Complex needs and ethical dilemmas—Care managers processing older clients to gerontological social work

In the times of neoliberal policies, care managers work as gatekeepers to different elder care services. In this study, we examined how care managers categorise older adults' life situations in relation to needs for gerontological social work. Our data consisted of focus group interviews with 19 care managers working in different parts of Finland and were analysed by category analysis. The results show that processing older adults as clients of social work is not unambiguous. The Finnish legislation does not offer a solid foundation for defining the complex needs of older adults in everyday practices of care managers, but abuse and several coincident support needs were recognised as criteria for social work services. Importantly, ethical issues concerning sensitive situations and the self-determination of older adults were categorised as situations where social work is needed. This sets high expectations for the ethical expertise of social work in elder care.