Strategies to handle the challenges of intimacy in night-time home care services

ABSTRACT

The provision of intimate and personal care constitutes a challenge for both careworkers and care recipients and is still a neglected area of research. An observational study of the interaction between the careworkers and care recipients in night-time home care services was conducted in a large municipality in Sweden. The results were analysed in light of previous research and theorising on strategies for handling intimacy in intimate care. The study highlights what appears to be a tension between the ways in which the recipient of care is conceptualised as an active consumer of care in present-day guidelines and the strategies chosen on the part of both caregivers and care recipients, when intimacy and integrity is most at stake, and framed as it is by the care recipients’ situation of dependency and vulnerability. Home care services night-time was shown to be a case that markedly differs from many other settings of intimate care, but in the interactional routines intimate care came forth as a smooth and minimally obtrusive activity. The careworkers and care recipients engaged in strategies such as disattention, eye-discipline, middle-distance orientation, and objectification, thereby serving the purpose of balancing the transgressions of thresholds of intimacy.

ABSTRAKT

Intim hjälp och omsorg i hemtjänsten innebär en utmaning för både omsorgstagare och omsorgsgivare och utgör ett eftersatt forskningsområde. Artikeln presenterar resultat från en observationsstudie av interaktionen mellan omsorgsgivare och omsorgstagare i en nattlig hemtjänstverksamhet i en större kommun i Sverige. Resultaten har analyserats i förhållande till tidigare forskning och teoretiska studier vad gäller hur intimitet hanteras i omsorg och vård. Den intima hjälp och omsorg som utförs på natten inom hemtjänsten skiljer sig markant från den omsorg som utförs dagtid, liksom inom ramen för andra institutioner. Så väl objektifierande som distanserande strategier påvisades i samspelet mellan omsorgsgivare och omsorgstagare. Strategierna bidrog till att i viss mån balansera de nödvändiga överträdelser av intimitetsgränser som gavs av omsorgstagarnas situation av utsatthet, beroende och sårbarhet. Resultaten står i bjärt kontrast till framställningen av omsorgstagaren som en ‘aktiv konsument’ i dagens riktlinjer.

KEYWORDS:

• Intimate care
• framing
• home care services
• participant observation
• night-time

NYCKELORD:

• Intim omsorg
• framing
• hemtjänst
• deltagande observation
• nattetid

Acknowledgements

A grant from the Swedish Research Council made this study possible within the larger project ‘Power and influence in elderly care: Structural conditions and individual expressions’.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Katarina Andersson is associate professor of Social Work at Umeå University in Sweden. Her current research focuses on changes of elderly care and how night-time care is provided in Sweden with perspectives of dignity, gender and diversity.

Hildur Kalman is Professor of Social Work, and Reader in Philosophy of Science at Umeå University in Sweden. Her current research focuses on methodology, ethics, gender, and emotions.

ORCiD

Katarina Andersson http://orcid.org/0000-0003-1456-1207

Additional information

Funding

This work was supported by Vetenskapsrådet [grant number 2007-7231].