This paper studies, from a client perspective, how three Swedish municipalities work with information about a voucher system in homecare. The paper is a qualitative study using structured informant interviews and analysis of documents. The interviewees are responsible of information about the voucher system in the municipalities. The studied documents describe and clarify the voucher system of the municipality. Neo-institutional organization theory is used to analyse the result. Existing research has showed how pensioners find information on the voucher systems lacking. The research also shows how care managers have difficulties relating to their new roles as information coordinators on the voucher system. With this background, the study focuses on examining how the municipalities work with and organises the information on the voucher system as well as how the responsibiliy of the information is handled. The result shows that the studied municipalities mainly deal with the issue from a market point of view, where the care providers are to be presented in a neutral way. However, one of the municipalities has reconsidered the principle of neutrality and works to clarify the information to the elders. All three municipalities place the responsibility of information on the care managers in their interaction with the elder. There is no further communication between the municipality and the elderly people in the form of client studies or fora of discussion and review of the information on the voucher system.

<p>This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).</p><p>Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.</p><p>Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.</p><p>Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.</p><p>The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.</p>

<p>Syftet med studien är att belysa hur människor med funktionsnedsättning upplever att vara i behov av stöd och hjälp för att klara vardagliga göromål. Därtill syftar studien till att undersöka hur denna målgrupp upplever att de kan påverka utformningen av hemtjänstinsatserna och i så fall på vilket sätt?</p><p>För att besvara syftet och fånga människans egen upplevelse användes kvalitativ metod i form av intervjuer. Studiens resultat bygger på fem intervjuer med människor i varierande ålder och med olika funktionsnedsättningar. Gemensamt för intervjupersonerna är att de alla har hjälp från hemtjänsten.     </p><p>I analysfasen framkom fyra huvudkategorier: ”upplevelser av påverkansmöjligheter”, ”självständighet och beroende”, ”anpassning” samt ”strategier”. Utifrån dessa kategorier diskuteras resultatet i förhållande till tidigare forskning gällande människor i behov av stöd och hjälp. Därtill har teorier använts för att försöka förklara det resultat som framkommit vid genomförandet av studien. Bland annat så förs resonemang omkring hur individualismen i vårt moderna samhälle påverkar en människa med funktionsnedsättning som är i behov av stöd och hjälp.   </p><p>Resultatet från studien visar att det finns vissa faktorer som har större betydelse än andra för hur den enskilde upplever att vara i behov av stöd och hjälp från hemtjänsten. Det kan till exempel handla om huruvida funktionsnedsättningen är medfödd eller förvärvad. I studien framkom att den tydligaste strävan efter självständighet kan ses hos dem som upplever beroendet till hemtjänsten som mest påfrestande.</p> / <p>The aim of this study was to explore how people with disabilities experience to be in need of support and help to cope with everyday tasks. The aim was also to study if they feel that they can influence the design of the home help and, if so, how?</p><p>To answer the purpose and in order to capture the man's own experience qualitative methodology was used, and interviews were carried out. The result of the study is based on five interviews with people of different ages and with various disabilities. Common to all interviewees was that they all have help from home care.</p><p>The analysis revealed four main categories: “perceptions of influence”, “independence and dependence", "adaptation" and “strategies". From these categories the results are discussed in relation to previous research about people in need of support and help. In addition, the theories used to explain the results of the study which obtained during implementation. Among other things, so the argument about the individualism in our modern society, affecting people with disabilities in need of support and assistance.</p><p>Results of the study show that there are certain factors that are more important than others for the experience of having public home care. It is a matter of whether the functional limitation is congenital or acquired. It appears that the obvious desire for independence can bee seen by those who experience addiction to home care as most stressful.</p>

This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+). Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up. Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults. Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment. The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.

This dissertation studies factors that predict use of public eldercare, informal care, and purchase of private services in relation to an individual’s needs, social network characteristics, and sociodemographic factors. A further purpose is to examine whether use of public eldercare is correlated to receipt of informal care and purchase of private services in the Swedish welfare state. The dissertation is based on the Kungsholmen Study, a population-based longitudinal study. Studies I–III used cross-sectional data from community-dwelling people aged 81-100 and examined (I) gender, (II) marital and parental status, and (III) dementia and depressive symptoms as predictors of use of home help. Study IV analyzed factors related to moving into institutional care and receipt of home help from 1994/96 to 2000. The majority of support provided to elders living in the community comes from informal sources, even among people living alone. There was considerable overlap between home help and informal care. When all sources of care were considered, childless individuals had comparatively lower odds of receiving care. Factors predicting use of public eldercare and informal care differed depending on whether or not elders coresided. No gender differences in use of formal and informal care were found when controlling for household composition. Living alone, dementia, need of help with household chores, and walking limitations increased the likelihood of using public eldercare. Coresidence, informal care from outside the household, and use of private services decreased the likelihood. Depressive symptoms increased the likelihood of receiving home help and institutionalization when using longitudinal data, but not in the cross-sectional studies. Educational level was of importance and interacted with several factors; persons with higher levels of education were advantaged. Very few people moved into institutional care without previously having received home help services. Essentially the same factors that predicted receipt of home help services also predicted institutionalization.

Syftet med studien är att belysa hur människor med funktionsnedsättning upplever att vara i behov av stöd och hjälp för att klara vardagliga göromål. Därtill syftar studien till att undersöka hur denna målgrupp upplever att de kan påverka utformningen av hemtjänstinsatserna och i så fall på vilket sätt? För att besvara syftet och fånga människans egen upplevelse användes kvalitativ metod i form av intervjuer. Studiens resultat bygger på fem intervjuer med människor i varierande ålder och med olika funktionsnedsättningar. Gemensamt för intervjupersonerna är att de alla har hjälp från hemtjänsten.      I analysfasen framkom fyra huvudkategorier: ”upplevelser av påverkansmöjligheter”, ”självständighet och beroende”, ”anpassning” samt ”strategier”. Utifrån dessa kategorier diskuteras resultatet i förhållande till tidigare forskning gällande människor i behov av stöd och hjälp. Därtill har teorier använts för att försöka förklara det resultat som framkommit vid genomförandet av studien. Bland annat så förs resonemang omkring hur individualismen i vårt moderna samhälle påverkar en människa med funktionsnedsättning som är i behov av stöd och hjälp.    Resultatet från studien visar att det finns vissa faktorer som har större betydelse än andra för hur den enskilde upplever att vara i behov av stöd och hjälp från hemtjänsten. Det kan till exempel handla om huruvida funktionsnedsättningen är medfödd eller förvärvad. I studien framkom att den tydligaste strävan efter självständighet kan ses hos dem som upplever beroendet till hemtjänsten som mest påfrestande. / The aim of this study was to explore how people with disabilities experience to be in need of support and help to cope with everyday tasks. The aim was also to study if they feel that they can influence the design of the home help and, if so, how? To answer the purpose and in order to capture the man's own experience qualitative methodology was used, and interviews were carried out. The result of the study is based on five interviews with people of different ages and with various disabilities. Common to all interviewees was that they all have help from home care. The analysis revealed four main categories: “perceptions of influence”, “independence and dependence", "adaptation" and “strategies". From these categories the results are discussed in relation to previous research about people in need of support and help. In addition, the theories used to explain the results of the study which obtained during implementation. Among other things, so the argument about the individualism in our modern society, affecting people with disabilities in need of support and assistance. Results of the study show that there are certain factors that are more important than others for the experience of having public home care. It is a matter of whether the functional limitation is congenital or acquired. It appears that the obvious desire for independence can bee seen by those who experience addiction to home care as most stressful.

Introduction. Municipal eldercare is increasingly multifaceted. First line managers in nursing homes and home help services are responsible for personnel, budget and processes. The resources and work conditions of these managers have changed over time. The first line manager is often responsible not only for economic but also for quality development of their unit. Research focusing on first line management within municipal eldercare is lacking in specific contexts, for example, research on leadership in nursing homes and home help services. Aims. The aim of this thesis is to study and analyze perceptions of leadership in eldercare. The main objective is to analyze differences in leaders’ and nursing assistants’ perceptions of leadership in nursing homes and home help services, and to study leadership factors and their associations with psychosocial work environment among nursing assistants who are engaged in eldercare. Design and methods. This thesis is based on two studies, and uses cross-sectional data from two different surveys: the Developmental Leadership Questionnaire, DLQ (Larsson, 2006a) and a Questionnaire for Psychological and Social factors at Work, QPS, (Dallner, et al.,2000). Assessments from 21 leaders and 95 nursing assistants in nursing homes and home help services were analyzed in study I. Assessments from 1132 nursing assistants in nursing homes and in home help services (n=844 nursing homes and n=288, home help service units) were analyzed in article II. The data were analyzed with descriptive and analytic statistics. Results. Nursing assistants in nursing homes assessed their leaders to be more controlling and observant than nursing assistants in home help services. According the leaders self assessment, leaders in home help services were less successful at being supportive, being a good example, and promoting creativity than leaders in nursing homes. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. The leadership factors empowering leadership, support from superiors, focus on human resources and control over decisions were associated with better results on all the variables that were related to the psychosocial work environment in both nursing homes and in home help services. Conclusions and implications for practice. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better conditions for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in organisational settings, it is important to consider the differences in conditions for conducting leadership. To influence nursing assistants’ performance and to increase quality in eldercare in the long term, appropriate leadership is necessary. Therefore, it is important for the leaders to provide support in work, help to develop skills, encourage employees to participate in important decisions, and show interest in nursing assistants’ well-being. Also, the leaders might benefit if they reduce the specialisation of work, which counteracts the possibility to have variation in work in nursing homes and home help services. In particular, nursing homes should benefit if they reduce the amount of role conflicts, and if nursing assistants receive reasonable quantitative work demands. The municipality eldercare should take into account the organisational differences in conducting leadership in nursing homes in relation to home help services. Recruiting leaders with characteristics that are desirable in the specific context will create better conditions for a good psychosocial work environment in nursing homes and home help services.

Syftet var att undersöka äldre personers uppfattningar om självbestämmande och inflytande relaterat till rambeslut i hemtjänsten. Att respektera individens rätt till självbestämmande och inflytande är grundläggande värden och förhållningssätt i svensk äldreomsorg. Rambeslut i hemtjänsten är ett salutogent arbetssätt som syftar till att i högre utsträckning stärka individens möjlighet till självbestämmande och att utöva inflytande över insatsernas utformning avseende hur och när de ska utföras. Uppsatsen tar sin utgångspunkt i den salutogena teorin.   Studien genomfördes med kvalitativ metod. Åtta äldre personer deltog i semistrukturerade intervjuer. Intervjuerna bandades och transkriberades ordagrant och analyserades med kvalitativ innehållsanalys. Deltagarna ingick i ett pilotprojekt där rambeslut skulle utvecklas för att därefter införas för alla hemtjänstkunder i den aktuella kommunen.   Analysen resulterade i tre kategorier som beskriver äldres uppfattningar om självbestämmande och inflytande relaterat till rambeslut i hemtjänsten. Kategorierna inkluderade 1) de äldres vaga uppfattningar om innebörden av begreppen, 2) vad de äldre tycker är viktigt att ha inflytande över och 3) att de äldre uppfattar sig ha inflytande i stunden men inte i planeringen. De äldre uttryckte bland annat att det är viktigt att ha inflytande över när man ska få sin hemtjänst, hur städningen utförs och att det finns flexibilitet utifrån dagsform. En slutsats som kan dras utifrån detta är att det som de äldre tycker är viktigt att ha självbestämmande och inflytande över stämmer väl överens med intentionerna för införandet av rambeslut. En annan slutsats är att de äldre uppfattar att de har självbestämmande och inflytande i stunden, i den faktiska vardagen, men inte i själva planeringen av insatserna. En tredje slutsats är att samtliga tre salutogena faktorer, begriplighet, hanterbarhet och meningsfullhet, är essentiella för att rambeslutets intentioner om ökat självbestämmande och inflytande ska uppnås. / The objective was to examine older people’s perceptions of autonomy and influence related to Framework Decision in Home Help Services. Respect of individual's rights of autonomy and influence are fundamental values and attitudes in Swedish elderly care. Framework Decision in the Home Help Services has the main goal of strengthening the individual’s right to decide for himself and have influence over how the Home Help Service should be carried out and when it should be performed.   The study was conducted using qualitative method. Eight older persons participated in semi-structured interviews. The interviews were taped and transcribed verbatim, and the data was analyzed using qualitative content analysis. The participants were part of a pilot study aimed at developing Framework Decisionsin Home Help Services that subsequently would be implemented for all home care clients in the municipality.   The analysis resulted in three categories that describe the older persons’ perceptions of autonomy and influence related to the Framework Decision in Home Help Services. The categories included 1) the older persons have vague notions about the meaning of the terms, 2) what the older persons think is important to have influence over, and 3) that the older persons perceive themselves to have influence in the moment but not in the planning. The participants expressed, among other things, that it is important to have control over when to get help service, how the cleaning is carried out and that there is flexibility on daily basis. One conclusion that can be drawn from this is that the things the older persons think is important to have self-determination and influence over is in line with the intentions of the introduction of the Framework Decision. Another conclusion is that the older persons feel that they have autonomy and influence in the moment, in the actual everyday life, but not in the planning of activities. A third conclusion is that all three salutogenic factors, comprehensibility, manageability and meaningfulness, are essential in order to achieve the Framework Decision’s intentions of greater autonomy and influence.

Problemformulering: Arbetsmiljön inom hemtjänsten består av höga krav och begränsade resurser. Detta bedöms vara orsaken till hög sjukfrånvaro och personalomsättning. Behovet av hemtjänstinsatser förväntas dock öka och utifrån detta behöver arbetsmiljöåtgärder sättas in för att kunna bibehålla och rekrytera personal till hemtjänsten. Forskning visar att delaktighet från personal tenderar att öka möjligheterna att lyckas i interventioner men forskningen inom detta område är tunt. Syfte: Dels att studera personalens upplevelse av den egna arbetsmiljön inom hemtjänsten, dels vilka åtgärder som de anser skulle förbättra arbetsmiljön. Metod: Semistrukturerad intervjuer gjordes på elva personer som jobbar inom hemtjänsten. En kvalitativ metod användes med induktiv ansats och analysen gjordes genom en kvalitativ innehållsanalys. Huvudresultat: Arbetsmiljön i hemtjänsten beskrevs främst utifrån den psykosociala arbetsmiljön i termer av arbetsbelastning, stöd och avlastning från arbetsgivare, erkännande, kollegialt stöd, föränderligt, kompetens och planering. Den fysiska arbetsmiljön nämndes sparsamt och då i termer som utrustning samt brukares hem. För att förbättra arbetsmiljön önskades åtgärder såsom mer stöd och avlastning, förändring i planeringen, ökad grundbemanning, möjlighet att påverka, mer kompetens, mer uppskattning, adekvat utrustning samt större hälsofokus. Slutsats: Viktigt att inkludera personalen för att tillvarata deras reella kunskap och erfarenheter. Denna studie skulle kunna öka kunskapen hos arbetsgivaren och göra det möjligt att behålla och rekrytera hållbar arbetskraft inom hemtjänsten. / Aim: Partly to study the staff's experience of their own work environment within home help service, and partly which measures they believe would improve the work environment. Method: Semi-structured interviews were conducted with eleven employees who work in home help service. A qualitative method was used with an inductive approach and the analysis was done through a qualitative content analysis. Findings: The work environment in home help service was mainly described based on the psychosocial work environment in terms of workload, support and relief from employers, recognition, collegial support, changeable, competence and planning. The physical work environment was mentioned briefly in terms of equipment and factors within the homes of users. To improve the working environment, measures such as more support and relief, change in planning, increased basic staffing, opportunity to influence, higher competence, more appreciation, adequate equipment, and a greater focus on health were desired. Conclusion: Important to include the staff to take advantage of their real knowledge and experience. This work could increase the knowledge of the employer and make it possible to retain and recruit sustainable labour in home help service.

En undersökning av det upplevda behovet att införa digitala lås på en enhet i Södertälje kommun, ett kvalitetshus används för att välja ett system utav tre. Därefter kalkyleras vad en investering skulle kosta och slutligen levereras en kalkyl som visar vad ett införande skulle kunna generera i monetära termer. Att investera i en pilotanläggning med 77 brukare skulle kosta cirka 50 000 kronor, detta är en sanning med modifikation – alla kostnader är inte medräknade, utan bara licens för mjukvara och hårdvaran. Kalkylen visar en potentiell besparing på: 200 000 kronor om man räknar på 20-minuter, 100 000 kronor om man räknar på 10-minuter och 120 000 kronor om man räknar på 12-minuter. Idag använder kommunen traditionella (fysiska) nycklar och förvarar brukarnas nycklar i både större och mindre skåp hos enheterna. Enligt rutinen ska nycklarna tillbaka till nyckelskåpet vid ett eventuellt byte, detta medför att det blir väldigt mycket spring med nycklarna. Om ett trygghetslarm utlöses så har utföraren 30-minuter att inställa sig hos brukaren. Problem kan uppstå om nycklarna inte finns registrerade i systemet på rätt sätt, samt att personalen under dagen har överlämnat nycklarna till någon annan i personalen och inte lämnat tillbaka nycklarna till nyckelskåpet mellan överlämningarna. Det kan också vara så att nycklar försvinner, som sedan måste ersättas av kommunen. De största tidstjuvarna finns: vid larm, morgonrutinen och byten på dagen. Det händer mycket under en arbetsdag, vilket gör att personalen behöver byta nycklar med varandra och personalen löser detta på det bästa sättet för tillfället och inte alltid enligt rutinen. I rapporten undersöks vilka system som utförarna använder och slutsatsen är att det är lämpligt att försöka använda ett system som passar in smidigt i befintliga system, så att det inte blir ytterligare system. Det är även viktigt vid ett eventuellt införande fundera på hur kommunen tänker organisera sig vid: installation, underhåll och förvaltning – vill kommunen disponera antingen en central enhet, decentraliserad ute hos enheterna eller använda externa entreprenörer, exempelvis en låssmed. Utförarna är positiva och upplever att behovet finns att införa digitala lås, medan fastighetsägarna inte ser en direkt nytta med lösningen. Mycket beror på hur kommunen för dialogen och bjuder in till samtal vid ett tidigt stadium och förklarar vad man har tänkt sig för lösning. / A study of the perceived need to introduce digital locks on a unit in Södertälje municipality, a quality house is used to select a system of three. Then calculates what investment would cost and finally, a calculation will be presented which shows what an introduction could generate in monetary terms. Investing in a pilot plant with 77 users would cost about SEK 50,000, this is a truth with modification - all costs are included, but only software and hardware licenses. If you count in 20 minutes, 100,000 kronor if you count 10 minutes and 120,000 kronor if you count in 12 minutes. Today, the municipality uses traditional (physical) keys and stores users' keys in both larger and smaller cabinets at the units. According to the routine, the keys should be returned to the key cabinet in the event of a change, which means that there will be a lot of running with the keys. If a security alarm is triggered, the operator has a 30-minute setting for the user. Problems can occur if the keys are not properly registered in the system, as well as during the day that staff have handed the keys to someone else in the staff and did not return the keys to the key box between the handover. It can also be that keys disappear, which must then be replaced by the municipality. The biggest time thieves are: in case of alarm, morning routine, and change of day. It happens a lot during a working day, which means that the staff needs to change keys with each other and staff solve this in the best way for the moment and not always according to the routine. In the reports investigate which system the executives use and the conclusion is that it is appropriate to use a system that fits smoothly into existing systems so that there is no additional system. It is also important for a possible introduction to thinking about how the municipality intends to organize: installation, maintenance, and management - which the municipality has either a central unit, decentralized out of the units or use external contractors, such as a locksmith. The performers are positive and feel that the need is to introduce digital locks, while the property owners do not see a direct benefit from the solution. Much depends on how the municipality for the dialogue and invites to talks at an early stadium and explains what you are planning for a solution.