Nedsatt beslutsförmåga på grund av kognitiv funktionsnedsättning är något som kan drabba alla och envar som följd av en skada eller sjukdom. I den här boken behandlas begreppet nedsatt beslutsförmåga, relevant lagstiftning samt riktlinjer inom området. 

Boken belyser de utmaningar som lagstiftningens intentioner om individens självbestämmande, integritet och delaktighet innebär när du möter en person med nedsatt beslutsförmåga. Den ger inga slutgiltiga svar på hur dessa dilemman ska lösas, utan erbjuder kunskap som behövs för att kunna reflektera kring frågor när det gäller att nå bästa möjliga lösning i varje enskild situation. Flera exempel från praktiken visar på utmaningar och möjligheter när det gäller att stödja beslutsförmågan. Dessutom ingår ett arbetsmaterial som kan inspirera till reflekterande samtal.

Nedsatt beslutsförmåga – rätt, riktlinjer och praktik vänder sig till studerande på utbildningar som i någon del behandlar mötet med personer med nedsatt besluts-förmåga. Den kan även vara till nytta för exempelvis anhöriga och yrkesverksamma inom socialtjänst, omsorg samt hälso- och sjukvård och därtill även gode män, förvaltare, överförmyndare, jurister och lärare.

Abstract: Syftet med artikeln är att synliggöra uppdraget som god man eller förvaltare till en person meden demenssjukdom. I den studie som ligger till grund för artikeln undersöks hur rättsliga ställföreträdarebeskriver och hanterar uppdraget i praktiken och i relation till samtycke, självbestämmande och delaktighetför huvudmannen. Rättsligt ställföreträdarskap är ett forskningsområde i gränsområdet mellan socialtarbete och juridik som berör huvudmannens vardag men också rättstrygghet. Studien avgränsas tillställföreträdare med en äldre person med demens som huvudman och datamaterialet utgörs av intervjuermed ställföreträdare och överförmyndare. Resultatet visar att i uppdraget ställs socialtjänstlagens betoningpå självbestämmande och delaktighet och föräldrabalkens betoning på minsta ingripande åtgärd motfrågor om samtycke och demenssjukdomens kognitiva begränsningar. Kognitiva svårigheter begränsarhuvudmännens möjlighet att fatta relevanta självständiga beslut. Självbestämmande kräver delaktighetoch förmåga att lämna samtycke. Uppdraget att bevaka huvudmannens ekonomi utgör oftast huvudorsakentill beslutet om god man eller förvaltare men ställföreträdarna menar också att kontroll över ekonominutgör en förutsättning för att kunna sörja för person. Uppdraget är en balansakt mellan behovet av skyddoch rätten till självständighet. Uppdraget som ställföreträdare blir i huvudsak paternalistiskt med en ekonomiskinriktning. Det innebär kontroll och beslut för den enskildes bästa utan att huvudmannen görs delaktig. Autonomi och självbestämmande som grundprincip i lagstiftning väcker frågor om behovet av ettsärskilt utformat stöd till individer som inte kan leva upp till den ideala bilden av den autonoma medborgaren

Living with dementia, care and social care systems The aim of this article is to find out what impact national guidelines have on municipality dementia care. Furthermore, the aim is to compare organization of social care to the local adaptation of nationally invoked values. This article is connected to Living with dementia, care and social care systems , an interdisciplinary project between Health Sciences at Lund University and Social Sciences at Linnaeus University. The national guidelines for care and services to people with dementia recommend specialized units, and professional specialization in dementia care. Based on values of self-determination, integrity, accessibility, equity, rights and safety, they are meant to guide the dementia care in the community. In this article the organization of care is compared to how nationally invoked values are discussed in local policy documents in nine municipalities. These two aspects of dementia care are central to the national guidelines. The organization of care was explored by a mapping study of 19 municipality services. Type of organization was determined based on when, throughout the progression of the disease, services were made available, the existence of specialized dementia care units, and level of professional specialization. Information about values in local policies was examined by utilizing policy as discourse analysis of local policy documents. Four types of relationships between organization and value implementation were found. Eight out of nine municipalities failed to adapt to both aspects of the national guidelines.

Legislation for dementia care needs to be continually rethought, if the rights of older persons and other persons with dementia are to be addressed properly. We propose a theoretical framework for understanding vulnerability and dependency, which enables us to problematize the currently prevailing legal conception of adults as always able-irrespective of health or age-to act autonomously in their everyday lives. Such an approach gives rise to difficult dilemmas when persons with dementia are forced to make decisions on their own about basic living conditions, such as housing and care, without decision-making support. In Sweden, for example, such matters are frequently left to the person him-or herself to decide, often without any assistance from social workers, and with family members serving as caregivers of last resort. Using vulnerability theory as the framework for our discussion, we argue that policymakers should not apply a group-oriented approach (based on factors like age, legal status, or mental capacity) to persons suffering from dementia. The needs of such individuals are as complex and varied as they themselves are. We discuss our findings from an interdisciplinary (law/social work) research project in which we examine the dilemma that social workers face when they are required, under the terms of the Swedish Social Services Act, to determine whether persons with dementia are to be granted support. We argue further that a cross-disciplinary approach-in which vulnerability theory furnishes the framework-opens up for new ways of understanding and developing social welfare law and practice. This, we believe, can help us better address the rights, interests, and needs of people with dementia, of their families, and of professionals in the social welfare system. Finally, many of the problems faced by ageing societies in general can be understood on the basis of such an approach.

This article addresses the dilemmas concerning legislation, individual autonomy and the reality of everyday life for people coping with dementia. We describe and analyse decision-making in relation to older people with dementia in Sweden, within the area of social work regulated by the Social Services Act and the Parental Act. Swedish legislation is based on the individual's autonomy and capacity to consent to services without anyone having legal authority to decide on behalf of the individual. Based on data from interviews with family caregivers living at home, decision-making through family caregivers is discussed and formal guardianship is also considered. Swedish legislation leaves individuals with dementia and family caregivers in a vacuum between self-determination and full autonomy with the ideal of citizenship emphasised and recognised in the Social Services Act on the one hand, and on the other, a strong need for support in everyday life and with decision-making.

The methodology from the RightTimePlaceCare study of dementia care was tested locally in terms of relevance, acceptability and attrition. Comparing persons with dementia (PwDs) receiving home care (HC) with PwDs living in nursing homes (NHs), in urban versus rural areas, regarding their health conditions and informal caregiver burden was also done. Standardized measurements regarding sociodemographic, and physical and mental health was used. Questions related to legal guardianship were added. Interviews were conducted with PwDs and their caregivers in HC (n = 88) and in NHs (n = 58). Bivariate and multivariate logistic regression analysis was used. The attrition rate was higher in HC. In the bivariate regression model, for HC and NH, living at home was significantly associated with more severe neuropsychiatric symptoms (p <= 0.001) and being cared by a spouse (p = 0.008). In NH, the informal caregivers were significantly younger (p = 0.003) and living in rural areas (p = 0.007) and more often in paid work (p <= 0.001). In the multivariate regression model, informal caregivers were significantly younger (p = 0.007) when caring for a PwD in an NH and caregiver burden was significantly higher in HC and in urban areas (p = 0.043). Legal guardianship was very low. Professionals should acknowledge that PwDs in HC have more behavioural problems and caregivers in urban areas report higher caregiver burden.

BackgroundIn dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life.MethodsThe aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers' educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities.ResultsThe mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals' educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care.ConclusionsThe mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.

The overarching aim of this study is to explore guardianship in terms of its impact on daily lives of adults with intellectual disabilities in Sweden. Based on qualitative interviews, the article focuses on the expected and actual role of limited guardians for people with intellectual disabilities in the context of Swedish laws. Our findings show that the legal definition of limited guardianship is unclear, and that this lack of clarity among other dilemmas creates conflict among clients, guardians, relatives, professionals and care workers. The guardian may be expected to act as an accountant, a legal advocate, or even a surrogate family member. The result is consistent with previous research in other countries on the consequences of guardianship. The current legislation on limited guardianship is in need of amendment in order to avoid legal uncertainty and ambiguity among clients and their support network.