Using data from two representative surveys among the users of personal assistance in Norway carried out in 2002 and 2010, this paper examines developments and consequences of a strong increase of users and an extension of the target group. Users with mobility impairments still dominate, but the proportion of people with intellectual impairments, brain injuries, and sensory impairments have increased. The 'new' users seem to be allocated fewer hours compared with those who received personal assistance at the early stages of the arrangement. Still, most users experience an increase in their welfare arrangements, as compared with the situation before they received personal assistance. The user control of the arrangement seems to be preserved, but it takes more different forms. For a higher proportion of users, one of their relatives or a guardian acts as a manager of the assistance.
The importance of service-user participation has been growing in the care services, but what possibilities do service users have to influence these services? This article analyses how structural factors have an impact on the scope of possibilities for user influence in care services, especially with respect to how established structures and frameworks determine users’ opportunities to influence both the allocation and the provision of services. A study of five Norwegian municipalities where managers at different levels and within different areas of the services have been interviewed forms the basis of the empirical material. In the managers’ general opinion, over time there has been a stronger individual adjustment of the services and stronger user influence over both the allocation and the provision of services. However, if we look more closely at the service-delivery process, several structural factors limiting the scope of possibilities for user influence become apparent. These factors are discussed in light of different user typologies.
The hybridization of the welfare services has resulted in the emergence of a market of service providers for personal assistance in the Scandinavian countries. We describe and analyse two different aspects of the market development. First, we consider the development of the providers' market and the different regimes of regulations in the three countries. Second, we examine how the providers handle the multiplicity of claims and expectations in order to attract potential customers in competition with each other. We analyse the different types of organizational identities the providers develop by studying their expressed core values. The findings are presented in the form of three types of values: the value of empowerment, the value of flexibility and the value of professionalism. The differences in organizational values may suggest that the providers direct their services towards different segments of users.
Brukermedvirkning som samproduksjon har blitt et mer sentralt perspektiv de senere åra i den offisielle omsorgspolitikken. Denne artikkelen retter søkelyset mot lederes forståelser av brukermedvirkning innen kommunale omsorgstjenester. Det empiriske grunnlaget er intervjuer med omsorgsledere på ulike nivåer og tjenesteområder i fem kommuner. Lederne vektla en individuell tilnaerming der brukerne bør ha innflytelse både ved utforminga av tjenestetilbudet og ved sjølve tjenesteutførelsen. De hadde også en forventning om at brukerne skal vaere deltakende, aktive og benytte sine ressurser. Denne forventningen vil kunne skape spenninger mellom brukerne og fagpersonalet. I slike situasjoner blir styring ifølge lederne utøvd gjennom dialog, veiledning eller ulike former for motivering. Vi finner igjen sentrale elementer fra samproduksjonsperspektivet i omsorgsledernes vurderinger uten at de benytter samproduksjon som begrep.
User councils act as advisory bodies for the agencies with which they are associated. This article is based on interviews with user participants and agency representatives from a sample of user councils in Norway. The main question raised is how user participation functions in user councils. In general, the findings show that among the user councils there are active discussions, most of the user informants feel that they are respected as equal partners and that they are taken seriously. However, the work is characterized by representatives from the agencies taking the initiative to raise issues and the user representatives responding to these initiatives, and in that way the user participants function reactively. Most of the informants from the agencies want the user representatives to be more active and critical. This raises concerns about how user participants can be more proactive. Finally, some prerequisites for improving the functioning of user councils are discussed.
The paper is based on a study of the law-making process of personal assistance in Norway. It discusses some tensions between the state and the municipalities concerning the type and quantity of services with regard to personal assistance. Does introduction of personal assistance imply an extended quantity of services or is it just another way of organising existing services? The signals from the state authorities are ambiguous, and when implementing the reform the municipalities are left to find a solution to this question. This might create a strategic game between the state and the municipalities. It might become an unpredicted side effect of the legislation of personal assistance that the municipalities will become more restrictive in the provision of personal assistance than they were in the experimental period.
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