You could say that Rosmari Eliasson-Lappalainen is the mother of Swedish elderly care research. When she got a job at the Social Services research and development office in the early 1980s, research on the elderly was untrodden ground.
“Politicians had started to realise that care of the elderly was a rapidly growing expense for society and they therefore wanted to do research on it”, says Rosmari Eliasson-Lappalainen. Today, she is Professor Emerita and welcomes LUM to her attic flat in central Lund.
Before she got the job at the R&D office, she had conducted research on youth sexuality, psychiatry and socially excluded families. She knew nothing about elderly research:
“I was attracted by the fact that it was an unknown field and that work with the elderly was entirely done by invisible female labour”, she says, explaining that she got on the wrong side of her bosses almost straightaway, as they didn’t like the focus of her research.
They didn’t like the fact that besides focusing on the elderly, she also wanted to interview care workers and home helps about their work.
“Their attitude was ‘beating a carpet isn’t difficult; no one needs to do research on it’”, says Rosmari Eliasson-Lappalainen.
Luckily, she stood her ground. The research programme Äldreomsorgens vardag och villkor (Daily reality and conditions for care of the elderly), which she started in the 1980s, is still in full swing and has resulted in many theses and reports. To the question of whether the research on elderly care has led to changes in the care of elderly people, she is hesitant.
“A financial efficiency mindset controls elderly care. New Public Management is a guiding principle, despite there being no scientific evidence that this ideology and this type of control principle work in care services”, says Rosmari Eliasson-Lappalainen. “On the contrary, the research shows that it doesn’t work.”
However, even if the research has not succeeded in stopping the efficiency obsession in elderly care, she is still proud of other things that it has achieved:
“The carers were able to hold their heads high when we showed all the skills they had to have to do their job”, says Rosmari Eliasson-Lappalainen. “I am proud that we didn’t just run the errands of the powers that be and do research on efficiency improvements in elderly care, but rather continued to strive for knowledge of the daily reality and circumstances of those involved in care of the elderly.”
She points out that there are currently signs of a revolt against New Public Management within the health service:
“Doctors have started to protest and we hope this could spill over into other areas”, she says.
In the early 1990s, Rosmari got a post as professor in Lund and came back to her alma mater after 20 years doing research outside academia. In Lund she met Pauli, the love of her life, with whom she had nearly five years before he died of cancer in 1998.
During the last years of her husband’s life, Rosmari Eliasson-Lappalainen was thrown into a reality that had been close to her research field for many years – the day-to-day process of care.
At that time, in the late 1990s, the hospital staff in Lund were totally lost and could essentially only offer the ataractic drug Sobril.
“They were so horribly at a loss what to do”, says Rosmari Eliasson-Lappalainen. “Palliative care was not a high priority in the health service, despite even Hippocrates having said that one of the most important tasks of medicine is to offer relief and comfort.”
Rosmari Eliasson-Lappalainen and her husband thought they might as well abandon proximity to specialist care at the University Hospital in Lund to let Pauli spend his final months in their summer cottage close to the town of Hässleholm.
By chance they came into contact with KVH – kvalificerad vård i hemmet (Home Care Services) – a method that was then not common in many places, but is now increasingly used.
“The KVH team didn’t have a trace of New Public Management. The staff took all the time the patient needed and could be there in half an hour in an emergency”, she says.
Thirteen years after Pauli’s death, Rosmari Eliasson-Lappalainen wrote an article in Socialvetenskaplig tidskrift that was based on her own experiences. She thinks her encounters with the KVH team and their method of working served as confirmation of what she and many other researchers had already concluded in their research on elderly care:
“Their method showed clearly how well things can be done when competent staff are allowed to use their own judgement in care. Without measuring everything in time and money, they were able to create good care that was probably also much more cost-effective than if Pauli and I had travelled back and forth to the hospital for emergency treatment.”
ULRIKA OREDSSON
Footnote
New Public Management – a term used to describe the changes in the public sector over the past two decades. The management model is characterised by methods and ideas borrowed from the business sector.
