Exit, voice and indifference – older people as consumers of Swedish home care services

Abstract

Sweden has in the last 20 years undergone an extensive process of marketisation of its home care sector. Where the public sector once was the only provider of home care services, there is now a wide array of different, private alternatives for older people to choose from, using their publicly funded voucher. The publicly funded home care services in Sweden are, in other words, to a large extent organised according to the principles of a quasi-market. Older people with care needs are therefore now considered to be consumers of home care since they are expected to make an informed choice of home care provider according to their own preferences. This paper studies the extent to which older people with care needs assume this role and how they do it, using Hirschman's well-known theory on ‘exit, voice and loyalty’ and theory on the difference between care and market logic. The study is based on results from a research project using telephone interviews to ask a large number of older people in three Swedish cities about their experience of making this choice. The results show that they had difficulty understanding how to choose and what the purpose of the choice was. The conclusion of this study suggests some possible reasons why policy makers in Sweden continue to favour the freedom-of-choice model in spite of these poor results.

Autonomy, Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

“…An analysis of the information from providers showed that it provided little guidance for users to make informed choices (Moberg, Blomqvist & Winblad, 2016). Many older people do not see the value of choosing between different, more or less anonymous, service providing agencies and very few change their initial choice of provider of eldercare (Edebalk & Svensson, 2010;National Board of Health and Welfare, 2015;Vamstad, 2016). However, other findings have suggested that older people, especially those with higher income and educational levels, appreciate the opportunity to choose the provider of their care and services (Hjalmarsson & Norman, 2004;Vamstad, 2016).…”

“…Many older people do not see the value of choosing between different, more or less anonymous, service providing agencies and very few change their initial choice of provider of eldercare (Edebalk & Svensson, 2010;National Board of Health and Welfare, 2015;Vamstad, 2016). However, other findings have suggested that older people, especially those with higher income and educational levels, appreciate the opportunity to choose the provider of their care and services (Hjalmarsson & Norman, 2004;Vamstad, 2016). In a recent study of older users of Swedish home care services with Free Choice Systems, 13% claimed that they did not know that they could choose their provider, and almost 25% reported that the municipal authorities in fact had made the choice (Vamstad, 2016).…”

“…However, other findings have suggested that older people, especially those with higher income and educational levels, appreciate the opportunity to choose the provider of their care and services (Hjalmarsson & Norman, 2004;Vamstad, 2016). In a recent study of older users of Swedish home care services with Free Choice Systems, 13% claimed that they did not know that they could choose their provider, and almost 25% reported that the municipal authorities in fact had made the choice (Vamstad, 2016).…”

Knowledge and views about coordinated individual planning from the perspective of active older adults

“…Moreover, they are rarely trained to work with older people to ensure that they can increase control of their own health. In Sweden, as in many countries, "ageing in place is the current policy, de ined as remaining in the community with some level of independence, autonomy and connection to social supports including family and friends [27][28][29]. It also avoids costly institutional care.…”

Vanhuspalvelut ja valinnanvapaus - johtavien viranomaisten näkemyksiä palvelusetelistä

“…Siksi aito valinnanvapauden toteutuminen ja asiakkaiden mahdollisuus äänestää jaloillaan voi sopia huonosti palveluasumisen kaltaisiin palveluihin (Rostgaard 2006). Tutkimustietoa palveluntuottajan vaihtamisesta vanhuspalveluissa on jo Ruotsista, missä vanhusten kotipalvelut on jär-jestetty asiakkaan vapaalla valinnalla (Vamstad 2015). Tutkimuksen mukaan vanhukset eivät vaihtaneet palveluntuottajaa lähes lainkaan, ja osa heistä ei edes ollut tietoisia siitä, että he olivat tehneet valinnan palveluntuottajien välillä.…”