Keeping the older population and their informal carers healthy and independent using digital technology: A discourse analysis of local policy

Why local policy?

Health and social care services for older people in Sweden are organised and provided mainly at the local level under the constitutional principle of local self-government, which leaves extensive room for financial manoeuvring and responsibility to the municipalities. Local authorities determine eligibility and how to meet older people’s needs according to available resources.

The municipalities in our study were chosen based on a classification scheme developed by the Swedish Association of Local Authorities and Regions, distinguishing larger cities and towns from smaller and more rural municipalities. We wanted to ensure a high level of variation in terms of population in the municipalities since the population base affects how much the municipality spends on care for older people.

Via contacts with local officials and based on the principle of public access to official documents (the Freedom of Press Act 1949:105), a total of 61 policy documents concerning care for older people, digital technology and support for carers, valid during 2018-20, made up the ‘practical texts’ and the entry-points for our analysis.

The main concern of our analysis was the discursive constructions of older people and their informal carers, and how the concept of health was constructed within the discourse. The “What’s the Problem Represented to be” method (WPR) as described by Bacchi (2009) and Bacchi and Goodwin (2016) was used as the analytical tool.

What did we find?

In the local policy, the strategic plans for digital technology are called e-health strategies, which signals that these plans are concerned with the concept of health. However, health proved to be rather hard to locate in these strategies. The policies appeared to be a strategy to manage future staff shortages, and in the policies where health was mentioned, it was treated as a means to reduce the need for care rather than a value in its own right.

Health promotion using digital technology referred to physical activity, surveillance, video calls and gaming. The policies promoted digital technology to support older people’s independence, meaning remaining in their own homes. Any risk that digital technology could contribute to social isolation or alienation was not highlighted in these policies.

Older people were written about as one homogenous group with ever-increasing needs for support. It was not a question of if, but when care is needed.

Finally, throughout the analysis of policy documents concerned with support for informal carers, digital technology was absent. Despite promoting digital technology as a necessary part of care, it was apparently not considered to carry the same potential in the policy documents concerning support for informal carers. The policies for supporting carers did not highlight any option for digital technology. The telephone was the most advanced technology.

A possible explanation is that even though there are digital technologies supporting carers, in a Swedish context, this can be perceived as problematic. Supporting the informal carer to provide care, as many of the information communication technologies for carers aim to do, could be argued to create another form of dependence for the older person, namely, dependence on informal care. The basic ideas underpinning the Swedish welfare state consider dependence on family as undesirable (Berggren and Trädgårdh, 2015).

Acknowledgements

The study was conducted during our time with the Sustainable Care programme, and we would like to express our thanks for the opportunity to present preliminary findings and receive invaluable feedback during the 2021 Sustainable Care conference. We would also like to express our sincere thanks to Patrick Hall for providing advice and suggestions on how to think about policy analysis in general in the initial phases of the study.

About the authors

Maria Nilsson is a doctoral student at the Swedish Family Competence Centre (Nka for short) at the faculty of Health and Life sciences Linnaeus University. Maria’s thesis is focused on the driving forces behind the implementation and use of digital technology in the care of older people, and the consequences for older people and their informal carers.

Stefan Andersson is a PhD and clinical lecturer at the Department of Health and Caring Sciences at Linnaeus University. He is a researcher at the Nka and has an interest in digital technologies that support older people and their carers, in particular working informal carers.

Lennart Magnusson is Director of the Swedish Family Care Competence Centre which is a centre of excellence in the area of informal care. He is also associate professor at the Department of Health and Caring Sciences at Linnaeus University. Lennart led the pioneering work with the first information and communication technology based fully-fledged support service for and with informal carers called “ACTION” that had its origins in an EU project in the late 1990s.

Elizabeth Hanson is professor at the Department of Health and Caring Sciences and heads up the Informal Carers Care and Caring research group which acts as the research arm of Nka. She’s the research director at Nka and has a long-standing interest in digital technologies that have a positive impact on the everyday quality of life of older people and their informal carers.