Article i 'Tidsskrift for arbejdsliv' 1 2006, page 49-66.
Organisational changes and everyday realities
A comparative study of home-care services in Scandinavia
Public home based care for elderly people is often regarded a cornerstone of the Scandinavian welfare model. Among international researchers the idea that a unique Scandinavian eldercare model exists is rarely contested. Yet very few researchers have attempted to compare the Scandinavian home-care services. The main aim of this article is to fill this knowledge gap by analysing and comparing the organisation of home-care services in Scandinavia and to relate the everyday realities and experiences of the care workers to different ways of organising care. The study is based on both an extensive literature review of Scandinavian care research and a qualitative comparative case study of a group of home-care workers in Copenhagen, Oslo and Stockholm. The study shows that there are both similarities and differences in the way the Scandinavian home-care services are organised and perceived by care workers. In all the Scandinavian countries market-inspired remodelling trends have had an impact, including a wide use of purchaser-provider models, a stronger emphasis on standardised tools to assess care needs, and an increasingly stricter pre-regulation of the tasks provided. These new steering principles have led to fragmentation of care and reduced freedom of action for the care workers who report increasing difficulties in meeting the varying needs of the care recipients. According to the case study, Copenhagen was found to have had the most far-reaching organisational changes. However, participant observations indicate that the care workers actually often secretly violate the formalised care model and try to provide help that fits their own, often very high, standards of “decent care”. This care-centred disobedience is only possible if the time-frames are not too tight. A scarcity of time combined with “de-caring” organisational principles are a threat to more than the quality of care. Feeling inadequate in relation to the care needs of the elderly is also a serious work environment problem which negatively affects the possibilities to recruit and keep care workers