The Dementia Problematic - an Institutional Ethnography of a Life-World and a Professional Service.

This paper presents some of the results from an institutional ethnography of a life-world and a professional social work on two residential homes for people with dementia and some kind of challenging behavior. The two residential homes were subject to a one year ethnographic research comprising observations, interviews, questionnaires as well as talks and discussions. Professionals, residents and relatives were used as informants when trying to identify the basic problematics that defined the influence of discourses and regulating texts on the professional practice and the interaction between residents and staff members.

Dementia is a term covering diverse aspects of neurological functions disturbing communication and social interaction. It has no specific etiology but might be related to brain injuries, substance abuse or better defined neuro-degenerative diseases. The individual variance is significantly giving each person a specific profile with respect to personality, communication and social interaction. This is a challenge when trying to understand and present the life world of these people and the interaction between residents and staff members.

The final thick description of everyday challenges at the residential homes and its relation to discourses and governance contributed to the general understanding of the workings of such professional services in a modern institutional setting where the daily practice and communicative action is penetrated by institutional regulations, New Public Management, market competition and professional discourses. The final thick description seemed to widen the horizon of both staff-members and managers, disclosing the knowledge, experiences and conditions of the different groups and organizational levels leaving a rather huge material for reflection and contemplation. To the researchers it became a model for how institutional ethnography can be useful even when involving people whose life-world are rather inaccessible due to cognitive and communicative complications.