Limits to the Proxy Role

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to perform caregiving’⁵⁶⁷. The time care workers spend on conflicts with relatives is described as taking up valuable time from the ‘direct-user-time’ hampering the quality and efficiency of eldercare.⁵⁶⁸

I take such expressions as demonstrations of how a salient feature of the proxy role is that it is a role limited by an opposite role as an opponent. If the relative fails to meet the expectations of how and when to enact the proxy role, the relative appears in an opponent role on the problem side of the function of public eldercare, considered then as contributing to the efficiency and quality problem by taking up valuable time of the care workers and hampering their efforts to provide the politically defined appropriate service and quality level. A conflict relationship is thus continuously expected in this period, even though, as I will demonstrate below, the policy now pays great attention to how to avoid the enactment of such conflict relationship. The proxy role is thus an ideal role constructed with expectations of failed expectations and the opponent role is constructed of expectations of failed expectations. As such the opponent role can be considered to reduce uncertainty about how to continue subsequent local eldercare communication in case of unfulfilled expectations of a proxy.

Returning again to my demonstration of the temporal limits to the proxy role, I also support my argument that the proxy role is only welcomed in the assessment process and in the user-councils and -surveys by pointing out how the eldercare policy devotes great attention to how to prevent enactments of the proxy role in local care interactions. Notably the written rulings, now mandatory to accompany information to elderly about their allocated services, can be observed as means to discourage the proxy role in the care interactions. This can be seen as the written rulings are presented as a means to ensure, that the relative, and of course also the elderly itself, is properly informed about not only what services the elderly has been assessed entitled to, but also about where to direct any possible complaints and critique, if dissatisfied with the ruling, instead of raising it to the employees in the care interactions.⁵⁶⁹

567 My translation: ’Samarbejdsproblemer’, ’Der kan forekomme situationer, hvor samarbejder mellem kommunen og de pårørende ikke fungerer tilfredsstillende ’, ’ de pårørende blander sig’, ’er til hinder for, at personalet kan udføre hjælpen’

(Socialministeriet 2006c: 21).

568 Erhvervsministeriet et al. 1995: 96, 97; Socialministeriet 1996c: 3, 23-24, 26-34, 38, 40, 48; Socialministeriet 1997: 9;

Socialministeriet 2000: 25; Socialministeriet 2003c: 8; KL & KTO 2007: 34.

569 Socialministeriet 2000: 25; Socialministeriet 2003c: 8; Socialministeriet 2003b: 32, 33, 42.

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As regards the thematic limits to the proxy role, the relative is, as presented, expected to help elderly family members raise their voice, or to raise its voice on behalf of them, if they are not offered the services they are entitled to, or if the services provided do not match the quality promised. But importantly, it shall also be noted that the relative is expected to use the quality-level and service-quality-level defined by the municipalities, as their scale.⁵⁷⁰ The policy does not consider it to be relevant whether public eldercare meets the standards of the elderly or their relatives. It is only considered relevant whether the services meet the politically prioritized level of service and quality as this is expressed in management tools such as quality standards and service information. Relatives are only welcomed to raise their voice, if the quality and service they encounter does not meet these political priorities.⁵⁷¹ This can, for example, be noted as the management tools of service-information and quality standards are described as tools aimed at ensuring that the expectations of the citizens and their relatives are aligned with the actual service level to be expected in the municipality or at the institution, such that they know on what basis to evaluate the allocated and provided eldercare.⁵⁷² Accordingly it can be noted how relatives, who raise critique framed in a terminology or based on standards different from the management tools, are described as being critical and troublesome, and as lacking realistic expectations. Relatives that do raise critique by referring to their own observations of what a sufficient level of services or quality is, instead of referring to the standards and using the terminology of the management tools, are described as having misunderstood or misused their proxy role. Such misuse or misinterpretation is defined as disturbing noise, counterproductive to the quality and efficiency of public eldercare, and as something to be avoided or dismissed.⁵⁷³ This is especially observable as the policy describes relatives as often misunderstanding the efforts of the care workers and as often not familiar with the standards and principles, which the efforts rests on, and how they therefore hampers the quality and efficiency of the care interaction, because they disturb it with unreasonable and unjust criticism and demands, and creates an unreasonable and unmeetable pressure on the service level. ⁵⁷⁴ Again, this demonstrates how the opponent role is constructed as an available opposite to the proxy role,

570 KL 1997c: 16; Socialministeriet 1998: preface, 8; KL 1999c: 13, 21, 26; KL et al. 1999: 181-204; Socialministeriet 1999:

22; Socialministeriet 2000: 7-10; KL 2002c: 20; Socialministeriet 2002b: 37; Regeringen 2003: 8; Socialministeriet 2003b:

32, 33, 42; Socialministeriet 2005: 12, 15; Regeringen 2007b: 19, 34, 36, 38, 43, 44, 120.

571Erhvervsministeriet et al. 1995: 96, 97; Socialministeriet 2000: 25; Socialministeriet 2003d: 1; Socialministeriet 2003b: 32, 33, 42; Socialministeriet 2005b: 18; Regeringen 2007b: 19, 34, 36, 38, 43, 44, 120.

572 KL 1997c: 16; Socialministeriet 1998: preface, 8; KL 1999c: 13, 21, 26; KL et al. 1999: 181-204; Socialministeriet 1999:

22; Socialministeriet 2000: 7-10; KL 2002c: 20; Regeringen 2003: 8; Socialministeriet 2005: 12, 15; Regeringen et al. 2007:

4,5; Ministeriet for sundhed- og forebyggelse & indenrigs- og socialministeriet 2009: 41; Regeringen 2009: 13.

573 Erhvervsministeriet et al. 1995: 96, 97; Socialministeriet 2003d: 1; Socialministeriet 2003b: 32, 33, 42.

574 Erhvervsministeriet et al. 1995: 96, 97; Socialministeriet 1996c: 3, 23-24, 26-34; Socialministeriet 1997: 9.

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enabling and premising further eldercare communication in the case of a misinterpreted proxy role.

What I term as the eldercare policy’s attempt to construct a thematic limit to the proxy role, can also be observed as the policy in the 15 years covered in the chapter, pays great attention to how to prevent relatives from misunderstanding the thematic limits of the proxy role. It is described how, if the relative is carefully informed about the level of quality and service to expect, the relatives’ expectations will be realistically aligned with the political prioritization and then the relative will know on what standards to evaluate the service and quality level and will be familiar with the terminology to use when expressing critique.⁵⁷⁵ For example, the Ministry of Commerce (Erhvervsministeriet) in 1995 states that

the prerequisite of an efficient resource-management is a well-functioning collaboration between the politicians of the municipality, the administration, the homecare personnel, the elderlies and their relatives. The ingrediencies in this collaboration is knowledge, understanding and solidarity as well as clear political objectives.⁵⁷⁶

The ministry emphasize how it is the relatives who must exhibit ‘understanding and solidarity’⁵⁷⁷ with the politically prioritized service level and quality and must be supplied with information regarding such ‘clear political objectives’⁵⁷⁸ in order for them to know what to show understanding and solidarity towards.⁵⁷⁹ Likewise, the Ministry of Social Affairs in 2005 calls upon relatives to develop realistic expectations, when stating that ‘It is also important to have realistic expectations to the help the municipality is able to offer. Get familiar with the frames of the help such that your expectations can be attuned’.⁵⁸⁰

The quality standards and written rulings are also to this end presented as management tools intended to inform elderly citizens and relatives alike about what level of quality and service to

575 Erhvervsministeriet et al. 1995: 97; Socialministeriet 2000: 25; Socialministeriet 2002b: 37; Socialministeriet 2003c: 8;

Socialministeriet 2003d: 1; Socialministeriet 2003b: 32, 33, 42; Socialministeriet 2006e: 28; Regeringen 2007b: 19, 34, 36, 38, 43, 44, 46, 120.

576 My translation: ’Forudsætningerne for en effektiv ressourcestyring er et velfungerende samspil mellem kommunens politikere, administrationen. Personale i hjemmeplejen, de ældre og deres pårørende. Ingredienserne i dette samspil er viden, forståelse og solidaritet samt klare politiske målsætninger’ (Erhvervsministeriet et al. 1995: 96).

577 My translation: ’forståelse og solidaritet’ (Ibid.: 96).

578 My translation: ’klare politiske målsætninger. (Ibid.: 96).

579 Ibid.: 96, 97.

580 My translation: ’Det er også vigtigt at have realistiske forventninger til den hjælp, kommunen kan tilbyde. Sæt dig ind i, hvordan rammen for hjælpen er, så I kan afstemme jeres forventninger’ (Socialministeriet 2005b: 18).

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expect. Such that their expectations will be realistic. Likewise, the written rulings are presented as management tools to inform elderly citizens and their relatives about the services assigned and the reason of the particular assignment, such that relatives can be expected to understand that the assignment is objective and meets the politically prioritized standards, which is then expected to make both elderly citizens and relatives satisfied with the services assigned.⁵⁸¹To give an example, a 2007 quality reform cites a nursing home manager of saying that:

In recent years the residents and relatives have started to concern themselves more with the activities we offer. This is why it is important to know their positions and attune their expectations to the possibilities we have both financially and with respect to personnel – It is thus far from all wishes and needs we have the resources to meet.⁵⁸²

To provide elderly citizens and their relatives with information regarding the service level they are entitled to, is hence expected to lead relatives to adjust their expectations to public eldercare and hence prevent relatives from criticizing quality and service on false premises.⁵⁸³ The quality standards, service informations, time registrations are hence not only constructed as internal public sector management tools but also as tools aimed at managing the expectations of the relatives and the way they engage with the proxy role.

On the above pages I have demonstrated how the relative in the ‘user in the center’ solution to the efficiency and quality problem is constructed as a proxy to the self-determinant, free choosing and actively engaged user in the center, thus being expected to be part of the solution to the problems of public eldercare. I have argued that the proxy role, as such, can be considered an ideal role, too important for the eldercare policy to tolerate any uncertainty about whether, and especially how and when, the relative is addressed in the role, why the role is conditioned in management tools, expected to absorb such uncertainty. I have also demonstrated the proxy role to be a role with strict limits to the themes and temporal encounters of the role, simultaneous turning all other temporal and thematic engagements with the proxy role into

581 KL 1997c: 16; Socialministeriet 1998: preface, 8; KL 1999c: 13, 21, 26; KL et al. 1999: 181-204; Socialministeriet 1999:

22; Socialministeriet 2000: 7-10; KL 2002c: 20; Regeringen 2003: 8; Socialministeriet 2003d: 1; Socialministeriet 2003b: 32, 33, 42; Socialministeriet 2005: 12, 15.

582 My translation: ’Beboerne og pårørende er de senere år begyndt at tage mere stilling til de aktiviteter, vi tilbyder. Derfor er det vigtigt at kende deres holdninger og afstemme deres forventninger med de muligheder, vi har både økonomisk og personalemæssigt- Det er jo langt fra alle ønsker og behov, vi har ressourcer til at imødekomme’ (Regeringen 2007b: 43).

583 Erhvervsministeriet et al. 1995: 96; Socialministeriet 2000: 25; Socialministeriet 2002b: 37; Socialministeriet 2003d: 1.

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noisy disturbances, considered as taking away valuable time from the direct user time and hence as contributing to the efficiency and quality problem instead of to its solution. I have argued that as such the proxy role is made up not least of expectations of failed expectations. On a final note, the proxy role is difficult to pin in either a complementarity or substitution relationship to public eldercare – I assert the closest being the proxy as expected to in a strictly limited way and time complement public eldercare in improving efficiency and quality.