Sven, inter-organisational relationships and control : a case study of domestic care of the elderly

Abstract: Care of the elderly is frequently debated in the Swedish media. Pensioners, who are often ill and lonely, need help with social care, such as cleaning and cooking, and health care, such as taking medicine and treatment of injuries and wounds. They are aided by home helpers from the home helper unit and assistant nurses and nurses from the health centre. How does control operate in this intimate and private situation, and what influences the home helpers? What is the relation between control and the delivery of care to the pensioners? These are the questions explored in this dissertation, based on an empirical study of domestic elderly care in a large city in Sweden.The thesis explores the conflict between the productification of care, manifested in administrative controls, and the needs and desires of the pensioners in specific care giving situations, manifested in self controls. It is seen that even during periods of high financial pressure, the home helpers are influenced by the pensioners. The home helpers are flexible and do extra things not included in the pre-specified social care contract for some pensioners. Flexibility is shown to be important for the pensioners, but the increased financial pressure makes it harder and harder for the home helpers to be flexible. It is therefore suggested in the thesis for social care service purchasers to put in some unspecified time in the social care decisions and not just pre-specified operational activities. In this way some flexibility will be built into the administrative system.The importance of cooperation between the health centre and the home helper unit is also stressed in the thesis. There is a need to issue administrative controls for cooperation. A joint task group, with members from the health centres and the home helper units, meetings between the home helpers and the nurses and specified guidelines for cooperation tasks can act as controls which would sustain significant and positive effects on the cooperation.Finally, a problematic underlying financial process for the home helper units is identified. The home helper units are not often compensated for yearly salary increases. The problems of the moment receive significantly more attention, but this thesis points to the need for discussing the ongoing, underlying and problematic financial process in the elderly care.