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Change, reorganization and quality of home carefor elderly people in Sweden during the 1990s : paper to 17:e Nordiska konferensen i gerontologi 23-26 maj 2004 i Stockholm

Publiceringsår: 2004
Språk: Engelska
Publikation/Tidskrift/Serie: Working paper-serien
Volym: 2004
Nummer: 2
Dokumenttyp: Working paper
Förlag: Lunds universitet : Socialhögskolan


During the 1990s several kinds of reorganization has taken place in public services in Sweden.
Reorganizations according to the idea of market economy have been most salient and
debated. In many municipalities private companies have started to organize home care service
for elderly, financed by tax. Public home care organizations have reorganized the working
organization and managing structure, partly to save money and partly to reach better quality
of care. The home care services have a key role in the care of the elderly in the society. The
quality of care is important for the possibility for elderly to stay as long as possible in their
ordinary homes. We have performed a longitudinal study of the reorganizations during the
1990s in order to explore the consequences for quality of care.
The study was performed in seven districts in three different municipalities representing
different types of municipalities and different kinds of reorganizations. It comprises private
companies, traditional public organizations, public organizations with changed managing
structure and co-ordination of home help and home health care. Quality of care is studied
through assessment of the communication in the organization, the psychosocial working environment
of the caregivers and the quality of the care work. Politicians, managers, ca. 100 care
givers and ca. 500 elderly receiving help and care have been interviewed four times during the
period (1993, 1995, 1997 and 2002/2003).
The traditional organization within small districts with small autonomous working teams
and easy accessible supervisor expose the best quality. There are no unambiguous differences
between public and private organizations. There is however a tendency for successive decline
of quality for private companies after they have been established. Other aspects of the reorganizations,
e. g. to have special officials for assessment of help need, do not contribute to
better quality but create new communication gaps in the organization and have negative influence
on the working environment.
Stability in the composition of the care worker teams, leadership, decision-making processes
in the organization and the district area promote high quality of care. The reorganizations
during the 1990s seem on the whole to function contrary to promotion of high quality in
the care and service for the elderly.



  • Social Work


  • ISBN: 91-89604-27-X

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