The purpose of the study is to investigate how first-line managers in municipal elderly care perceive and manage the balance between market-oriented working methods and trust-based leadership. The study also aims to investigate whether these experiences differ depending on whether the managers work in small or large municipalities. The method in this study was qualitative semi-structured interviews with six informants working as first-line managers in a municipal nursing home. The experience of working as a first-line manager differs, as several of the informants feel that they have less participation in decision-making processes and have to report upwards a lot, which leads to difficulties in working in a trust-based way. First-line managers in smaller municipalities experience a closeness to superiors and others in the organisation, which makes them feel more involved. The results are discussed in relation to previous research and analysed with the theories Job-demand resources and Coping. / Syftet med studien är att undersöka hur första linjens chefer på inom kommunal äldreomsorg upplever och hanterar balansen mellan marknadsorienterade arbetsmetoder och tillitsbaserat ledarskap. Studien ämnar också undersöka om dessa upplevelser skiljer sig åt beroende på om cheferna arbetar i små eller stora kommuner. Metoden i denna studie var kvalitativa semistrukterade intervjuer med sex informanter som arbetar som första linjens chef på kommunalt SÄBO. Upplevelsen av arbetet som första linjens chef skiljer sig åt då flera av informanterna upplever att de har mindre delaktighet i beslutsprocesser och får rapportera mycket uppåt, vilket leder till svårigheter att arbeta tillitsbaserat. Första linjens chefer i mindre kommuner upplever en närhet till stegen över sig och övriga inom organisationen vilket gör att de känner sig mer delaktiga. Resultatet diskuteras i förhållande till tidigare forskning samt teorierna Job-demand resources och Coping.

Biståndshandläggare inom äldreområdet är en profession med hög arbetsbelastning och ett komplext uppdrag att verka i skärningspunkten mellan intentionerna i en målrationell lagstiftning, kommunal budget och den enskildes behov. Genom att låta handläggare besvara en vinjettstudie, där de presenterats för Esther, undersöktes biståndshandläggare som profession utifrån ett cyniskt perspektiv, hur biståndshandläggare hanterar sin arbetssituation utifrån diskretionsteori och om egenskaper hos biståndshandläggaren påverkar utfall i handläggningsprocessen. Studien visar att Esthers ärende handläggs på olika sätt, att handläggare fokuserar på olika behov och gör olika bedömningar av hennes rätt till bistånd i form av särskilt boende enligt 4 kap. 1 § SoL. Vidare undersökning av samband mellan egenskaper hos handläggare och utfall i handläggningsprocessen påvisar inga signifikanta samband som kan förklara utfallet. Resultatet pekar på att egenskaper som ålder, erfarenhet av biståndshandläggning eller annan myndighetsutövning och socionomutbildning inte skapar en mer rättssäker handläggning. Skillnader i biståndshandläggningen tycks i stället orsakas av de strategier som biståndshandläggare använder för att klara sin vardag. / Decision makers in the field of eldercare is a profession with a high workload and a complex assignment while navigating in the intersection between the intentions of a goal-oriented legislation, a municipal budget, and the needs of the individual. By asking decision makers to answer a vignette study, where they were presented to Esther, decision makers as a profession were examined from a cynical perspective. Examining the use of strategies to handle their workload, based on theories of discretion and if characteristics of the decision maker affect outcomes in the needs assessment process. The study shows that Esther’s case was handled in different ways, that decision makers focused on different needs and made different assessment regarding her right to accommodation at a retirement home according to chapter 4 § 1 in the Social Services Act. Further examination of the relationship between characteristics of decision makers and outcomes in the needs assessment process shows no significant relationships that explains the outcome. The results indicate that characteristics such as age, experience in needs assessment and other experience of authority or a degree from higher education in social work does not create a more legally secure process. Instead, the differences in the needs assessment seems to be caused by the strategies that decision makers use to cope with their working situation.

Enhetschefer är benämningen på den yrkesverksamma grupp som ansvarar för verksamheter som drivs enligt socialtjänstlagen och lagen om stöd och service till vissa funktionshindrade. De befinner sig i en politiskt styrd organisation med socialnämnden som uppdragsgivare. Enhetschefer är identifierade som en yrkesverksam grupp med hög arbetsbelastning och högre risk att utsättas för stress, i jämförelse med andra yrkesgrupper i ledande position. Syftet med studien är att undersöka hur olika stressfaktorer bidrar till upplevelsen av arbetsrelaterad stress hos enhetschefer inom kommunal äldre- och funktionshinderomsorg. Metodvalet är en kvantitativ enkätundersökning med syfte i att nå ut till fler personer och på så sätt få en bred överblick av enhetschefernas arbetssituation. Studien har genomförts i en medelstor svensk kommun där samtliga enhetschefer inom kommunal äldre- och funktionshinderomsorg valts ut. Av resultatet framkommer att de faktorer som i störst utsträckning bidrar till upplevd arbetsrelaterad stress, är för hög arbetsbelastning i förhållande till arbetstiden samt  bristande möjlighet att uppfylla önskemål från brukare. / Middle managers is the name of the professional group who is responsible for institutions that are run by the Social Service Act and Act concerning Support and Service for Persons with Certain Functional impairments. They work in a politically controlled organization with the municipal social welfare committee as the outsourcer. Middle managers are identified as a profession with a high workload and a higher risk of being exposed to stress, in comparison with other occupational groups with a leading position. The aim of the study is to examine how various stressors contribute to work-related stress. The method is a quantitative survey with the aim of reaching out to more people and to get a larger overview of the middle managers work situation. The study has been carried out in a medium-sized Swedish municipality, where all middle managers in municipal elderly and disability care were selected. The result shows that the stressors that contribute most to work-related stress are the high workload in relation to working time and a lack of opportunity to fulfill the client’s wishes.

This thesis holds how to reach a new target group through market mix. The purpose of the thesis is to study how the organization can reach a new target group which is new potential employees in the care of the elderly by working on the market mix. The theory that was used are offensive quality development by which continuous improvements can be achieved. Theory about communication was used and the importance of rhetorical skills while presenting the information to the target group. When it comes to transformation theory the digitized change, employees are often determined that it is important to start marketing themselves digitally and get the equipment needed. A major role played also the theory about marketing mix which was a major part of this study. Examination methods used were written interviews and the letter method. The written interviews was done by contacting the municipalities in Sweden to know how they do the marketing to the potential employees. On the other hand the letter method was done by contacting the studied organizations employees to know their ideas about how to encounter the new employees. The results of this study was that the organization’s employee mentioned that marketing should be done by digital channels because the time we are living in requires it. Lastly, the conclusions was that market mix can be a great strategy to reach the new target group and to always improve the marketing by doing a plan and then also realize the plan by doing the events and campaigns. / Examensarbetet handlar om att nå en ny målgrupp genom marknadsmix. Syftet med examensarbetet är att studera hur organisationen kan attrahera en ny grupp av medarbetare genom att arbeta med marknadsmixen. Teorin som användes är offensiv kvalitetsutveckling genom vilken kontinuerliga förbättringar kan uppnås. Därefter användes teori om kommunikation och betydelsen av retoriska färdigheter samtidigt som informationen presenterades för målgruppen. Teorin om förändring tar upp den digitala förändringen som avgörande då det är viktigt att börja marknadsföra sig digitalt och få nödvändig utrustning. Teorin om marknadsmix var en viktig del av denna studie. De använda undersökningsmetoderna var skriftliga intervjuer och brevmetoden. De skriftliga intervjuerna gjordes genom att kontakta kommunerna i Sverige för att veta hur de marknads för sig mot de potentiella medarbetarna. Brevmetoden gjordes genom att kontakta den studerade organisationen för att samla in deras idéer om hur man skulle möta de nya medarbetarna. Resultaten av denna studie var att organisationens anställda nämnde att marknadsföring bör ske genom digitala kanaler på grund av att den tid vi lever i kräver det. Slutligen var slutsatserna att marknadsmixen kan vara en bra strategi för att nå den nya målgruppen och att alltid förbättra marknadsföringen genom att göra en plan och sedan genomföra planen genom att göra kampanjerna.

<p>This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power.</p><p>This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals.</p><p>One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.</p>

This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power. This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals. One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.

This dissertation examines how perceptions of competence affect the care of older persons, and the values ​​and vocational conceptions of care work and care recipients that are tied to the perceptions of what skills that are needed and why. Competence is defined by three parts with relevance for the content of care work: what knowledge the care workers should have, what tasks they should perform and how they should respond to care recipients. The aim of this dissertation is to analyse how the care managers' and care workers' perceptions of competence form the direction of the care work and how that direction relates to the care recipients’ perceptions of and expectations on the care work.   The care work is characterised by what is analysed as an activation of the recipients - that the recipients themselves should perform as much of the care work as possible. The activation aims at managing the decay of the aging body and is motivated by a vocational conception of the care recipients as different from others, with designations as grateful and passive. This conception is analysed as generation character based on an idea among the care managers and care workers that the society in which the recipients grew up gave them certain cognitive prerequisites that have to be managed in the practical care work.   The care recipients in the study have opposing conceptions and perceptions of care work compared with the care managers and care workers. The recipients’ central objective with the care work is to prevent what has been interpreted as the disrepair of the home. The care recipients’ position in the organisation raises the problem of loyalty towards the care workers and in some sense the care managers. Their loyalty reduces their ability to complain and to influence their situation to the better.   Keywords: care of older persons, care needs, care work, care relationship, care receivers, care workers, care managers, competence, technologies, activation, generation character

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. / <p>Diss. Stockholm : Handelshögskolan, 2007</p>

This dissertation aims at contributing to social scientific knowledge about prevailing prioritizations in eldercarepractice by looking at an economic and a caring logic, and how these logics are overlapping, contradictory or comein conflict with each other. A more concrete aim is to understand how the personnel describe their work with orfor balance between the logics and their justifications prioritizations made in the care of older persons. The researchquestion is: How do personnel and care unit manager at a public nursing home understand and handle the twologics that govern care work for facilitating wellbeing of the residents. The aim and research question led to threesub-aims: 1) to analyze the personnel’s experiences of and meaning making about the care work they carry out, 2)to illuminate and problematize the two logics above, and 3)to analyze how the personnel justify their prioritizationsin prevailing context, and how their accountability have an effect on their professional identities.Empirical material was gathered through 13 individual interviews with care personnel and their care unitmanager at a public nursing home in Sweden. These interviews were complemented by a group interview. Thematerial was analyzed by the use of three methods: phenomenology (Paper I and II), reflexive analysis (Paper III),and a positioning analysis (Paper IV). Paper I found that the personnel understands the residents’ well-being asbeing characterized by feeling of being existentially touched. This essence is constituted by feeling freedom ofchoice, pleasure, and closeness to someone or something. In Paper II, the work for facilitating this kind of wellbeingwas characterized by three ambiguities: (i) freedom of choice for the older persons vs. institutionalconstraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need forroutine vs. the eldercarers' not being able to know what the residents need. Paper III showed that the care unitmanager created a hybrid of the two logics (economy is care and vice versa) and that the personnel oppose thishybrid. The opposition is shaped as the personnel divides their work in care and “those other things”. Thesefindings showed how interaction between the logics expresses itself in practice and that it is the personnel who hasto handle contradictions between the logics in their everyday care work. The positioning analysis in Paper IV hadthree levels. The first level showed how the carers align with their peers and that they find the organizationalframe, within which they have agency, changed due to increased workload. This change led to an order of priorities.The second level showed that the carers relate to three aspects when making accounts: the care itself, the olderpersons, and the media. The third level showed that the carers share a view of administration, cleaning, servingmeals, and filling up supplies, as not being parts of caring.The dissertation’s theoretical framework focused on theories on logics, accountability, and professionalidentity. The conclusion is that both logics are needed in order to facilitate the well-being of the older persons. Therelationships between the two logics are not always clear and if their contradictions are not illuminated, there is arisk for a care practice that does not facilitate the well-being of their residents. An important theoreticalcontribution is that logics of activities should be understood vertically (form political, through management, anddown to the level of practice) instead of horizontally. The practical implications emphasize the importance ofsupporting the personnel’s professional identity on the one hand, and discussing the logics on the other. Byunderstanding differences between definitions on management-level and practice level, a homogeneity can bereached. / <p>Huvudämne: Välfärd och socialvetenskap</p>

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed. / <p>Härtill 4 uppsatser</p>