A common trend in Scandinavian countries today is that policies on the formation of elderly care is framed by concepts such as freedom of choice and marketization, where ‘clients’ are implicitly conceptualized as active and alert customers, whereas the levels of dependency amongst those living in the community is increasing. E.g. the 1992 reform of elder care in Sweden prioritized enabling older people to continue living in their homes in spite of conditions such as disability, frailty, illness or dementia. One result of this reform is a 25% reduction in the number of beds for the care of older people in residential homes over the past years despite an increase in the number of citizens aged 65 and over. This to the effect that those now receiving home care services are on average in worse condition than before, and that only those in need of a great deal of help receive such services.
Disability and the frailty of old age put many people in need of help with intimate care in their homes: e.g. undressing, using the toilet, changing adult diapers or incontinence pads, showering, washing intimate parts of the body, brushing teeth, shaving, etc. — still little attention is being paid to this hidden ‘off the radar world’. Set betwixt and between home and institution, private and professional, the situation and relation of intimate care in home care services is a particularly precarious one.
Whilst legislation and guidelines emphasise participation and influence, our recent observational studies of intimate care in home care services show strategies of objectification, distancing and routinization to be used in an interaction between care workers and care recipients, as ways to balance the intimate, and safeguard the integrity of the person. These results challenge professed ideals, and show how dependency in others may neutralise users’ power.