“It’s a very difficult balancing act”: Social workers’ relational discretion in navigating home care assessments for older couples

Social workers assessing home care needs for older couples face complex relational and ethical challenges, as partners’ wellbeing, autonomy, and care responsibilities are deeply intertwined. This study explores how social workers collectively make sense of and reflect on these dilemmas when assessing older couples in which one partner provides informal care. Drawing on nine focus group interviews with 50 practitioners from nine Swedish municipalities, the analysis applies sensemaking theory and the concept of professional judgement to examine how practitioners interpret relational dynamics, navigate legal ambiguities, and manage emotional strain. Findings show that social workers engage in relational sensemaking, transforming individual experiences into shared professional understanding. Professional judgement emerges as a socially and emotionally grounded process—what we term a relational epistemology of practice—in which practitioners exercise relational discretion to balance legal norms, ethical principles, and couples’ lived realities. Emotional attunement and collegial reflection are central to how practitioners discuss autonomy, risk, and wellbeing in ethically ambiguous situations. The study argues that policy frameworks built on individualistic assumptions fail to capture the relational nature of later-life care. A supportive organisational environment that fosters reflection, dialogue, and discretion is essential if self-determination and personhood are to be realised in gerontological social work.