Ældreliv i plejebolig: Et studie af ældres autonomi- og livssituation i den politiske tilrettelæggelse af plejeboligens rammer

The dissertation entitled " The life of the Elderly in Residential Care Facilities - a Study of Autonomy and Life Situation of Elderly People in the Context of the Political Organisation of the Facilities" is an examination of how the political organisation of residential care facilities have an influence on autonomy and life situation of elderly in practice.

Owing to the current tendency towards individualisation in society, the autonomy of the elderly has become a key concept in the health sector with the implementation of user orientation. The dissertation therefore examines, how the political value attached to rational competent and active elderly people influences the autonomy and life situation of vulnerable elderly people, when they are no longer capable of maintaining an independent life at home and move into aresidential care facility.

The dissertation is based on a practical-philosophical approach in which theory and practice are inextricably linked as well as mutually informing each other.

The autonomy of the elderly in the structural context of the residential care facilities cannot be captured and unfolded with philosophical perspectives of the concept of autonomy alone. Neither is the autonomy of the elderly drifting around in the daily practice in the residential care facilities. The autonomy of the elderly can be determined in relation to lived lives of elderly people in their encounter with the political framework of residential care facilities, and is therefore anthropologically present in the form of practical concept(s).

The dissertation comprises a historical perspective because the daily practices in the residential care facilities are embedded in a historical practice related to societal trends and political organisation of help to vulnerable elderly in the society. As a public service available to elderly people, who are no longer capable of independent livng, residential care facilities therefore contain the standards of the past. The focus is placed on the political framework for autonomy of elderly people and its significance for how elderly people are perceived as individuals in public institutions in their vulnerable life situation over time. Consequently, the dissertation includes insight into vulnerable elderly in society.
The empirical material is generated by participant observation studies and interviews. Selected extracts of this material are introduced to contextualise the elderly, their autonmy and life situation and their daily living subject to the political organisation of the framework of such facilities.

This presentation, of selected extracts of the emphirical material, requires closer examination of the content of the current politically dominanted concept regarding the autonomy of elderly people. This because the empirical material shows that external conditions concerning the political organisationof the residential care facilities, the framework conditions of residential care facilities, comprise particular circumstances which acknowledge the autonomy of the elderly in a special way by organising residential care facilities as homes, helping performed as tasks, and using families as a resource.

In general terms, the content of the contemporary political dominant concept of the autonomy of the elderly concerns their vigour, which is interpreted to mean taking responsibility for yourself, caring for yourself, and retaining the ability to make rational decisions.This concept of autonomy is embedded in the arrangement of public help, which is meant to allow or compensate for internal conditions connected to the impaired elderly people, who are no longer capable of leading an independent life. The fieldwork shows that these internal conditions consist of physical disability, mentally problems and/or reduced cognitive ability.

The analysis shows that the current dominant political concept of autonomy is a standardised concept of autonomy. It is a concept, which in its generalised form turns out to be contradictory to the life situation of impaired individual elderly people. The analysis namely shows, that the impaired elderly, who is not able to match up to the standardised concept of autonomy and with the correct actions embedded in it, are ignored or rendered invisible. This becomes clear when either they themselves or their family prove unable to act adequately in relation to more calculated customer-sales-oriented relationships in the market bureaucratic organisation of care for elderly. The analysis thereby demonstrates that legalised consumerism is an embedded condition as an inherent term for the impaired elderly in the competition for help,and identifies civil rights as an offer.

Politically concealed intended efficiency improvements in connection with the standardized concept of autonomy are identified, and a political moralising optimisation discourse appears. The analysis of the empirical material and of pertinent policy documents reveals that elderly are politically valued, when they manage to avoid drawing on the services that are available to them. When they apply for help, they are assessed by an official representative of the authorities using standardised tools based on two principles: helping them to help themselves, and equal rights. These equal rights are challenged in the competitive market bureaucratic organisation with the material produced during fieldwork revealing, that the impaired elderly seem to be abandoned and dehumanised in an undignified and meaningless life, as it turns out that the principle of equal rights contributes to inequality among the impaired elderly.

The analysis shows that taking responsibility for yourself, caring for yourself, and retaining the ability to make rational decisions are also required in order to gain access to the services provided and therefore to the rights to which elderly are entitled.