care – resonate in the conversations, a phenomenon which becomes even more awkward in the private domain of older adults. In practice, however, rather than mediating participative citizens, kitchen table conversations mainly generate ambiguity in relationships between professionals and citizens.

SAMENVATTING

In de context van de transformatie van verzorgingsstaten naar participatiesamenlevingen krijgen zorg- en welzijnsprofessionals nieuwe rollen toebedeeld. In Nederland hebben zij de taak gekregen om ouderen te activeren en te ‘empoweren’, terwijl zij tegelijkertijd zorg-op-maat onderhandelen. Om dit doel te kunnen bereiken introduceerden beleidsmakers het keukentafelgesprek als een sociale technologie, om daarmee behoeften en mogelijkheden in een informele omgeving te kunnen toetsen, bijvoorbeeld bij burgers thuis of op een publiek (toegankelijke) plaats. Het begrip keukentafel refereert aan het idee dat een informele sfeer de mogelijkheden van de professional vergroot om op de behoeften en mogelijkheden van burgers af te kunnen stemmen. Dit paper bediscussieert bevindingen uit een kwalitatieve studie waarin we etnografische methoden gebruikten om keukentafelgespreken met ouderen in de praktijk te onderzoeken. Hoewel het doel van het instrument is om de afstemming tussen professionals en burgers te vergroten, laat onze studie zien dat het instrument in werkelijkheid spanningen creëert tussen beleid, professionals en burgers. Professionals worstelen met hoe andere beleidsverwachtingen – zoals het terugbrengen van de zorgkosten – resoneren in de gesprekken. Dit wordt nog ongemakkelijker op het moment dat de gesprekken in het privédomein van ouderen plaatsvinden. In de praktijk zien we dat keukentafelgesprekken niet zozeer participatieve burgers mediëren, maar vooral ambiguïteit creëren in de relaties tussen professionals en burgers.

KEYWORDS:

• Ageing-in-place
• older people
• social policy
• participation/citizenship

TREFWOORDEN:

• ageing-in-place
• ouderen
• social beleid
• participatie/burgerschap

Acknowledgements

The authors thank the respondents for their willingness to participate in interviews, focus groups and observations for this study. We also would like to thank everybody who commented on earlier drafts of this paper, especially participants of the EASST 2014 conference in Toruń and participants of the WTMC-dissertation day in May 2015. The research reported here was part of a project funded by ZonMw – the Netherlands Organisation for Health Research and Development (grant 314070201). The financial sponsors did not play a role in the design, execution, analysis and interpretation of data, or writing of the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Susan van Hees obtained her PhD degree in 2017 at the Department of Health Services Research, Maastricht University. In her dissertation she explored how an ageing-in-place policy in the Netherlands worked out in practice, focusing on the tensions between policy ideals, professional care and welfare practices, and experiences of older adults. As a postdoctoral researcher at Tilburg University, she currently investigates how frail older adults can be given a voice at a strategic level in research.

Klasien Horstman is professor of Philosophy and Sociology of Public Health at Maastricht University, and she is director of the research line Inequity, Participation, Globalization of the Care and public health Research Institute CAPHRI. www.klasienhorstman.nl

Prof. Dr. Ir. Maria Jansen is professor Population Health at Maastricht University and programme leader of the Academic Collaborative Center for Public Health. She has broad experience in supervising and executing research on the research – policy and practice triangle. Her expertise is in / her focus is on improving population health by means of multidisciplinary research cooperation and inter-sectoral implementation of public health (policy) interventions to prevent avoidable chronic diseases and socio-economic health inequalities.

Dirk Ruwaard is professor of Public Health and Health Care Innovation and chair of the Department of Health Services Research at Maastricht University. He founded the Academic Collaborative Centre on Sustainable Care Limburg. He is a public health physician with experience in epidemiology, public health, chronic care, integrated care and health policy. He is (co-) author of numerous publications and chair or member of several committees in the field of prevention, public health and health care.

ORCID

Susan van Hees http://orcid.org/0000-0001-8057-2356

Dirk Ruwaard http://orcid.org/0000-0003-4887-8413

Additional information

Funding

The research reported here was part of a project funded by ZonMw – the Netherlands Organisation for Health Research and Development [grant number 314070201].