Study design

This study is a discourse analysis based on the poststructuralist tradition.

Poststructuralism proposes that the realities we live in are contingent and open to challenge and change (Bacchi, Reference Bacchi2016). Social policy is a highly normative discipline that constructs ideal models of society (Bacchi and Goodwin, Reference Bacchi and Goodwin2016). Discourse analysis is a useful method to increase or even create awareness of assumptions and perceptions taken for granted and underpinning the governing of health and social care (Bacchi, Reference Bacchi2009), with consequences for older people and their informal carers. Discourse means ‘practices that systematically form the objects of which we speak’ (Foucault, in Bergström and Ekström, Reference Bergström, Ekström, Boréus and Bergström2018). This study focuses on what we call ‘the digital technology solution’ discourse.

Data collection

Policy documents are seen as cultural products and political actors that define, organise, and transform health and social care (Timmermans and Berg, Reference Timmermans and Berg2010). Our data consisted of policy documents from Swedish municipalities, randomly chosen based on the often employed classification scheme of municipalities developed by SALAR (2016) (see e.g. Malmberg and Andersson, Reference Malmberg and Andersson2021) SALAR's classification defines three main categories (A, B and C) and nine subcategories of municipalities (see Table 1), distinguishing larger cities and towns from smaller and more rural municipalities.

Table 1. Classification of municipalities

We created notes for all 290 municipalities and sorted them into each group. One note from each group was randomly drawn, constituting our selection. We wanted to ensure a high level of variation in terms of population in the municipalities since the population base affects how much the municipality spends on care for older people. A comparison of how much each municipality in the final sample spent on health and social care of older people revealed that the municipalities in group A spent around 10,000 SEK per inhabitant whilst the municipalities in group C spent around 17,500 SEK per inhabitant (Council for the Promotion of Municipal Analyses, 2021). The nine municipalities approached were helpful and accommodating, sending all available documents. However, the municipality from group C6 did not send any documents despite repeated promises, nor was it possible to identify any published material on their website. The ongoing situation with the COVID-19 pandemic might have contributed to this, and apart from repeated friendly reminders, it seemed unethical to persist under the circumstances.

Via contacts with local officials (email and telephone) and based on the principle of public access to official documents,Footnote ² excluding documents containing any form of personal data, the following documents were retrieved:

• • Operational plan for the local committee responsible for the health and social care of older people.

• • Local vision and strategy documents.

• • Digitalisation plan/plan for e-health.

• • Budget for the local committee responsible for the health and social care of older people.

• • Local project plans including digital technology.

• • Operational plan/strategic plan for the support of informal carers.

The collected documents were annual reports from 2018 to 2020 and other documents on the list that were valid during this specified timeframe to capture an image of the current state starting from the latest Swedish election. A total of 61 policy documents made up the ‘practical texts’ and the entry-points for analysis (see Table 2).

Table 2. Local policy documents

Data analysis

The discourse analysis was conducted using the ‘What's the Problem Represented to Be’ (WPR) method as the analytical tool (Bacchi, Reference Bacchi2009). The method with its framework of questions is considered apt at interrogating the problem representation in policy and can therefore be deemed well suited as an analytical tool for use in the often highly normative and complex social care domain (Daly and Westwood, Reference Daly and Westwood2018).

It is important to note that every policy constitutes a problematisation by nature. In this way, no concept or category can be accepted as value-free and uncontested. The term ‘problem’ is used in everyday speech to describe something that is difficult to deal with or to refer to a challenge that needs to be solved. In the poststructural approach, the word ‘problem’ is used in a different way. It refers to the kind of change implied in a particular policy proposal. ‘The problem’ – what is seen as in need of fixing – can be determined according to the actions proposed, i.e. the problem representation (Bacchi, Reference Bacchi2009).

The analysis started with repeated close readings of the policy documents, looking for the topic of interest and contextual paragraphs connected to the topic. After the initial readings, all policy documents were uploaded to the NVivo software program (QSR International, 2021) for further organisation and analysis of text excerpts. We employed the following main questions from Bacchi's (Reference Bacchi2009) framework:

1. (1) What is the problem in local policy concerning health and social care for older people and informal carers represented to be?

2. (2) What deep-seated presuppositions or assumptions underlie this representation of the problem? The task includes reflecting on the meaning of the categories, which are considered to be socially constructed.

3. (3) What is left unproblematic in this problem representation? Where are the silences? The task is to question and challenge the ideas proposed in the policy text to open up alternative representations of the problem.

4. (4) What discursive, subjectification and lived effects are produced by this representation of the ‘problem’? However, this is not a question of measuring ‘outcomes’.

The analysis continued with identifying text/s in the policies that described the problem, goals and solutions related to the care of older people. These statements were extracted and analysed regarding the underlying assumptions upon which these problematisations rested. The analysis then went on to identify text that described older people and informal carers. These categories based on age or social role have subjectification effects producing the policy subjects ‘older people’ and ‘informal carer’. In the same way, text describing health and welfare technology was extracted and examined to see how these concepts formed policy objects (Bacchi, Reference Bacchi2009, Bacchi and Goodwin, Reference Bacchi2016).

By challenging the ideas and proposals in the policies, it was possible to identify silences, meaning factors that were not mentioned in the text but that could nevertheless be argued to play a role for the issue in focus. Finally, through reflecting on the problematisations, proposals, and policy subjects and objects, it was possible to elaborate on effects that these policies might produce as part of the discourse (Bacchi, Reference Bacchi2009, Reference Bacchi2016). This process was not linear. Instead, the analytical questions were posed several times to the text and discussed in the research group. The policy documents were all written in Swedish. Quotes were translated into English.

Methodological considerations

Discourse analysis relies on interpretation, but using a framework, in this study the WPR method, allows for a systematic and rigorous manner of analysis constituent with epistemological and theoretical assumptions (Greckhamer and Cilesiz, Reference Greckhamer and Cilesiz2014). Transparency is in this study obtained through describing the chosen method and process of analysis, providing a list of all included policies and providing supporting quotes throughout the Results section that allows the reader to assess the rigour of the knowledge claims.

We selected the policy documents through discussion with local government officers with extensive experience of working with local policy development. It is important to reflect on alternative samples; the study could have focused on policy documents from municipalities with different socio-economic profiles or municipalities from various regions mirroring geographical and cultural differences between northern and southern Sweden. Several municipalities are involved in regional collaborations for e-health and welfare technology (NBHWS, 2021b), and the inclusion of strategic documents at the regional level might have provided additional perspectives. However, we made our choice based on an attempt to provide an overview of local Swedish policy concerning health and social care for older people, where municipalities that differ concerning structural parameters, such as population (SALAR, 2016), were represented.

The context of the study is the Swedish secular individual culture. We do not argue that the findings are transferrable to health and social care in other countries or regions. Such a generalisation would ignore the cultural differences between different regions and societies. Instead, we believe that the findings can inspire comparisons and discussions about how the digital technology solution discourse is treated in local policy in other regions.

The digital technology solution discourse in local policy

The well-known discourse that we refer to as the digital technology solution discourse, describing the necessary development of digital equipment and services to facilitate and support older people, was evident in the local policy. Several of the policies stated the necessity of digital technology to manage future needs, as exemplified in the following quotes:

The assumption concerning the potential of technology in terms of the ability to promote independence, wellbeing, social inclusion and meaning seemed to be generally incorporated. The discussion in the policy documents was mainly about how to organise implementation so that neither staff nor users lagged behind in this implementation process. A critical analysis of the consequences of such implementation was not found. Instead, the policies repeatedly described the values that would be achieved using digital technology, and the words ‘independence’ and ‘efficiency’ re-occurred:

The digital technology solution discourse as expressed in local policy could be seen to correspond with what international research refers to as the ‘the ageing and innovation discourse’, positioning ageing as a problem and technology as a possible solution (Neven and Peine, Reference Neven and Peine2017). This discourse uses a powerful rhetorical combination, stating that new technology will provide a triple-win for (a) older people, (b) society and (c) private investors and companies (Oudshoorn et al., Reference Oudshoorn, Neven and Stienstra2016). The digital solution discourse, on the other hand, as seen in the selected policy documents for this study, differed slightly from the ageing and innovation discourse. The producers of the technology (the tech companies) were not mentioned, and the third winner (as described in the ageing and innovation discourse) remained invisible throughout the policy documents. The focus in local policy was on identifying the ‘best technology’ and what outcomes could be expected from its implementation. The winners in the local policy documents were stated to be older people, professional health-care workers and society via increased efficiency in terms of economic resources, thus leaving the role of private investors and companies a silence.

The discursive construction of health

In this section, we turned the focus to the concept of health and how it was constructed in policies concerning digital technology and health and social care for older people and their carers. In the municipalities, the strategic plans for digital technology are called e-health strategies, which signals that these plans are concerned with the concept of health. However, health proved to be rather hard to locate in these strategies. The following quote is derived from the e-health strategy of the municipality from group A2, motivating the need for an e-health strategy:

In this policy, it is stated that ageing populations have increasing needs and demands. The pursuit of healthy lives and wellbeing for all at all ages, as stated in the third Sustainable Development Goal (United Nations, 2021) and the Swedish Health and Medical Services Act,Footnote ⁴ does not seem to be a focus. Instead, this policy appears to be a strategy to manage future health and social care staff shortages. The policy explains the direction and principles for the work as follows:

Even though the strategy is called a ‘strategy for e-health’, health is not in any way part of the intended outcome. Instead, it can be argued that the concept and role of health is a silence in this municipality. In municipality A1's strategy for digitalisation and e-health, there is a brief definition of health, but the strategy returns to the more traditional values of independence and safety and a needs-based approach. Health promotion is limited to fall prevention, surveillance, video calls and gaming. The e-health strategy from municipality B4 includes health, although not as a major heading. The technology is promoted to support activity, thereby increasing health and decreasing the need for care. The perspective is focused on the individual taking up activities, such as exercise and entertainment via technology, and thereby reducing the need for care. Health is thus treated as a means to an end rather than a goal per se:

The activities in the example above seem to have a rather narrow focus, referring to physical activity, entertainment or social gatherings. Other activities, such as active participation in current debates, education, social responsibility or environmental issues, are not a focus for this group. In the introductory statement to the Social Services Act, public social services are stated to promote people's active participation in the life of the community. Nilsson et al. (Reference Nilsson, Andersson, Magnusson and Hanson2020) showed a gap in research and a lack of technology-mediated interventions for older people supporting their ability to contribute to society, such as volunteering, mentoring, or providing care or support.

The e-health policies talk about the need to protect older people from danger and explain how technology can provide safety and security, thus placing high expectations on these technologies:

The examples provided as the policy text continues are sensors for detecting falls or safety alarms; however, provided that the hazard in many cases is a traumatic fall, none of these technologies actually prevent the fall from happening in the first place. Nevertheless, the technology is stated to protect the users from danger. No potential limitations in these technologies' ability to be an integral part of the care and promote health and wellbeing are highlighted.

In the documents' named strategies for digitalisation, there is no focus on health or digital technology to support care for older people; however, one document emphasises the goal to increase quality in health and social care. In the more general policy documents concerning health and social care, in this case, the budget, it is stated that to face the increase in the number of older people, which implicitly increases care needs and thereby constitutes a cost, it is of strategic importance to influence and optimise all factors enabling a healthy and independent life:

We argue that health is thought of as a tool to avoid a significant increase in the demand for care, rather than a value in its own right. Operational plans highlight the importance of health promotion. Health-promoting activities focus on the individual participating in social activities, engaging in physical activity and taking up a healthy diet. These are thought to increase people's quality of life, reduce suffering and prevent them from becoming an additional economic burden for society. It is unclear how this preventive work is to be executed; the policy only points to specific areas of focus for preventative measures. The policy explains good health using a statement from Antonovsky's (Reference Antonovsky1987) sense of coherence model; however, this is not operationalised or developed, but instead, the text returns to the individual responsibility of adopting a healthy lifestyle, pointing especially to the lifestyle among the oldest old:

This individual focus in the local policy documents on lifestyle can give cause for concern. Bennett et al. (Reference Bennett, Kingston, Spiers, Robinson, Corner, Bambra, Brayne, Matthews and Jagger2021) stated that primary prevention strategies focusing on proximal factors, such as diet, have appeared to benefit only the most advantaged. Further, as an explanation, Bennett et al. (Reference Bennett, Kingston, Spiers, Robinson, Corner, Bambra, Brayne, Matthews and Jagger2021) suggested that the least advantaged may be less likely to adopt behaviours if they perceive their life expectancy as being limited.

The following example is from the same action plan highlighting gender equality and social equality. However, it relates only to how preconditions and expectations might differ according to one's socio-economic position:

Graham (Reference Graham2007) points to how the process of ageing in low socio-economic groups begins approximately 10 years earlier than that in high socio-economic groups, with men and women in disadvantaged circumstances ageing more quickly than their financially advantaged contemporaries. Chronic illnesses, such as heart disease and respiratory illness, increase in line with declining social class (Graham, Reference Graham2007). Head et al. (Reference Head, Chungkham, Hyde, Zaninotto, Alexanderson, Stenholm, Salo, Kivimäki, Goldberg, Zins, Vahtera and Westerlund2019) reported that men and women in Sweden with high social positions can expect 80–83 per cent of their life between the ages of 50–75 to be in good health, compared to 72–75 per cent for those in lower social positions. According to the Public Health Agency of Sweden (2020), people with no or little secondary education have higher mortality rates for coronary heart disease, cancer and suicide than people with a tertiary education level. In the overall sample, these inequalities in health affecting older people and their carers are only briefly discussed in the policies of municipalities in group A, that is the most urban municipalities in the sample. The responsibility for health in old age appears to be placed on the older person him- or herself, something that becomes clear in the following quote:

The policy programme emphasises individual responsibility, which can be interpreted as an ideological stance. The policy continues:

Litva and Eyles (Reference Litva and Eyles1994) earlier described how being healthy becomes a moral code. Petersen and Lupton (Reference Petersen and Lupton1996) argued that in contemporary Western society, the pursuit of good health is both a right and an obligation. Being ill tends to be equated with not being a good citizen, and one may become an economic burden. Now, suppose that remaining healthy or, as stated in the policy text above, ‘taking account of one's health’ becomes an obligation. What consequences would that entail for an older person? For example, recent research shows that if a person with three chronic conditions hoped to follow all clinical guidelines, from self-care and prescribed medication to appointments, that person would need to spend up to 70 hours per month in health-related activities. The potential workload increases significantly with the increasing number of conditions (Buffel du Vaure et al., Reference Buffel du Vaure, Ravaud, Baron, Barnes, Gilberg and Boutron2016). This raises questions regarding from what or whose perspective these policies are written. In the following quote, preventive measures are seen as a way to control costs rather than decrease human suffering:

In a telecare service study, Lynch et al. (Reference Lynch, Glasby and Robinson2018) discussed how the aspirations of service users are initially at the forefront of consideration but how thinking quickly turns to organisational issues, particularly cost savings. This tension between perspectives was also evident in the local policy texts we analysed. The intended outcomes for older people were consistently accompanied by intended outcomes for the public sector.

The discursive construction of older people

In the previous section looking at how health was constructed, it was possible to discern how the policy documents positioned older people as in need of care and protection but still responsible for their own health. In this section, we look closer into how older people are constructed and what subject positions are ascribed to them in the policy documents. Throughout all the policies, the demographic challenge forms a background for the digital technology solution discourse; see, for instance, this quote from an e-health strategy:

Tornstam (Reference Tornstam2018) stated that the argument about the ageing population as a demographic bomb that will shortly explode continues to live, as it can support necessary reinforcements in health and social care. Alternatively, Tornstam (Reference Tornstam2018) stated that it was a reflection of society's views on the older population as a large and costly group.

In the policy documents, older people are written about as one homogenous group with ever-increasing needs for support, for example:

Pulkki and Tynkkynen (Reference Pulkki and Tynkkynen2016) showed how the political debate placed all older people as potential care recipients. It is not a question of if, but when care is needed. This is also evident in the local policy where the text explicitly states which group poses a threat to the budget and who is also quite demanding, as shown in the following quote:

Tronto (Reference Tronto2015: 39) wrote that ‘The purpose of economic life is to support care, not the other way around.’ In this vein, it appears from the above quote that it is the budget itself that appears to be in need of more care, rather than the older people.

In policy documents regarding the economy, preventive measures and health promotion for older people are stated to prevent the overuse of scarce resources. However, prevention is also presented as an unproblematic win–win for all:

The quote brings to mind the concept of biopower. Biopower, Cruikshank (Reference Cruikshank1999) explained, turns human needs, welfare and desires into governance. It seeks to unite the interest of the individual with the interest of society.

There seems to be a need for more independent citizens in the following statements, suggesting a current problem regarding ‘dependent’ and ‘passive’ older people. The policy text defines the needs and wishes of older people:

In general, older people are recognised not for who they are but for what they presumably lack. Weicht (Reference Weicht2013) wrote about how a collective of younger people defines the situation for a collective of older people. In the above case, it seems that older people's quality of life needs to be and will be increased if they receive support to live up to an independent and involved citizen ideal. This could potentially reinforce stereotypes of older people as passive and dependent. The concept of independence is commonly an objective and a goal for introducing and using digital technology. Tornstam (in Odén et al., Reference Odén, Svanborg and Tornstam1993) wrote about a fundamental value theme in society that guides our way of perceiving both ourselves and the people surrounding us. Productivity, efficiency and independence are salutary words in a performance-oriented society. The ideal citizen is active and successful, with physical and mental strength. These ideals and norms risk causing contempt for weakness and unproductivity (Odén et al., Reference Odén, Svanborg and Tornstam1993). Hillcoat-Nallétamby (Reference Hillcoat-Nallétamby2014) earlier wrote that from the perspectives of policy makers, practitioners and older people, remaining independent becomes synonymous with remaining in one's own home. Critique of this approach points to a tendency to overromanticise the home, ignoring its potential as a place that creates social isolation, alienation and disempowerment (Hillcoat-Nallétamby, Reference Hillcoat-Nallétamby2014). The risk that digital technology could contribute to social isolation or alienation is not highlighted within the analysed policy documents.

The concept of safety and security is another frequently used concept in the digital technology solution discourse:

In particular, digital technology artefacts, such as GPS alarms and webcams, are attributed names such as security camera or safety alarm, with the implicit intention to lead the associations to safety and security-creating properties for older people instead of surveillance. Safety and security conceptualised in these policies seem to be attributed several meanings, such as protection from harm and even danger and crime, a sense of trust and an absence of anxiety. They also appear as an historical rewriting of trust. Ideologically, social work has highlighted solidarity, equality and safety as a substitute for Christian ideals of mercy while aspiring to set boundaries and exercise control to enhance people's ability to fend for themselves (increasing independence) (Carlström, Reference Carlström2005).

In the policy documents, older people are semantically treated as their own group:

This quote distinguishes older people as something other than adults. While the text specifies adult individuals with some kind of need due to illness or loss of function, older people make up a group based solely on the fact that they are older. The implicit assumption is that they have needs and are separated from the category of adults. The term ‘Project culture for older people’, in one of the documents, also supports the statement that they are seen as ‘the others’, separated from the middle-age norm. Palmore (Reference Palmore2000) argued that normal ageing is seen as a loss of functioning and abilities, thus not needing any further explanation. The word ‘older’ carries negative connotations. This corresponds with Nuessel (Reference Nuessel1982), who stated that language shapes reality and constructs the meaning of old age. Further, through the prescription of various tools to measure risks and ill-health, the image of the group of older people is created and maintained:

All users of home health care from the age of 65 are apparently considered as being at risk. This is seen not least in the name of the tool, Senior Alert. It appears to alert professional staff that they are dealing with an older person, and special attention is needed. Accounting practices constitute the very realities they supposedly count (Cruikshank, Reference Cruikshank1999); in this case, when all home health-care users of a certain age are registered with a risk assessment, the image of older people as vulnerable and at risk of becoming dependent might be reinforced. Lupton (Reference Lupton1995) argued that the experience of being labelled ‘at-risk’ may be detrimental to people's health status, causing stigma associated with being a member of an at-risk group.

In these last quotes, digital technology was not part of the target for policy. However, we argue that the construction of older people, as shown in these quotes, provides further insights into the ideas underpinning the ‘digital technology solution’ discourse.

The discursive construction of informal carers

In the final section, we focus on the discursive construction of informal carers. We found that four municipalities had strategies for informal care support, and informal carers were included in other documents as well. Throughout the analysis of policy documents concerned with support for informal carers, digital technology was absent. Despite promoting digital technology as a necessary part of care, it was apparently not considered to carry the same potential in the policy documents concerning support for informal carers. The policies for supporting carers did not highlight any option for digital technology. The telephone is the most advanced technology referred to in these documents. A possible explanation is that even though there are digital technologies supporting carers, in a Swedish context, this can be perceived as problematic. The digital technology solution discourse is promoted to support older people's independence, in accordance with the Social Services Act and the state-individualism treaty of the welfare state. Supporting the informal carer to provide care, as many of the information communication technologies for carer support aim to do, could be argued to create another form of dependence for the older person, namely dependence on informal care. The basic ideas underpinning the Swedish welfare state consider dependence on family to be undesirable (Berggren and Trägårdh, Reference Berggren and Trägårdh2015).

The stated objectives of the support for informal carers, according to the policies, are to reduce their burden, reduce the risk of ill-health and support them in achieving a higher quality of life:

One way of interpreting the objectives is that informal carers, like older people, are seen as a homogenous risk group in need of interventions to avoid constituting a social or economic burden on society through ill-health. This corresponds to Twigg and Atkin's (Reference Twigg and Atkin1994) models of carers, one of them being ‘carers as co-clients’; also:

The category of informal carers is constructed on the basis of the assumption that they need support to continue providing support for their kin. The group is generalised to have a lower quality of life and worse health:

In a recent study concerning informal care, declines in quality of life were not observable since the carers provided few hours of care or reported caring as not burdensome. However, for carers who provided care ≥50 hours weekly or who reported that care was often burdensome, quality of life was decreased (Sacco et al., Reference Sacco, Konig, Westerlund and Platts2020). Despite these differences in informal caring experiences, the assumption is that informal care, by nature, entails strain and risks. This assumption and construction of carers as vulnerable hinders any problematisation of how structural factors might contribute to the burden. Furthermore, carer burden is a complex concept, and in fact, some carers gain much satisfaction from caring and have a relatively high subjective quality of life, particularly when they are able to ask for help from other family members/friends and are able to talk about their situation with others (Erlingsson et al., Reference Erlingsson, Magnusson and Hanson2012). When care in itself is considered a problematic factor causing ill-health, we would argue rather that it is a sign of care being undervalued in society.

The municipality from group B5 divides informal carers into groups based on the recipient of care. For example, whether individuals care for an older person or for a person with a mental illness. The problematisation surrounds the recipient of care, missing all other social structures, such as economic position or labour market position, that might affect the informal carer and potentially facilitate their life situation, as is the stated purpose of the policies. Already in the political debate preceding the legislation for supporting carers in 2009, individual explanatory models were dominant, emphasising how every situation is unique, to the detriment of models pointing to how the surrounding structures, such as gender-, class- or ethnicity-bound injustices, might produce unfair outcomes (Katzin, Reference Katzin2014).

The quote ‘They shall take part in the care of their next-of-kin’ presents informal care as natural and self-evident, not requiring further problematisation. The paradox that informal care is voluntary while at the same time needed due to reduced public finances remains invisible in this statement. It is often assumed that all family members automatically want to care for their aged relative, but this is a highly individual situation. For example, in conflict-filled, strained or distant relationships, it is not at all automatic that a family member will wish to take on a caring role. Indeed, taking on a caring role in this situation, where no or little satisfaction is experienced, can lead to a situation of potential or actual abuse of the older person, and poor mental health and wellbeing for the carer (Nolan et al., Reference Nolan, Grant and Keady1996). The focus is to a large extent still on the care recipient, and the informal carer is seen as one of many resources surrounding the care recipient. This is in line with Twigg and Atkin's (Reference Twigg and Atkin1994) typology of ‘carers as resources’:

In a recent scoping review by Nilsson et al. (Reference Nilsson, Andersson, Magnusson and Hanson2020), this was the role of carers in many of the intervention studies mediated by technology. Seeing carers as resources could potentially impede a more person-centred approach towards carers, allowing carers to formulate their own priorities and preferences both with regards to their caring situation and in their lives in general.

Overall, the policies tended to focus either on the older person or on the informal carer. A dyadic perspective, where services and interventions were created to maintain and preserve the relationship between the informal carer and care recipient and where the needs and preferences of both parties were considered, could not be found. Persson et al. (Reference Persson, Benzein and Morberg Jämterud2020) stated that dyads living with illness may face the impending threat of the relationship transforming from a reciprocal to an asymmetrical relation if the relationship is reduced to a mere description of one's function for the other.

In other policies, informal carers are viewed not as resources but rather as a kind of counterpart or even a threat to the work environment for the staff:

Jönson (Reference Jönson2011) described a fight theme in the social care of older people, where older people and their carers are positioned in opposition to professionals/care systems. According to Twigg and Atkin (Reference Twigg and Atkin1994), this is the case of the ‘superseded carer’, where the staff come in and take over all the care of the older person without considering the needs and preferences of the carer, who (contrary to the above quote) is the one often left feeling helpless, because she or he may still want to contribute to the care of their older relative.

The construction of informal carers can further be seen in how the policy text assumes that informal carers fail to recognise and understand their own needs, which would implicitly underpin the need for further support:

‘The assumption that people do not know their own best interests is politically suspect’ (Cruikshank, Reference Cruikshank1999: p. 86). The construction of carers as being unaware of their own needs might contradict a person-centred approach (for an explanation of the person-centred care concept, see e.g. Gyllensten et al., Reference Gyllensten, Björkman, Jakobsson Ung, Ekman and Jakobsson2020) if the point of departure is that professionals know more about the carer than the carers know about themselves and their personal caring situation.

Except in municipality A1, informal care is not discussed in relation to socio-economic position in any way. This is worth noting since chronic illness and disability affect people in lower socio-economic positions at an earlier age than they affect people in higher positions (Graham, Reference Graham2007; Head et al., Reference Head, Chungkham, Hyde, Zaninotto, Alexanderson, Stenholm, Salo, Kivimäki, Goldberg, Zins, Vahtera and Westerlund2019), implying that there are more informal carers taking on care-giving responsibilities from a younger age in socio-economically disadvantaged groups. Using the concept of differential vulnerability, meaning that the effects of a given risk factor are likely to be stronger in groups with lower socio-economic positions (Diderichsen et al., Reference Diderichsen, Andersen, Manuel, Andersen, Bach, Baadsgaard, Brønnum-Hansen, Hansen, Jeune, Jørgensen and Søgaard2012), it is possible to assume that being an informal carer might have a more detrimental effect with subsequent worse health outcomes for people from disadvantaged groups. However, any form of inequality affecting informal carers remains a silence in the policy documents.

Concluding discussion

We set out to interrogate critically the digital technology solution discourse in local Swedish health and social care policy. We primarily focused on the discursive constructions of older people and their informal carers and how the concept of health was constructed within this discourse, as expressed in these policies. The analysis revealed that health is not a leading concept in the discourse. Health is in some policies connected to an idea of activity, but the activity supported by technology is mainly limited to recreation. There is a focus on the need for a healthy lifestyle, and in some parts, it can be interpreted that older people have an obligation to remain as healthy as possible. Informal carers are constructed as being at risk and are seen as one of many resources in the older person's environment. Previous research shows that health inequalities persist (or even increase) when digital technologies are employed (see e.g. Davies et al., Reference Davies, Honeyman and Gann2021). Even though in this study, policies from more urban municipalities highlight the situation, they in no way develop arguments about whether and how care mediated by digital technology might affect these inequalities. Instead, the responsibility for health tends to rest solely with the older individuals themselves.

Based on these findings we argue that the digital technology solution discourse has the effect of changing how we conceptualise care of older people, turning the focus to assistance for the individual. Maibaum et al. (Reference Maibaum, Bischof, Hergesell and Lipp2021) stated that the expectation to fix demographic change by focusing on technology, in their case, care robots, creates an economic-instrumental interpretation of care.

In the same way, the conceptualisation of health changes when it is reduced to activities or behaviours following a healthy lifestyle. Katz (Reference Katz2000) wrote about how activity has become a panacea for the political woes of the declining welfare state in the management of so-called ‘risky populations’. The political demand for solutions might be in the way of critical reflection and the failure to see weaknesses may lead to policy strategies that have unrealistic beliefs in the impact of the technology.

The digital solution discourse, as expressed in the local policies, does not emphasise an increased reliance on family, even though this has been the trend since the 1990s (Ulmanen and Szebehely, Reference Ulmanen and Szebehely2015; Swedish Family Care Competence Centre, forthcoming). Based on our analysis, we suggest that while policy is aware of the retrenchment of the welfare state, preventive measures (by the older persons themselves) and technology are the answer to the question of who will provide care in this discourse. Traditionally, when discussing caring responsibilities, one speaks of the state, the market or the family, but neither the market nor the family is visible in the discourse. Arguably, the role of the market (not least in terms of producers of technology) and the role of informal care largely remain a silence. This is problematic because while informal care increases, the gap between policy and reality faced by older people and their carers widens.

Future policy would do well to consider older people as contributors to society, not least in terms of providers of care and support to family members/significant others. Policy should usefully recognise, empower and support those informal carers who wish to care for their relative/significant other and provide them with real choices, acknowledging the reality that informal care forms a key part of care for older people; yet, at the same time acknowledging that taking on a caring role is neither desirable nor appropriate for everyone (Nolan et al., Reference Nolan, Grant and Keady1996; Eurocarers, 2017). In Sweden, with a devolved government, there is a possibility for the wider public, including older people, informal carers and their organisations, to be involved and influence policy at local level. Indeed, several municipalities in Sweden have a senior citizens' council with representatives from pensioners' organisations as a consultative assembly to the local government. While the digital solution discourse will most likely prevail, future research should usefully engage in how the use of welfare technology can be developed to help reduce health inequalities in old age and counteract ageism as part of the work towards more age-friendly societies.