Background: Some persons with intellectual disability may express, e.g., distress, protest or pain in a manner that is perceived as challenging by staff and an entire organisation. Although these persons are few, their support requires knowledgeable staff who are supported by front-line managers within a capable organisation, as well as sufficient and adequate resources. The aim of this study was to explore organisational factors that enable or hinder good quality of support from the perspective of staff in group homes and day programmes.

Method: 96 staff in group homes and day programmes were interviewed in groups. Their experience with working in services for persons with intellectual disability ranged from 2 months to 35 years, with a median of 10 years. The interviews used the problem-centred interview method described by Witzel and Reiter, allowing interviewer and participants to explore and co-create topics of interest and importance.

Findings: According to staff, it was difficult to meet the needs of persons with intellectual disability when they experienced an organisational focus on budget and administrative procedures. Managers who lacked adequate knowledge or were seldom present in a service were of no help when difficulties arose. Participants described a lack of alignment and logical connection between decisions and procedures at the organisational level and the support provided by staff. They also maintained that preventing staff and manager turnover would enable continuity, stability and trustful relationships. Providing support of good quality would also require front-ine and senior managers who truly understood or recognised the needs of the service users.

Conclusion: Staff in group homes and day programmes report that staff satisfaction and good quality support require an organisation that can be trusted. This involves that managers have a clear focus on and knowledge about what is essential in supporting persons with intellectual disability.

Artikelns resultat baserar sig på en enkätstudie till handläggare inom funktionshinderområdet i Sverige och redovisar deras arbetssituation, med fokus på konsekvenser for enskildas rättssäkerhet. Det övergripande syftet med artikeln ar att belysa aspekter av rättssäkerhet i ärenden enligt LSS. Rättssäkerhet är ett begrepp som givits flera betydelser, framfär allt en formell och en materiell definition (Peczenik, 1995). Vi argumenterar för att den materiella definitionen hör bättre samman med lagmotivens, liksom funktionsrättskonventionens (CRPD) fokus på mänsklig värdighet och likvärdigt bemötande vad avser LSS tillämpning. Resultaten visar att flera LSS-handläggare inte anser att deras hemkommuner fattar rättssäkra beslut och att utförda bedömningar är lite av gissningar eftersom tydliga riktlinjer saknas. Vidare anges att arbetsledare ger instruktioner om vilka insatser som får beviljas och vilka som ska avslås, utifrån budgethänsyn snarare än bedömningar av behov. Enkätsvaren redovisar också situationer där brukare blivit kränkande bemötta. Sammantaget leder detta till en oförutsebar rättssäkerhet for brukaren.

På intensivvårdsavdelningen vårdas personer med kritisk sjukdom som är i behov av både omfattande medicinsk behandling och omvårdnad och har behov av psykosocialt stöd. En kvalitativ intervjustudie genomfördes i syfte att undersöka hälso- och sjukvårdskuratorns yrkesroll på IVA i relation till förutsättningar och handlingsutrymme där. Analysen, som skedde i en växelverkan mellan utsagor och sociologisk professionsforskning och rollteori, visar att yrkesrollen utvecklas både i förhandling med omgivningen och utifrån hur kuratorn hanterar sitt handlingsutrymme. Det finns en risk att kuratorns specialiserade roll på IVA blir personbunden, d.v.s. att kompetens inte förs vidare i organisationen eller till professionellt socialt arbete. Resultatet pekar på ett behov av fortsatta studier av hälso- och sjukvårdskuratorns yrkesroll – hur rollen utvecklas och vad utvecklingen får för konsekvenser för profession och organisation. 

This article investigates the need and sources of knowledge among LSS administrators in Sweden (i.e. social workers handling service and support for individuals with disability according to the Swedish Disability Act [LSS]). Changing and challenging working conditions and issues concerning professional status warrant the aim. A questionnaire distributed via gatekeepers in a number of municipalities demonstrated that knowledge about ‘disability’, ‘law’, ‘ethics’ and ‘augmentative and alternative communication’ was rated highly. This result is particularly interesting given that many social work education programmes do not have compulsory courses in disability. Colleagues appear to be relied upon as essential sources of support and knowledge, but the knowledge sharing seems unorganised. Findings are discussed in relation to communities of practice (CoP) and shows that, due to the lack of essential knowledge from formal education and the strong dependence on colleagues, a locally developed praxis might be established. Inadequate theoretical and research-based knowledge, together with this local praxis knowledge, may result in the LSS administrators’ work becoming inadequate. A specialist education in disability studies is proposed as a prerequisite for being employed as an LSS administrator, and the inclusion of a theoretical and scientific framework in the regular CoP interaction is also recommended.

Hälso- och sjukvårdskuratorernas legitimation infördes 1 juli 2019. Legitimationen har skapat en ny riktning för de socionomutbildade och samtidigt tydliggjort vikten av att placera hälso- och sjukvårdens hälsobegrepp i en samhällelig kontext. Därmed sätter förändringen ljus på viktiga frågor som hälso- och sjukvården brottats med under lång tid och som nu skulle kunna debatterats på allvar med kuratorn i centrum.

AIMS: To describe and compare perceptions of collaboration between care providers on the part of three groups of Registered Nurses working in municipal care and having particular responsibility concerning the care of frail older people with intellectual disability (ID); and, furthermore, to investigate the presence of and compliance with guidelines for the coordination of care.

DESIGN: National survey study with cross-sectional design.

METHODS: Nurses (N = 110) with key positions concerning people with ID answered a national questionnaire about collaboration, guidelines and coordinated individual plans. Descriptive and comparative statistical analyses were applied.

RESULTS: The meetings on cooperation and coordination of interventions were attended most frequently by nurses, and least frequently by social workers. The nurses were overall satisfied with the collaboration but perceived shortcomings in the case of inpatient and outpatient psychiatric care. Only in about half of the meetings for making care plans participated the people with intellectual disability and next of kin.

Äldre personer med intellektuella funktionshinder (IF) representerar en växande grupp med multisjuklighet och komplexa vårdbehov. Samverkan mellan huvudmän och berörda verksamheter förutsätts underlätta insatser för ett hälsosamt åldrande med hög livskvalitet. Syftet med studien var att utforska uppfattningar hos strategisk personal på kommunal- och regional nivå om hindrande och främjande faktorer för samverkan mellan socialtjänst och hälso- och sjukvård, avseende komplexa behov hos äldre personer med IF. Åtta personer intervjuades utifrån ett fenomenografiskt perspektiv. Hinder för samverkan dominerades av den pågående samhällskrisen, olika lagstiftningar och uppdrag, avsaknad av styrning, hög personalomsättning och svårigheter i kommunikationen mellan organisationer. Resultatet visar att samverkan tvingas bli nedprioriterad när en samhällskris utsätter välfärdssystemet för stora påfrestning. Implementering av samverkan för denna sårbara grupp äldre är en angelägen fråga för både praktiken och forskningen.

Introduction: Health problems in people with intellectual and developmental disability (IDD) are traditionally known to be common in adults of all age, with at least twice as many health problems in this group as the general ageing population. In addition, there is considerable international evidence indicating an earlier death for people with IDD compared to the general population, exacerbated by fragmentation in health care systems and resulting in poor coordination between various health care services (WHO, 2018). Methods: An evaluation was done in Sweden, to estimate the effectiveness of the health system integration for people with IDD, and quality of coordinated care by professional health care personnel who had a coordinating function. In a survey, 114 medically responsible nurses, operating in key positions in 109 municipalities throughout Sweden, were asked to assess quality of co‐ordination between various centres for social services and health‐care units for frail older people with IDD who in need of both social service and healthcare. Results: Results showed diverse coordinated care, ranging from very good to very poor cooperation between the nurses and various types of care and service units. Implications: The study findings emphasise the importance of effective coordinated care.

Introduction: According to Swedish legislation, persons with ID have the right to support that enables their full inclusion in society, “living like others”. One tenet, as specified in the CRPD, is the opportunity to gain a living through freely chosen work on the labour market, “on an equal basis with others.” These concepts need to be understood in relation to people with moderate to severe ID. Methods: To explore the concepts of “work” and “living like others” in support for people with moderate to severe ID, two researchers engaged staff and persons with ID in translational research. Each group met six times separately, and one time together. Results: The staff group found that the organisation lacks structures that support the implementation of the goals of the CRPD. Organisational requirements, such as legislation on public procurement, availability of buildings and other facilities, as well as staffing, are factors that need to be addressed. Values based discussions involved the question if people with ID (in general) can take on the responsibilities of work. Preliminary data show that service users are satisfied with their opportunities to choose fulfilling and meaningful activities. Implications: The CRPD must be built into the organisational structure.

An increasing number of people with intellectual disability (ID) are reaching older ages today although they experience more health problems than the older population without ID. Leaders in intellectual disability services can greatly influence the conditions for a healthy ageing, and the aim of the present study was to explore healthy ageing in this group from the perspective of the leaders. Interviews with 20 leaders were subjected to qualitative content analysis. The findings gave rise to the overall theme ageing in dependence, which emerged from the following six categories: Supporting self-determination; Inaccessible activities after retirement; Signs of decline; Increased and specific needs for support and care; A non-question of gender; Aspects concerning the end of life and death. A prerequisite for healthy ageing in the case of people with ID is, according to the leaders, that they can live the life according to their preferences and make independent choices whilst at the same time receiving adequate support. With the shrinking of their social network after retirement, they become increasingly dependent on staff and leaders in the group home, who need to know what healthy ageing implies.

Antologin beskriver processen hur Tillväxten börjar som ett projekt med siktet inställt på att bli ett socialt företag. Projektledare och projektmedlemmar beskriver resans gång med både med- och motgångar

I kapitlet fokuseras unga personer med funktionsnedsättning och frågan om huruvida förändrade villkor på arbetsmarknaden är försvårande för gruppen när det gäller etablering i arbetslivet. Inledningsvis beskrivs för sammanhanget relevanta delar av arbetsmarknads- och funktionshinderspolitiken i Sverige. Därefter riktas intresset mot den flexibla arbetsmarknaden och de förändringar som skett över tid. Även den växande bemanningsbranschen beskrivs och diskuteras. Vidare förs en diskussion om hur dessa förändringar och nya krav kan påverka sysselsättningsvillkoren för personer med funktionsnedsättning.