Merely a rhetorical promise? Older users' opportunities for choice and control in Swedish individualised home care services

Abstract

A policy shift has taken place in Sweden towards individualised elder-care and consumer choice. The aim of the study is to investigate how older users of home care services view and experience their opportunities of exerting influence and having choice and control in their everyday living, in terms of receiving preferred services that are flexible and responsive to their actual needs and priorities. The study was conducted in three local elder-care authorities, reflecting diverse present models of organising home care services in Sweden. Data consisted of responses to a postal survey (N = 2,792) and reports from qualitative interviews (N = 28) with older users. Our findings point to similarities rather than differences between the views and experiences of the users in the three participating local municipal elder-care authorities. A majority of users were positive about their home care services. The experiences ranged from being active and enabled to choose between providers and services, to being more or less passive dependants having to rely on the decisions of family and staff. The importance of supportive relationships, and interdependence between older people and their formal as well as informal support networks, became clear. Our findings may guide policy makers in refining home care services, irrespective of preferred model. In particular, efforts to facilitate staff continuity and prevent high staff turnover need to be prioritised.

Choice, needs or equality? Discursive struggles about defining home care for older people in Sweden

“…Equality has often been highlighted as a defining feature of the Nordic universalistic care regime, connected to policies that reduce both class and gender inequalities (Szebehely and Meagher, 2018). Nevertheless, the introduction of choice systems in the Nordic countries has often been framed by their advocates as the solution to the 'problem' of equality, referring to publicly provided, uniform, standardised and inflexible care services (Moberg, 2017;Dunér et al, 2019). Both Nordic and Anglo-Saxon scholars have linked the introduction of choice to a policy discourse on individualised care, diversity of services and empowerment of users (e.g.…”

“…Research focusing on choice in practice criticises the assumption of the 'rational' care consumer and underlines that older people face great impediments in making informed choices (e.g. Glendinning, 2008;Meinow et al, 2011;Moberg et al, 2016;Vamstad, 2016;Dunér et al, 2019). Those with the greatest care needs are most dependent on choosing a provider that will offer good care, but have the least capacity to do so (Meinow et al, 2011).…”

Paid informal care within Swedish eldercare: prevalence, change and variation among Swedish municipalities 2006–2016

“…Since cash schemes have been described in national policy as a form of financial support, it is possible that this has made municipalities more inclined to implement paid informal care. Another trend is the policy shift towards providing older people with more choice and control over their care arrangements (Dunér et al, 2017). Internationally, cash-for-care has functioned as a way of achieving such personalised care (Netten et al, 2012) and it is therefore possible that Swedish municipalities have also become more inclined to use paid informal care as a strategy to achieve this.…”

“…This factor was operationalised using a categorisation of municipality types based on information about the municipaly's population size and density. As cash-for-care schemes in other countries have coincided with a political ambition to provide more personalised care, the presence of consumer-choice systems was seen as an indicator of this, as municipalities have implemented such systems to achieve more personalised care (Dunér et al, 2017). To a higher extent than men and right-wing voters, women and left-wing voters support the notion that informal caregivers should be able to get paid (Mellgren, 2017).…”

“…In Sweden, the organisation and provision of services for older people is the responsibility of the local authorities in 290 self-governing municipalities (Dunér et al, 2017). Although local authorities are required to offer home-care and institutional care, each municipality is free to decide whether to deploy cash-for-care schemes or not.…”