Two Principles of good elderly care: Help-to-self help and Service - Contradictions?

NPM brings new understandings into elderly care and has recently in Denmark taken a turn towards quality. Quality has, amongst others, been implemented through a general focus upon the self-determination of the elderly and more specifically through various policy tools such as Free Choice (2003) which is a possibility for the elderly to choose a private provider. Stressing the self-determination of the elderly and the help provided as service is potentially at odds with one of the existing principles of elderly care, namely the professional principle of help-to-self help. It aims at activating the elderly person to manage as much as possible themselves and is based upon a socio-pedagogical culture, where the professional is teaching elderly people about the proper behavior. It’s based upon a formal knowledge of aging and upon different techniques to motivate and involve the elderly.

These are clearly different logics. However, no research has so far studied how these concepts are translated from a national to the municipal level to groups of home helpers and to individual home helpers. And how are these principles played out in different contexts of private firms and public providers? Different contexts that are subject to the same national legislation concerning the amount and character of the help provided, through amongst others the provider-performer model.

In this paper we use material from 12 focus group interviews and participant observations from four municipalities (both private and public providers) conducted in 2010 to investigate how these different logics are played out. Using neo-institutional theory we analyze whether a layering of principles is the case, or alternatively contradictory logics are at play in elderly care.