How power manifests in elderly care

Structural power – the role of the organization
Decisions about resource allocation, working hours and care direction often lie with managers and decision-makers. This power can lead to:
- Priorities that do not always align with the needs of the elderly.
- Staff feeling powerless to influence the quality of care.

Professional power – knowledge and hierarchy
Nurses, occupational therapists, physiotherapists, and nursing assistants have different degrees of authority, which can create imbalances. Examples:
- A nurse's medical decisions can override an elderly person's own wishes.
- Relatives' views can be overridden by "expert" assessments.

Everyday power – small actions with great significance
Even small choices have implications for power:
- Whether a resident gets to choose their clothes or meals.
- Whether the staff talks *with* or *about* the elderly in their presence.

Ethical risks and consequences

When power imbalances occur, it can lead to:
- Loss of autonomy – The elderly do not feel heard.
- Overcare or undercare - Decisions are made based on routines rather than individual needs.
- Burnout among staff – The feeling of powerlessness can undermine job satisfaction.

How we can promote a more ethical balance of power

Awareness and self-reflection
- For staff: Reflect on – "Who really has the power in this situation?"
- For managers: Create forums where staff can raise power-related issues without fear.

Strengthen participation and consent
- Involve the elderly in decisions through clear communication and alternatives.
- Use decision aids that promote self-determination (e.g. future planning with residents and relatives).

Clear routines for equalizing power
- Regular evaluations of care decisions with both staff and residents.
- Ethical councils or support groups to handle difficult situations.

Reflection questions - Power Ethics

Care staff:
- When have you felt that you *unintentionally* exerted too much power over a resident?
- How can you better amplify the elderly's voice in everyday life?

Manager, nurse, occupational therapist and physiotherapist:
- In what ways can the organization's structure result in unequal power distribution?
- How can you create more equal decision-making processes?

Residents and relatives:
- When have you felt excluded from care decisions, and what would have been needed to change that?
- What role do you want to have in the elderly's daily life and future planning?

Erland Olsson
Specialist nurse
Sofrosyne – Better care every day