<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.</p><p>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.</p><p>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.</p><p>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.</p><p>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>

Since the 1980s, practically all of the western welfare states have developed social policies, which aim at shifting the responsibilities for welfare services from the state to the family, the civil society or to the market. In Sweden, this political transformation has particularly hit the public eldercare. In the last twenty years, the percentage of the population 65 years and older receiving public home help services in Sweden has decreased from 23 to 8 per cent at the same time as the number of beds in hospitalized eldercare has been heavily reduced. Moreover, during the course of the 2000s, the majority of the Swedish municipalities have reintroduced means testing of the eldercare based on whether the elderly have relatives or not that can perform the services. Parallel with these downsizes in the publicly financed and organized eldercare; privately produced eldercare services have increased, carried out by large and internationally own business corporations. Based on an theoretical framework, which combines the historical approach within the neo-institutional research tradition with a discursive method of analysis, this thesis explores if the period from the 1980s and onwards has been a formative moment in Swedish eldercare during which new ideas have become embedded in the institutional frameworks regulating the division of responsibility for eldercare services between the state, the family and the market. To examine if and how the municipalities, which are principally responsible for organizing and financing the public eldercare in Sweden, have implemented the change in ideas that have emerged in national politics since the 1980s, the thesis also examines how the eldercare has developed in two of Sweden’s municipalities since the 1980s. The results of the thesis demonstrates that the period from the 1980s and onwards has been a formative moment in the Swedish eldercare during which new ideas regarding the public responsibility for eldercare service have emerged and become institutionalized. Since the 1980s, senior citizens’ need for care has increasingly been re-interpreted from a public to a private issue with the consequence that today, their need for certain services, in particular those related to housework, are no longer regarded to be a public responsibility but a private matter that the elderly will have to solve, either by buying the services on the market, or, by asking relatives for help and assistance. The main problem connected with this reprivatization of senior citizens’ need for care is, however, that as the state has withdrawn its responsibility, women, in their role of being wives, daughters, or daughters-in-laws, have been forced to step in as informal and unpaid providers of care. Therefore, regardless of political reigns and modes of production, women have been forced to taken on an increasingly larger responsibility for their elderly relatives.

Literature on lifelong learning indicates that major life transitions lead to significant learning. However, compared to learning in paid jobs, learning in and through household work has received little attention, given the unpaid nature and the private sphere where the learning occurs. The current study examined the changes and the learning involved in three aspects of household work: food work, childcare/parenting, and emotion work among recent Chinese immigrants in Canada. This study draws on data from a Canadian Survey on Work and Lifelong Learning (WALL), 20 individual interviews, a focus group, and a discussion group with new Chinese professional immigrants in the Greater Toronto Area. The results indicate that food work and childcare increased dramatically after immigration due to a sudden decline of economic resources and the lack of social support network for childcare. Emotion work intensified due to the challenges in paid jobs and the absence of extended families in the new homeland. To adapt to the changes in their social and economic situations, and to integrate into the Canadian society, Chinese immigrants learned new beliefs and practices about food and childrearing, developed new knowledge and skills in cooking and grocery shopping, in childcare and disciplining, in solving conflicts with children and spouses, and in transnational kin maintenance. In addition, the Chinese immigrants also developed new views about family, paid and unpaid work, meaning of life, and new gender and ethnic identities. However, these dramatic changes did not shatter the gendered division of household work. Both the qualitative and the quantitative data suggest that women not only do more but also different types of household tasks. As a result, it is not surprising that both the content and the ways of learning associated with household work varied by gender, class, and ethnicity. By exploring learning involved in the four dimensions of household work: physical, mental, emotional, and spiritual, this dissertation demonstrates that learning is both lifelong and lifewide. By making household work visible, this research helps make visible the value of the unpaid work and the learning involved in it.

Literature on lifelong learning indicates that major life transitions lead to significant learning. However, compared to learning in paid jobs, learning in and through household work has received little attention, given the unpaid nature and the private sphere where the learning occurs. The current study examined the changes and the learning involved in three aspects of household work: food work, childcare/parenting, and emotion work among recent Chinese immigrants in Canada. This study draws on data from a Canadian Survey on Work and Lifelong Learning (WALL), 20 individual interviews, a focus group, and a discussion group with new Chinese professional immigrants in the Greater Toronto Area. The results indicate that food work and childcare increased dramatically after immigration due to a sudden decline of economic resources and the lack of social support network for childcare. Emotion work intensified due to the challenges in paid jobs and the absence of extended families in the new homeland. To adapt to the changes in their social and economic situations, and to integrate into the Canadian society, Chinese immigrants learned new beliefs and practices about food and childrearing, developed new knowledge and skills in cooking and grocery shopping, in childcare and disciplining, in solving conflicts with children and spouses, and in transnational kin maintenance. In addition, the Chinese immigrants also developed new views about family, paid and unpaid work, meaning of life, and new gender and ethnic identities. However, these dramatic changes did not shatter the gendered division of household work. Both the qualitative and the quantitative data suggest that women not only do more but also different types of household tasks. As a result, it is not surprising that both the content and the ways of learning associated with household work varied by gender, class, and ethnicity. By exploring learning involved in the four dimensions of household work: physical, mental, emotional, and spiritual, this dissertation demonstrates that learning is both lifelong and lifewide. By making household work visible, this research helps make visible the value of the unpaid work and the learning involved in it.

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>

Globalization has facilitated international communication and economic activities that motivate more international migration. Different cultures and values from the West and the East are interwoven in the same social context. Meanwhile, aging has become a notable phenomenon in most developed countries due to declining fertility and increased life expectancy. A digital transformation of society is taking place alongside the aging and international migration that will start to question the image of older adults and the patterns of providing elderly care. Chinese elderly care is characterized by familism providing family-based informal care to an older family member. Despite the influence of migration and modern lifestyles, filial piety is expected to continue to guide the care responsibilities and care providing among Chinese families.  This thesis aims to understand the cultural provision of support and care for Chinese older adults living in Sweden and under the influence of the digital transformation of society. It starts by exploring the disparities, barriers, and facilitators for older immigrants in need of home care to utilize digital technology. After constructing knowledge about the influences of the foreign environment and continuous digitalization in home care, the thesis seeks to understand how filial piety continues to be enacted; what part of the tradition is preserved, and what is changed; how the internal and external factors influence the decision of elderly care; and the role of digitalization in this process. The thesis utilizes qualitative in-depth interviews to continue investigations among eight midlife and older Chinese immigrants living in Sweden. Thematic analysis was employed for data analysis. Berry’s acculturation framework and Yeh’s Dual Filial Piety Model provide the theoretical ground for the research.  The results indicated that filial piety is in transition in terms of filial responsibilities, filial behaviors, and intergenerational relationships. Despite the differences in the acculturation level, the authoritarian element of filial piety lacked ground in the Swedish social context. Respondents showed their willingness to strengthen the reciprocity with their adult children by providing additional support, valuing affections rather than hands-on care, respecting adult children’s decisions. The uptake of digital technologies has enabled midlife and older Chinese immigrants to maintain more frequent contact with family members and friends in other countries. It also improves the autonomy and capabilities for respondents to plan more independent later lives. The conclusion is that traditional values such as filial piety was not as prominent in Sweden as they are in China. / Globaliseringen har möjliggjort gränsöverskridande kommunikation och export samt import av varor och tjänster. Även människor rör sig över olika delar i världen och emigrerar till främmande länder. Detta i sin tur innebär att olika kulturer och värderingar från väst och öst behöver vävas samman och samsas i samma sociala kontext. Förutom globaliseringen så har åldrandet; på grund av sjunkande fertilitet och ökad livslängd, blivit en betydande företeelse i de flesta utvecklingsländer. En digital omvandling av samhället pågår parallellt med åldrandet och den internationella migrationen. I det avseendet blir äldre immigranter, deras teknikanvändning och syn på äldreomsorg allt viktigare.  Kinesisk äldreomsorg kännetecknas av familjebaserad informell vård till av äldre familjemedlemmar. Trots samhällets förändring och digitalisering, förväntas barnen ha huvudansvaret för vård och omsorg av sina äldre familjemedlemmar. Fenomenet kallas ”filial piety” och beskriver barnens skyldigheter att sörja för sina föräldrar på ett respektfullt sätt.  Denna licentiatexamen syftar till att öka kunskapen om äldre kinesiska immigranter som bor i Sverige och deras förväntningar på omhändertagandet och äldrelivet i Sverige relaterat till digitaliseringen.  Licentiatexamen börjar med att utforska skillnaderna, hindren och möjligheter i att använda digital teknik bland äldre invandrare i behov av hemtjänst. Licentiatexamen använder kvalitativa djupintervjuer för att undersöka hur åtta medelålders och äldre kinesiska invandrare, bosatta i Sverige. Intervjuerna har analyserat med hjälp av tematisk analys. Berrys ramverk för ackulturation och Yehs ”Dual Filial Piety Model” utgör den teoretiska grunden för forskningen. Resultaten indikerade på att synen på ”filial piety” är i förändring när det gäller vårdnadsansvar, beteenden och relationer mellan generationerna. Trots skillnaderna i nivån av ackulturation saknades det auktoritära inslaget av ”filial piety” i den svenska kontexten. Intervjupersonerna betonade sin vilja att stärka samspelet med sina vuxna barn genom att ge stöd och affektion snarare än att de förväntade att barnen skulle ge praktisk vård och omsorg. De intervjuade visade stor respekt för sina vuxna barns beslut och självständighet. Användningen av digital teknik möjliggjorde att de intervjuade kunde hålla tät kontakt med familjemedlemmar och vänner i andra länder. Den digitala kontakten med familjemedlemmar och vänner i sin tur, ansågs stödja deras autonomi och förmåga att planera sina framtida liv och äldreomsorg. Slutsatsen är att traditionella värderingar så som ”filial piety” påverkades av den svenska kontexten och förväntningarna på de vuxna barnen var inte lika höga och framträdande som de traditionellt sett varit i Kina. / <p>QC 2021-11-02</p>

Major demographical changes, such as aging population, constantly increases the demand for healthand social care services and technologies. The concept of welfare technologies is a response to meet this demand, since it increases independency, activity, participation and safety for people that has or is at risk of developing a disability. The procurement process of welfare technology is described as ineffective and problematic and is one of the major bottlenecks in implementing this type of technology. The aim of this study was to explore how the practical procurement process of welfare technology is performed in Swedish municipalities, an area which is currently under-researched. Moreover, the main problematic areas in the procurement, and their causes were investigated, which was carried out through qualitative semi-structured interviews with municipal actors. Data was collected from 3 municipalities, with 8 interview participants in total. The collected data from these interviews was transcribed, using intelligent verbatim, and analyzed inductively in the framework of qualitative content analysis. The data analysis yielded 7 main categories of problematic areas in the procurement process, along with 47 sub-categories. The main issues discussed were related to insufficient resources, such as competence, time and money, too little focus on the userneed, and difficulties with integrating welfare technology with other technical systems. A set of concrete advices for how to target some of the identified problems was generated, along with a couple guidelines for how to streamline the procurement process of welfare technology. It is argued in this report that the municipal organization of this process needs to be looked over, which cannot solely occur within municipalities, but must also be decided from a higher political level.