This article focuses on the most vulnerable among the elderly receiving home-based care. The subjective perspective of the elderly is extrapolated on the basis of qualitative interviews and observations, as well as illustrating the needs and wishes of the elderly with “complex problems”. This term covers a mixture of psychosocial problems such as alcoholism, psychiatric diseases and dementia. These people, who have often lived a life on the edge of accepted standards for living, want to live as they always have, to be respected as competent human beings and to be identified through the life they have lived. To meet these various needs, I point to the need for home care helpers to recognize their relationships with the elderly as being of crucial importance. To establish a relationship in which an elderly person can be recognized in an existential sense could indeed be the key to establishing contact. In order to develop this approach, the staff has to possess special competencies, and there needs to be some organizational backup for developing this type of relationship. Home-based care in Denmark is founded on new public management theory (NPM), although rules and regulations implied in NPM do not always provide home helpers with the time, support, autonomy or flexibility necessary for them to establish a recognizing type of relationship. Therefore, the critical question is raised as to whether when applying new public management in practice, the welfare state risks excluding those citizens who are most dependent on public help.

Keywords: Elderly care, relationships, recognition, new public management, exclusion.