Tradition, change and variation : past and present trends in public old-age care

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.Härtill 4 uppsatser</p

Omsorgstjänster för äldre och funktionshindrade: skilda villkor, skilda trender?

Care services for elderly and disabled persons: different conditions, different trends? Care services for disabled and elderly persons are essential parts of the Nordic welfare states. While these services are often not separated in statistics and research, a comparison of the two services reveals substantial differences in the case of Sweden. This article focuses the recent developments of Swedish elder care and disability care; the changing roles of the state, the family and the market; and the consequences of the changes for all parties concerned: the elderly and disabled persons, their next of kin and the care staff. The analysis shows that the financial resources for elder care have declined in relation to the increasing number of old people, while the resources for disability care have increased substantially. The coverage of services has decreased among elderly people and increased among the younger. The care workers in elder care and disability care report very different working conditions regarding their workload and the possibility to meet the needs of the care recipients. Private providers (mainly for-profit companies) of publicly financed care services have enlarged their share in both services, but are far more common in disability care than in elder care. The boundary line between formal and informal care has changed in both groups, but partly in opposite directions. There is a trend of informalisation among elderly people with larger as well as smaller care needs, especially among elderly with lower education. Among less disabled younger persons there is a similar trend of informalisation, while there is an opposite trend towards more formal care services among disabled persons with large needs of assistance and support. In relation to the Nordic welfare state model, care services for elderly and for disabled people in Sweden seem to be moving in different directions. An increasing number of disabled people with extensive care needs can lead their lives with greater autonomy and less family dependency than previously. Among frail elderly people, decreasing public support and increasing, often coerced, family dependency, might instead be a sign of a departure from the Nordic model

Marketisation in Nordic eldercare : a research report on legislation, oversight, extent and consequences

The Nordic countries share a tradition of universal, tax-financed eldercare services, centred on public provision. Yet Nordic eldercare has not escaped the influence of the global wave of marketisation in recent years. Market-inspired measures, such as competitive tendering and user choice models, have been introduced in all Nordic countries, and in some countries, there has been an increase of private, for-profit provision of care services. This report, researched and written by Normacare members, is the first effort to comprehensively document the process of marketisation in Sweden, Finland, Denmark and Norway. Our hope is that the report will provide both a foundation and an inspiration for further research on change in Nordic eldercare. The report seeks to answer the following questions: What kinds of market reforms have been carried out in Nordic eldercare systems? What is the extent of privately provided services? How is the quality of marketised eldercare monitored? What has the impact of marketisation been on users of eldercare, on care workers and on eldercare systems? Are marketisation trends similar in the four countries, or are there major differences between them? The report also includes analyses of aspects of marketisation in Canada and the United States, where there is a longer history of markets in care. These contributions offer some perhaps salutary warnings for the Nordic countries about the risks of increasing competition and private provision in eldercare