This chapter presents a study of the contested status of elderly people and professional work at two nursing homes in Gothenburg. Within Swedish health care, nursing homes have arrived at a crossroads and are confronted with conflicting frames of organisation. The status of professional work and of the elderly has become questioned - a consequence of the recent introduction of new public management (NPM) ideas, especially those relating to customer responsiveness. In 1992 a government reform was implemented, which explicitly defines the elderly living in nursing homes as 'customers', i.e. as consumers of a particular kind of housing and complementary services.
Our chapter raises three aspects of plural frames on the nursing homes. First, the identity of these sites is in flux, as a result of the government reform. Are nursing homes a kind of hospital, or sites for providing care for the very old, or a special kind of housing? Second, the status of the elderly is in a state of redefinition. Are they sick, and to be cured, or are they in a special stage of life with a special need for care, or are they tenants with unusual needs? Finally, the status of professional work is also in a state of change - is it nursing or medical work, or care of elderly people, or service for a particular type of customer? Work in nursing homes is also extremely gendered, as all employees are female. A complex pattern of relations between medicine, care and service as frames of action is presented in this chapter. The competing frames are restricted by an economic frame, which does not intervene in the practices as such but affects them indirectly. The pressure to cut the costs of running nursing homes - which has been very prevalent in the council of Gothenburg - has had an important influence on the emergence of a new balance between the frames of action at the nursing homes.
The chapter is organised as follows. The first section discusses how professions become involved in what we call plural framing - a redundancy of signification of professional work. The second section discusses the framing of professional identity and work and how rationalisation and NPM reforms may influence that. After that follows a background to our case, the reforms of the care for elderly people in Sweden. The frames identified in the case are