Welfare professionals in transformation: The case of elderly care

This chapter examines how New Public Management (NPM) and other contemporary forms of public governance transform welfare professionals’ working life in a specific field: Danish elderly care. NPM is often assumed to lead to a weakening of professions. However, we argue that this picture might be too simplistic, considering the professionalization that has taken place as part of the negotiated modernization in the Nordic contexts. The focus of our analysis is the transformation of the core task, autonomy, care relations and professional identities in the field of elderly care, during the period of reforms since the early 1980s under headings such as NPM and new public governance. This chapter presents a compilation of different studies, including our own research in the field together with that of other Danish and Nordic researchers. We show how the ideals of care, the professional orientation and the tasks of elderly care have changed dramatically over time. On the one hand, exclusion of tasks has constricted the field, narrowing the scope for holistic care and leading to shrinking autonomy and discretion. On the other hand, a strengthening of professional and workplace communities has taken place, supporting care workers’ exercise of responsible autonomy. However, we also show how new developments of rehabilitation and citizen-centred care may bring new possibilities to develop professionalism, autonomy and new core tasks. In a broader perspective, the case of elderly care demonstrates how Nordic NPM may provide possibilities to retain autonomy and professionalism, and indicates how new reforms may radically change the conditions for improving working life