**4. Background**

#### **4.1 Eldercare in Sweden**

In Sweden, eldercare work is professionalised because it is a profession that is tax-financed and publicly organised for the most part. Care research moves between philosophical discussions about care as a concept and empirical studies that include everyday life experiences. It is about understanding quality and competence in care work, discussing the consequences of different ways of organizing care work, implementing social policy interventions and conducting comparative welfare state research [20]. However, to understand the complexity of care work, it is crucial to understand what the word care in eldercare work means. This is more important than focusing on the words: care or nursing. One problem is that these latter concepts are of great importance for the work of care staff. Nursing provides stronger medical associations than care. Implicit in the idea of nursing lies the wish to cure the patient. Eldercare is not expected to make the old young again. In the same way, care for the older adults does not involve a change for the recipient [6].

The work in eldercare services often involves conditions that pressure the staff members in many ways. The relatively brief training, combined with demanding tasks, frequently results in physical strain and emotional stress among the care workers [21]. This emotional dimension is a crucial aspect and significantly impacts working situations. One essential element is that the healthcare personnel expect to use their empathic skills and common sense when encountering older clients [22, 23]. The staff work closely with the older adults in their daily activities and are also responsible for providing medical care delegated by licensed healthcare personnel. These are complex work tasks, and the care workers must correspondingly ensure that the older adults experience dignity in their daily lives, which is also regulated by the Swedish Social Services Act requirements. To promote dignity in eldercare services, are they expected to maintain a perspective based of the individual right to self-determination, individual adaptation, privacy, bodily integrity, proper treatment, good quality and older adults' individual right to participation [24]. The requirements for facilitating a life of dignity for the older adults assume the personnel's respect for the individual, and older persons must feel that they are safe and that their lives have meaning when receiving eldercare services. These are consequently highly ranked demands for an eldercare workforce, at the same time characterised by low wages and low status, often in combination with unfavourable working conditions.

#### **4.2 Care work and the female virtue**

A great majority of employees in eldercare services are women ([25], p. 280), making eldercare one of Sweden's most female-dominated occupations. This feminisation has consequences for how the work is perceived and valued, not least by the older adults. The working conditions in eldercare are primarily based on women's responsible and caring, rational actions. Caring rationality stands for compassion, closeness, treatment and an ability to see every person from a holistic perspective [26]. However, care actions' rationality can contain different spheres, and Franssén [27] divides the care work content into an instrumental (physical) and an emotional sphere.

#### *The Challenge of Migration in Swedish Eldercare: Experiences of Everyday Racism DOI: http://dx.doi.org/10.5772/intechopen.106609*

There is a significant risk of distinguishing between physical and emotional care work being determined too one-sidedly. A common notion about the care work is that the instrumental/physical part is an oppressive practice of women filled with repetitive and alienating tasks, such as cleaning, laundry, shopping, and washing. However, the emotional care work accounts for the positive and more gratifying and meaningful dimensions of the work. The danger lies in that the distinction does not give the physical aspects an emotional scope. Instead, the care profession contains both emotional and instrumental components. Both parts require an emotional commitment while the work is physically strenuous. The dynamic perspective risks idealising the care and ignoring the workload [28].

A notion of female virtue dominates the care work. Like feminine virtue, the care work performs in unpretentiousness and silence. This work fell on the woman's lot is sonically explained because the care corresponds to her nature [29]. Care has, therefore, been linked to 'femininity' and thus to women [30]. The dominance of women in the professional field consequently has a solid historical foundation, which can be traced to notions that women have an inherent ability to provide care.

To be a reliable employee in eldercare services, individuals must first and foremost conduct themselves by the common conceptions of gender and femininity and live up to the meaning of these conceptions. The sociologist Beverly Skeggs studied British working-class women in nursing schools and how the education shaped them into respectable healthcare workers. She considers that professional schooling has primarily focused on making women respectable by conveying typical 'female' characteristics [31]. According to Skeggs, there is a connection between the concept of female respectability and behaving in a caring, responsible and selfless manner.

Given these requisite circumstances, employment in eldercare services is less attractive than in many other professions. The striding working conditions concern everything from working conditions to wages [32]. There are, however, also other factors that could generate complications in this work. One such aspect is being a migrant. One explanation for why so many people with migrant backgrounds work in eldercare is that people with migrant backgrounds often take jobs in areas of labour shortage [33].

Therefore, Sweden has developed an increasingly 'ethnically coded' labour market. But also because migrant nursing assistants consider possessing more genuinely caring qualities [34]. There is, however, research indicating that ethnic discrimination and racism have a significant impact on working conditions in the health and care sector [30, 35–39]. The most common form of racism in the workplace is verbal racism [40]. Ethnic diversity in the workplace produces ethnic discrimination and racism ([41], p. 34). The Swedish Research Council [42] survey highlighted the scarcity of research on racism in the Swedish labour market. Since many people with migrant backgrounds work in eldercare services, it is necessary to ask about racism and discrimination in the workplace.

Much of the eldercare research on migration-related problem areas is based on a client/user perspective [43–45]. When research emphasises the staff's perspective, the dominant area has touched on how they can become culturally competent and work in a culturally congruent way in the encounter with the older migrant person. There are examples of research that concern migrant people's work in eldercare. Still, research is needed to highlight the migrants' own stories and experiences to create new knowledge more accurately.

## **5. Theoretical outline**

#### **5.1 Everyday racism**

Philomena Essed's [46] theory of everyday racism provides the framework for analysing the care workers' stories on ethnic discrimination and racism. Their experiences are analysed by using Essed's core theory that racism and racial bias are manifested daily. In short, everyday racism refers to the familiar, seemingly minor, but significant ways non-white people encounter racism through regular social interactions. Unlike blatant racism, which is obvious and easily identified, everyday racism is not always immediately visible and often embedded in daily life. Therefore, Essed argues that racism is more than structure and ideology. She emphasises that racism is expressed in everyday routines and behaviours and is transferred to and repeated in different situations. Essed claims that this racial bias and racism experienced by non-whites is theoretically relevant. The term 'experience' is the core of Essed's conceptualisation of everyday racism. It is consequently crucial to emphasise racialised people's specific experiences.

The sharing of experiences in the research circle is the dissemination of knowledge. The personnel can hereby discuss specific aspects of their daily working lives. Sharing these everyday experiences with the other participants underscore oppressive actions that are difficult to cope with at work and often become invisible. Eventually, in a work culture distinguished by subordination and vulnerability, this exchange of experiences may strengthen the care workers. When emotions are a significant part of the professional work, there is a risk of misjudgements and misunderstandings of situations, that might lead to discrimination and racism in the eldercare services [33, 47].

'Race' is a controversial term in Sweden and not necessarily loaded with the same meaning as in other parts of the world. Race relations and the academically developed term race theory are well-adapted academic and societal phenomena in South Africa, South America, Australia, the United Kingdom and the United States. The French philosopher and social scientist Étienne Balibar [48] has argued that racism, from an ideological perspective, is a discursive practice that hides class interests, social privileges and political power. He argues that it is irrelevant to talk about racism, as we should instead focus on the manifestations of racism found at structural, institutional and everyday levels. Altogether, racism constitutes a complex field of social practices and structures, where various types of people are emphasised and hierarchised.

By focusing on the significance of how concepts of race are created and transformed, we can understand what Omi and Winant [49] describe as racial formation. Racial formation or racialisation happens when people are categorised by complexion and viewed as distinctly different or uncharacteristic. Racialisation refers to explicit or unspoken categorisations, perspectives and associations that naturalise a hierarchical ranking of human beings that structure social relationships and positions of power and subordination [50]. Using terms such as 'racialised' and 'ethnicised' emphasises that specific individuals or groups, based on conceptions of race and ethnicity, are attributed behaviour patterns and are expected to stand for specific values [51].

*The Challenge of Migration in Swedish Eldercare: Experiences of Everyday Racism DOI: http://dx.doi.org/10.5772/intechopen.106609*

## **6. Result**

#### **6.1 Experiences of racism in Swedish eldercare services**

When the staff members presented their understandings in the research circle, it became evident that they had experienced racist behaviour by their older clients, amounting to 'everyday racism'. It was clear that this involved verbal expressions and a sense of being entirely ignored, especially when a 'Swedish' (read white) colleague was nearby. In her article on everyday racism, Essed [46] claimed that one of the guiding principles of racial bias is the feeling that a sense of superiority dominates an interaction. She believes that dark skin is viewed as a difference and ultimately characterised as a subordinate position in constant comparison with the dominant group of white individuals. Essed's perspective on racism is developed along with a series of vectors: (1) The importance of valuing individual experiences, (2) Recognition of the group's historical experiences, (3) An understanding of both historical and modern group experiences concerning race and ethnic dominance, (4) Confirmation of continuity between personal experiences and group experiences, and (5) Personal responsibility in the process. There is an assumption that racist incidents rely on interpreting the general knowledge of racism and considering what constitutes unfair treatment or discrimination considering these vectors. Ariel stated:

*When you come in, they [the older person] clearly show you that you don't exist. You're just air! It's only her ['Swedish' colleague accompanying Ariel]! I have tried to work through these feelings over the years, so I do not think about them as often now. But it is so clear, and it does not feel right (Ariel, a nursing assistant in-home care services).*

Ariel examines how she is subjected to racism in the workplace and how it makes her feel bad. Over the years, she has tried to work through her feelings of being ignored and unrecognised as an equal and valued colleague in eldercare services. Her experiences correlate to what Essed describes as a guiding principle of racial bias, expressed as a sense of superiority by merely pretending that Ariel is not in the room. According to Essed, everyday racism does not involve extreme incidents but rather more subtle actions and behaviours. Those targeted by these actions and performances will always sense them, but they are sometimes difficult to identify. For instance, patterns of avoidance and feelings of inadequacy may be challenging to pin down, especially in work-related situations.

The typical attitude regarding older clients' racist behaviour was that these situations were not that serious. The personnel did not view the conduct as problematic but rather an unpleasant part of their work. Racist performance and remarks by older clients were often not perceived as racist but rather as harmless and unintentional. The consensus was that older adults, given their age, ill-health and vulnerability, could not know what they were saying. This 'let-go' attitude among the staff members corresponds with other studies' results [33, 52]. The philosophy ascribes to the idea that racism among the older adults is inevitable and that the staff works with people who do not know any better. Another explanation is that the clients had grown up in a different era when racism was considered the norm. The staff members claimed that they could cope with these difficult situations and tried not to let older clients' behaviour affect them by viewing it due to age, social status or dementia.

The staff members' working life experiences are significant, mainly since they dismiss racial conduct as an unpleasant part of their work. As this unpleasant aspect has become part of the care workers' daily lives, it is essential to look more into the problem. Essed's [46] use of 'everyday racism' is about the boundaries between structural and interactive aspects of racist actions, thus linking the details of micro experiences to the structural and ideological contexts. Everyday racism is created through complex and cumulative incidents over time to occur as individual incidents. Therefore, specific actions and manners become meaningful as aggregated events. Another critical aspect of everyday racism involves racist activities that infiltrate daily life and becomes part of what is considered 'normal' by the dominant group. Examples of this are most clearly expressed in everyday language and popular culture.

Discursive formations and the constructions of race and ethnicity are mobilised through racist discourse. Everyday racism constructs false self-images, which also negatively affects the personal integrity of the victims of racialisation. Ariel described a situation in which she had visited a woman at her home:

*We had a client where her daughter also lived, and they were overly pedantic, and everything was so clinically clean that you could see yourself on the countertops and see my dark face [giggle]. So, when I come in, I'm working as an intern accompanied by a regular staff member. And when I come in, they will not shake my hand. The other staff member was Swedish and blonde and pretty and worked there for about six months. But this was a two-person job, with lifting and everything that needed to be managed. So, when we came in, I saw that they had the old type of lift. Not the kind you push a button on, but instead the kind that hangs and needs to be pumped. So, there had to be two of us. But whatever I did, she kept yelling:" Aaahhh!" and there was nothing I could do. My colleague said I should try, and the daughter heard how she was screaming. The woman turned to my colleague and said: "Look how black she is!" (Ariel, a nursing assistant in-home care services).*

The statements demonstrate the significance of skin colour, given its indisputable visibility and obviousness as a marker for perceived racial differences. The quote shows how skin colour is the essential aspect of the older client and enacts her determined rejection of Ariel. The testimonies also reveal that the staff members know the widespread and repeated doings manifested in everyday racism. Consequently, racist behaviours further reinforce the subordinate status of the work. Nevertheless, those involved often are the only witnesses to this kind of racism [53], given that these incidents take place in private homes, and the personnel often work alone. Even if a colleague is present, the experience of racism tends to be isolated incidents. It is as if the practice must be endured and worked through alone in silence by those subjected to it. Ariel must continue to visit her clients who openly discriminate against her. It appears to be her responsibility to deal with the experiences of racism in the workplace. While the older clients take the liberty to display blatant racism, they are simultaneously in a subordinate position, requiring help and assistance to manage their daily lives. The older adults often find themselves dependent on support from the staff visiting them. Ariel continues:

*After a while, I began arriving along with a dark-skinned guy, and strangely enough, she said to me: "Look at how black he is! Don't touch me!". She didn't have dementia (Ariel, a nursing assistant in-home care services). It's impossible to know how she thinks.*

These quotes illustrate the everyday racism of the care working situation. But also, how racist actions negatively affect the personnel. The older adults' conduct and values let black caregivers know they are unwanted. All in all, this is an alarming situation for the working environment in the eldercare services.

### **7. Discussion**

#### **7.1 The challenge of migration and antiracist social work**

There are many problem areas to study when it comes to the organisation of eldercare. Relatively small changes have been made over several decades in terms of the content and nature of the work. Of course, more people have training now than before, but the staff's level of training, composition, enrolment and working conditions have not developed satisfactorily. Eldercare is a broad arena and can be about everything from the older adult's living conditions to development assistance assessment, relatives' care, housing, care and nursing efforts to personnel issues and how those who perform care work perceive their work situation [54]. Care is perceived as something women practice and as something women do naturally. These ideals (ideas) come into conflict with standards that, among other things, concern gender equality in paid work and professionalism. One way of understanding the conditions of eldercare work is to study the concepts by which eldercare is surrounded. Examples of such ideas are the notions of care, female dominance and paid work, and how those concepts are essential for emotions at work, professionalism and social hierarchies.

Eldercare workplaces also have a relatively high personnel turnover, especially in the metropolitan regions where there are often short-term jobs and temporary positions, which creates instability in the workplaces. The main reason for the shortage of labour is not only that the older adults are becoming more numerous but also that fewer people want to work there. Staff turnover is thus high and young people do not apply there. Smaller, private companies may also find it difficult to provide full-time employment and thus become dependent on short-term workers. Short-term employment with a low employment rate, often with a spread of working hours around the clock, creates insecurity and poor working conditions. Research on working conditions in eldercare is of great importance in understandings about the so-called crisis that the skills supply issue is described as right now. Previous research has shown inadequacies such as overtime, time pressure, unreasonable tasks such as local coordination, unnecessary tasks with IT hassle, lack of clarity in goals and tasks and high demands on social interaction [55, 56]. 27 per cent of eldercare workers have stated that they want to leave the profession within a three-year period. It shows that the younger you are, the more inclined you are to change profession. Unfortunately, many people consider work in eldercare as a transitional profession, something you do for a while and then moves on from. This is something that management needs to consider when it comes to affecting leadership and further improving the management of the eldercare. For the future, it is about creating attractive and inclusive workplaces.

The main ambition of this chapter has been to present an understanding of how aspects of migration become useful for leadership in eldercare. A primary drive is to shift the focus from ethnicity per se to the relational part of constructions of race. This is done by showing how the ethnic dimension often is in language use, the relations created by various discourses and their institutional conditions. These conditions also create spaces of power in working life, pockets of mastery and

subordination and the social hierarchies that go with them. This chapter mainly presents experiences, expressions of racism in eldercare services, and how personnel deal with racist situations. It also illustrates how black women deal with racism and vulnerability in the workplace by taking moral responsibility for the racist contexts that subordinate them. One nursing assistant has explained that she uses strategies such as exposing herself to degradation. Staff members also describe their encounters with people who humiliate them and continue working under challenging conditions. Their statements demonstrate aspects of the struggle in working life to maintain both the profession's status and value as a human being.

Health and care services reflect incidents that are part of working life for one person, while it is the private life for the other part. Encounters between caregiver and client involve power relationships, and their interactions are fundamental in work. Simultaneously, collegial relationships are also essential to ensure a pleasant working environment that promotes growth. The care workers cannot exclude the emotional aspects of relationships with their care recipients, and it is impossible to perform care duties without feelings. The workplace culture and morality regulate expressions of these emotions. In the moral practice of behaviour, individuals constitute themselves as moral subjects. Foucault [57] views individuals in terms of subjectivity. The individual is an effect of discourse, which is always social (and collective). This perspective on the issue guarantees a social subject, where subjectivity is neither stable nor uniform but somewhat contradictory and constantly changing. One's actions become a manner of conduct, an attitude toward other people, regulated through shared views and perceptions about prohibitions, values, ideals and what is and is not fun. The personnel have a primary moral responsibility in their relationships with their older clients. They endure their vulnerability by viewing it as their job and infantilising their older clients. Those aspects of the working conditions are extremely important to be recognised from a management perspective.

However, is it reasonable to place the responsibility of dealing with racism on those subjected to it? Racism involves activities that we shape together, our thoughts and actions. The experience of racialisation is something that occurs through interactions with others. Therefore, racism is not one specific performance but rather a result of social activities or doings of various types. We are all morally responsible for bridging unequal relationships at work. Racialisation processes and doings have many serious consequences. These consequences include subordination, inequality and various forms of domination, which promote exclusion and discrimination in working life. Such effects result in more unsatisfactory living conditions for certain groups of individuals. Therefore, racialisation affects activities at a meso, macro, and micro level, as indicated by several of the chapter's examples. These activities depend on racist conceptions for their existence, created at a macro level. Racism in eldercare services is a complex issue that reflects the dynamics of inequality in society. Thus, well-considered and feasible efforts are needed to create equality at work. We are in a social climate with an increasing focus on the importance of origin, when racist organisations are rising and hate crimes have reached an alarmingly high level. That is why racism has also become essential for understanding eldercare services' conditions and practices are creating more profound inequalities.
