Change, reorganization and quality of home carefor elderly people in Sweden during the 1990s : paper to 17:e Nordiska konferensen i gerontologi 23-26 maj 2004 i Stockholm

During the 1990s several kinds of reorganization has taken place in public services in Sweden. Reorganizations according to the idea of market economy have been most salient and debated. In many municipalities private companies have started to organize home care service for elderly, financed by tax. Public home care organizations have reorganized the working organization and managing structure, partly to save money and partly to reach better quality of care. The home care services have a key role in the care of the elderly in the society. The quality of care is important for the possibility for elderly to stay as long as possible in their ordinary homes. We have performed a longitudinal study of the reorganizations during the 1990s in order to explore the consequences for quality of care. The study was performed in seven districts in three different municipalities representing different types of municipalities and different kinds of reorganizations. It comprises private companies, traditional public organizations, public organizations with changed managing structure and co-ordination of home help and home health care. Quality of care is studied through assessment of the communication in the organization, the psychosocial working environment of the caregivers and the quality of the care work. Politicians, managers, ca. 100 care givers and ca. 500 elderly receiving help and care have been interviewed four times during the period (1993, 1995, 1997 and 2002/2003). The traditional organization within small districts with small autonomous working teams and easy accessible supervisor expose the best quality. There are no unambiguous differences between public and private organizations. There is however a tendency for successive decline of quality for private companies after they have been established. Other aspects of the reorganizations, e. g. to have special officials for assessment of help need, do not contribute to better quality but create new communication gaps in th