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Care in Changing Societies


Wed 26. 8.  16:00 - 17:30
room FA 204

Explicit and implicit deinstitutionalization: Reforming long-term elder care in Finland


Anttonen, Anneli; Karsio, Olli
University of Tampere, Finland

Long-term care for older adults is under a profound redesign in Finland. Deinstitutionalization is one important policy aim that shapes long-term care practices. Institutional care in nursing homes and long-term care wards in hospitals is increasingly replaced by intensive service housing (ISH) units and supporting care at home. We described and evaluated the process of deinstitutionalization that aims at replacing nursing homes and care wards with homelike ISH units. The data consists of 37 interviews conducted in 2012-13 among municipal care administrators and was analyzed using thematic and discourse analysis. The findings show a deep structural change characterized by deinstitutionalization in the publicly financed eldercare. We divide deinstitutionalization into explicit and implicit deinstitutionalization. Explicit deinstitutionalization discourse implied that the coverage of institutional care needs to be reduced and instead homelike ISH units are prioritized. Home is the word that trasnform the ISH as different from ’old’ institutions. This discourse is in line with the official national and EU policy aims. Implicit deinstitutionalization discourse referred to unintended consequences such as a profound change in ISH fee policy and marketization of the ISH service. We also found references to ’false’ deinstitutionalization. Some commented the transition from nursing homes to ISH rather as a cosmetic change where the level of institutionalization has in fact not changed as also our statistical data shows. Deinstitutionalization needs to be discussed in a more critical way to understand the various aims and consequences of deinstitutionalization policy.