Katarina Andersson

The neoliberal turn and the marketization of care: The transformation of eldercare in Sweden

The care for older and disabled people has been described as a core area of the Nordic model. The Nordic countries’ welfare model has also been described as women friendly, as women are not forced to make harder choices than men between work and family. The Swedish eldercare system has, during the last several decades, undergone significant changes. Previously, eldercare could be described as universal, meaning a publicly provided, comprehensive, high-quality service available to all citizens according to need and not based on the ability to pay. In later years transformation of eldercare has been influenced by neoliberal politics, which emphasize economic efficiency and cost reduction through competition. Eldercare has become a more diverse multidimensional system, and a private market for home-based eldercare has been created. The numbers of eldercare providers have increased considerably, and new ways of organizing eldercare have been established. In January 2009, the Act on System of Choice in the Public Sector was introduced (in Swedish: Lagen om valfrihetssystem [LOV]). The Act was supposed to provide an opportunity for interested municipalities and county councils to expose their publicly provided services to market competition, and to enable users to choose their providers. This article aims to illustrate how neoliberal reasoning dominated the policy process leading to adoption of the Act on System of Choice in the Public Sector. With the use of a discursive policy analysis the authors specifically explore how neoliberal logic dominated, and also how choice and equality were understood and interpreted in the policy process. They conclude that the neoliberal turn in eldercare claiming to centre on the individual choice of persons in need of care runs the risk of creating unequal care that decentres the eldercare worker and creates precarious work situations.

Framing of Intimate Care in Home Care Services

Provision of intimate care is a challenge for the care worker, as well as for the recipient of care, in terms both of how this care is to be performed and of how to manage feelings such as anxiety and embarrassment. In home care services, most intimate care work is performed by non-professionals who have received little or no formal or in-house training, and who are at risk of being left to devise their own methods or coping strategies. This article reports on a participant observation study of intimate care in home care services in Sweden. The strategies used to handle intimacy in care work displayed similarities, as well as dissimilarities, to those of professional framing identified in earlier studies of medical and nursing practice. There are similarities in terms of how framing was accomplished in a balance between a distanced matter-of-fact stance and one of personal acknowledgement created in interplay between care workers and care recipient. There are dissimilarities in terms of the challenges presented by the home care setting. As the relationship between care worker and care recipient in intimate care is a particularly precarious one, lack of guidance and formal training may hamper care and lead to neglect.

Methodological challenges in the implementation and evaluation of social welfare policies

As social reality is quite elusive, even regarding seemingly well-recognized everyday concepts and objects, there are always methodological challenges underlying assessments and evaluations of implementation policies. The present article addresses this area of concern by presenting the results of a rereading of an empirical study of elderly home care services. Our results reveal the emergence of a dissolution of common and professional key concepts and objects in these welfare services to a degree that challenges both the implementation policy and the evaluation of policy. We claim that this has methodological implications for evaluation of implementation policies in general.

Governance, accountability, and organizational development: eldercare unit managers’ and local politicians’ experiences of and responses to state supervision of swedish eldercare

ABSTRACT This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV’s narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

Strategies to handle the challenges of intimacy in nighttime home care services

ABSTRACT The provision of intimate and personal care constitutes a challenge for both careworkers and care recipients and is still a neglected area of research. An observational study of the interaction between the careworkers and care recipients in night-time home care services was conducted in a large municipality in Sweden. The results were analysed in light of previous research and theorising on strategies for handling intimacy in intimate care. The study highlights what appears to be a tension between the ways in which the recipient of care is conceptualised as an active consumer of care in present-day guidelines and the strategies chosen on the part of both caregivers and care recipients, when intimacy and integrity is most at stake, and framed as it is by the care recipients’ situation of dependency and vulnerability. Home care services night-time was shown to be a case that markedly differs from many other settings of intimate care, but in the interactional routines intimate care came forth as a smooth and minimally obtrusive activity. The careworkers and care recipients engaged in strategies such as disattention, eye-discipline, middle-distance orientation, and objectification, thereby serving the purpose of balancing the transgressions of thresholds of intimacy.