Making sense of reablement within different institutional contexts. Collaborative service ideals in Norwegian and Danish home care

Abstract

With population ageing, many countries are setting up reablement—short-term rehabilitative eldercare interventions—aimed at helping older adults to regain independence and thereby curb their need for long-term care. Reablement is premised on a citizen-centred and collaborative service ideal intended to challenge the fragmented thinking associated with professionalism and a dispersed service delivery field. Drawing on contextualist sensemaking theory and cross-national qualitative case study data, we explore how historical and institutional conditions influence the way reablement is made sense of on the ground. In Danish settings, characterised by legal regulations and institutional arrangements rooted in previous New Public Management reforms, new service ideals were constrained by vertical levers of control. The Norwegian bureau–professional settings opened up for user involvement but also gave rise to tensions between reablement teams working to prevent ill health and agencies expected to respond to the urgent needs of the frailest elderly.