Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-30T23:49:35.588Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  26 October 2017

ANNA DUNÉR*
Affiliation:
Department of Social Work, Centre for Ageing and Health – AgeCap, University of Gothenburg, Sweden.
PÄR BJÄLKEBRING
Affiliation:
Department of Psychology, Centre for Ageing and Health – AgeCap, University of Gothenburg, Sweden.
BOO JOHANSSON
Affiliation:
Department of Psychology, Centre for Ageing and Health – AgeCap, University of Gothenburg, Sweden.
*
Address for correspondence: Anna Dunér, Department of Social Work, Centre for Ageing and Health – AgeCap, University of Gothenburg, PO Box 720, SE 405 30 Gothenburg, Sweden E-mail: [email protected]

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.

Type
Article
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barron, K. 2001. Autonomy in everyday life, for whom? Disability & Society, 16, 3, 431–47.Google Scholar
Berglund, H., Dunér, A., Blomberg, S. and Kjellgren, K. 2012. Care planning at home: a way to increase the influence of older people? International Journal of Integrated Care, 12, 10 August. http://dx.doi.org/10.5334/ijic.817.Google Scholar
Boyle, G. 2005. The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings. Ageing & Society, 25, 5, 731–48.Google Scholar
Clarke, J. 2006. Consumers, clients or citizens? Politics, policy and practice in the reform of social care. European Societies, 8, 3, 423–42.Google Scholar
Clarke, J. 2007. Unsettled connections. Citizens, consumers and the reform of public services. Journal of Consumer Culture, 7, 2, 159–78.Google Scholar
Collopsy, B. J. 1995. Power, paternalism and the ambiguities of autonomy. In Gamroth, L. M., Semradec, J. and Tornquist, E. M. (eds), Enhancing Autonomy in Long-term Care: Concepts and Strategies. Springer, New York, 314.Google Scholar
Donchin, A. 2000. Autonomy and interdependence: quandaries in genetic decision making. In Mackenzie, C. and Stoljar, N. (eds), Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford University Press, Oxford, 236–58.Google Scholar
Duffy, S. 2008. Personalisation in social care. Consumer Policy Review, 18, 5, 132–6.Google Scholar
Dunér, A. and Nordström, M. 2005. Intentions and strategies among elderly people: coping in everyday life. Journal of Aging Studies, 19, 4, 437–51.Google Scholar
Dunér, A. and Nordström, M. 2006. The discretion and power of street-level bureaucrats. An example from Swedish municipal eldercare. European Journal of Social Work, 9, 4, 425–44.Google Scholar
Dunér, A. and Nordström, M. 2010. The desire for control. Negotiating the arrangements of help for older people in Sweden. Journal of Aging Studies, 24, 4, 241–7.Google Scholar
Dunér, A. and Wolmesjö, M. 2015. Interprofessional collaboration in Swedish health and social care from a care manager perspective. European Journal of Social Work, 18, 3, 354–69.Google Scholar
Edebalk, P. G. and Svensson, M. 2010. Kundval i äldreomsorgen. Stärks brukarens ställning I ett valfrihetssystem? [Consumer Choice in Elder-care. Is the Patient's Position Strengthened in a System of Choice?] SKL, Stockholm.Google Scholar
Emerson, R. M., Fretz, R. I. and Shaw, L. L. 1995. Writing Ethnographical Fieldnotes. University of Chicago, Chicago.Google Scholar
Esping-Andersen, G. 1990. The Three Worlds of Welfare Capitalism. Polity Press, Cambridge.Google Scholar
Fine, M. and Glendinning, C. 2005. Dependence, independence or inter-dependence? Revisiting the concepts of ‘care’ and ‘dependency’. Ageing & Society, 25, 4, 601–21.Google Scholar
Gabriel, Z. and Bowling, A. 2004. Quality of life from the perspectives of older people. Ageing & Society, 24, 5, 675–91.Google Scholar
Glendinning, C. 2008. Increasing choice and control for older and disabled people: a critical review of new developments in England. Social Policy & Administration, 42, 5, 451–69.Google Scholar
Glendinning, C. 2012. Home care in England: markets in the context of under-funding. Health and Social Care in the Community, 20, 3, 292–9.Google Scholar
Government Bill 2008/09:29. Lag om valfrihetssystem [Act on Free Choice Systems]. Stockholm.Google Scholar
Government Bill 2009/10:116. Värdigt liv i äldreomsorgen [Dignity in Elder-care]. Stockholm.Google Scholar
Greener, I. 2008. Choice and voice – a review. Social Policy and Society, 7, 2, 255–65.Google Scholar
Gunnarsson, E. 2009. The welfare state, the individual and the need for care: older peoples’ views. International Journal of Social Welfare, 18, 3, 252–9.Google Scholar
Hatton, C. and Waters, J. 2012. Older People and Personal Budgets: A Re-analysis of Data from the National Personal Budget Survey 2011. Lancaster University, Lancaster and IN Control, London.Google Scholar
Hirschman, A. 1970. Exit, Voice and Loyalty: Responses to Decline in Firms, Organizations and States. Harvard University Press, London.Google Scholar
Hjalmarsson, I. and Norman, E. 2004. Att välja hemtjänst [To Choose Home Help]. Socialstyrelsen, Stockholm.Google Scholar
Janlöv, A.-C., Hallberg, I. and Petersson, K. 2006. Older person's experiences of being assessed for and receiving public home help: do they have any influence over it? Health and Social Care in the Community, 14, 1, 2636.Google Scholar
Kane, R. L. and Kane, R. A. 2001. What older people want from long-term care, and how they can get it. Health Affairs, 20, 6, 114–27.Google Scholar
Kittey, E. F. 2011. The ethics of care, dependency and disability. Ratio Juris, 24, 1, 307–26.Google Scholar
Kvale, S. and Brinkman, S. 2009. Interviews: Learning the Craft of Qualitative Research Interviewing. Sage, Los Angeles.Google Scholar
Lloyd, L. 2010. The individual social care: the ethics of care and the ‘personalisation agenda’ in services for older people in England. Ethics and Social Welfare, 4, 2, 188200.Google Scholar
Lymbery, M. 2014. Austerity, personalisation and older people: the prospects for creative social work practice in England. European Journal of Social Work, 17, 3, 367–82.Google Scholar
Mackenzie, C. and Stoljar, N. 2000. Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford University Press, Oxford.Google Scholar
Mahoney, K. J., Desmond, S. M., Simon-Rusinowitz, L. and Loughlin, D. M. 2002. Consumer preferences for a cash option versus traditional services: telephone survey results from New Jersey elders and adults. Journal of Disability Policy Studies, 13, 2, 7587.Google Scholar
Meinow, B., Parker, M. and Thorslund, M. 2011. Consumers of eldercare in Sweden: the semblance of choice. Social Science and Medicine, 73, 9, 1285–9.Google Scholar
Mikels, J. A., Reed, A. E. and Simon, K. I. 2009. Older adults place lower value on choice relative to young adults. Journals of Gerontology: Psychological Sciences, 64B, 4, 443–6.Google Scholar
Ministry of Health and Social Affairs 2007. Care of the elderly in Sweden. Fact sheet 18, September, Ministry of Health and Social Affairs, Stockholm.Google Scholar
Moberg, L., Blomqvist, P. and Winblad, U. 2016. User choice in Swedish eldercare – conditions for informed choice and enhanced service quality. Journal of European Social Policy, 26, 3, 281–95.Google Scholar
Moran, N., Glendinning, C., Wilberforce, M., Stevens, M., Netten, A., Jones, K., Manthorpe, J., Knapp, M., Fernandez, J.-L., Challis, D. and Jacobs, S. 2013. Older people's experiences of cash-for-care schemes: evidence from the English individual budget pilot projects. Ageing & Society, 33, 5, 826–51.Google Scholar
National Board of Health and Welfare 2011. Vad vill de äldre veta? En sammanställning av studier om äldres val inom äldreomsorgen [What Do Older People Want to Know? An Overview of Studies of Choice in Elder-care]. Socialstyrelsen, Stockholm.Google Scholar
National Board of Health and Welfare 2012. Öppna jämförelser. Vård och omsorg om äldre 2012 [Open Comparisons. Health and Social Care for Older People, 2012]. Socialstyrelsen, Stockholm.Google Scholar
National Board of Health and Welfare 2015. Stimulansbidrag LOV. Slutrapport 2011–2014 [Incentive Grants for Free Choice Systems. Final Report, 2011–2014]. Socialstyrelsen, Stockholm.Google Scholar
Netten, A., Jones, K., Knapp, M., Fernandez, J.-L., Challis, D., Glendinning, C., Jacobs, S., Manthorpe, J., Moran, N., Stevens, M. and Wilberforce, M. 2012. Personalisation through individual budgets: does it work and for whom? British Journal of Social Work, 42, 8, 1556–73.Google Scholar
Newbronner, L., Chamberlain, R., Bosanquet, K., Bartlett, C.Sass, B. and Glendinning, C. 2014. Keeping Personal Budgets Personal: Learning from the Experiences of Older People, People with Mental Health Problems and Their Carers. Adults' Services Report. Social Care Institute of Excellence, London.Google Scholar
Olaison, A. and Cedersund, E. 2006. Assessment for home care: negotiating solutions for individual needs. Journal of Aging Studies, 20, 4, 367–88.Google Scholar
Ottmann, G., Allen, J. and Feldman, P. 2013. A systematic narrative review of consumer-directed care for older people: implications for model development. Health and Social Care in the Community, 21, 6, 563–81.Google Scholar
O'Rourke, G. 2016. Older people, personalisation and self: an alternative to consumerist paradigm in social care. Ageing & Society, 36, 5, 1008–30.Google Scholar
Pearson, C., Ridley, J. and Hunter, S. 2014. Self-directed Support: Personalisation, Choice and Control. Dunedin, Edinburgh, UK.Google Scholar
Persson, T. and Berg, S. 2008. Older people's ‘voices’ ‒ on paper: obstacles to influence in welfare states ‒ a case study of Sweden. Journal of Aging & Social Policy, 29, 1, 94111.Google Scholar
Persson, T. and Wästerfors, D. 2009. ‘Such trivial matters:’ how staff account for restrictions of residents’ influence in nursing homes. Journal of Aging Studies, 23, 1, 111.Google Scholar
Reed, A. E., Mikels, J. A. and Simon, K. I. 2008. Older adults prefer less choice than young adults. Psychology & Aging, 23, 3, 671–75.Google Scholar
Rodrigues, R. and Glendinning, C. 2015. Choice, competition and care – developments in English social care and the impacts on providers and older users of home care services. Social Policy & Administration, 49, 5, 649–64.Google Scholar
Rostgaard, T. 2006. Constructing the care consumer: free choice of home care for the elderly in Denmark. European Societies, 8, 3, 443–63.Google Scholar
Roulstone, A. and Morgan, H. 2009. Neo-liberal individualism or self-directed support: are we all speaking the same language on modernising adult social care? Social Policy and Society, 8, 3, 333–45.Google Scholar
SALAR [Swedish Association of Local Authorities and Regions] Valfrihetssystem i kommuner, beslutsläget 2016 [Systems of choice in municipalities, current decisionstatus 2016]. Available online at http://skl.se/demokratiledningstyrning/driftformervalfrihet/valfrihetssystemersattningssystem/socialomsorg/valfrihetssystemikommunerbeslutslaget2016.8959.html [Accessed 27 October 2016].Google Scholar
Silverman, D. 2006. Interpreting Qualitative Data. Sage, London.Google Scholar
Sipilä, J. (ed.) 1997. Social Care Services: The Key to the Scandinavian Welfare Model. Aldershot, Avebury, UK.Google Scholar
Szebehely, M. and Trydegård, G.-B. 2012. Home care for older people in Sweden: a universal model in transition. Health and Social Care in the Community, 20, 3, 300–9.Google Scholar
Tester, S., Hubbard, G., Downs, M., MacDonald, C. and Murphy, J. 2004. What does quality of life mean for frail residents? Nursing and Residential Care, 6, 2, 8992.Google Scholar
Torres, S. and Hammarström, G. 2010. Being, feeling and acting: a qualitative study of Swedish home-help care recipients’ understandings of dependence and independence. Journal of Aging Studies, 24, 2, 7587.Google Scholar
Vamstad, J. 2016. Exit, voice and indifference – older people as consumers of Swedish home care services. Ageing & Society, 36, 10, 2163–86.Google Scholar
Van de Bovenkamp, H., Vollaard, H., Trappenburg, M. and Grit, K. 2013. Voice and choice by delegation. Journal of Health Politics, Policy and Law, 38, 1, 5787.Google Scholar
Vernon, A and Qureshi, H. 2000. Community care and independence: self-sufficiency or empowerment? Critical Social Policy, 20, 2, 255–76.Google Scholar
Wiener, J. M., Anderson, W. L. and Khatutsky, G. 2007. Are consumer-directed care beneficiaries satisfied? Evidence from Washington State. Gerontologist, 47, 6, 763–74.Google Scholar
Woolham, J., Daly, G., Sparks, T., Ritters, K. and Steils, N. 2016. Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have managed a personal budget or a direct payment. Ageing & Society, 37, 5, 961984.Google Scholar