The study concerns the needs assessment processes that older persons undergo to gain access to home care. The participation of older persons, their relatives and municipal care managers was studied from a communicative perspective. The assessment meetings functions as formal problem-solving events. The older persons´ accounts are negotiated discursively in interaction. Various storylines are used by the older persons and their relatives whether they view home care as an intrusion, as a complement or as a right. In case of divergent opinions the older person has the final say as prescribed by the Swedish social service act. One conclusion is that the role of relatives is not defined and a family perspective is not present. In the study the institutional structure of the assessment process was also analyzed. Older persons are processed into clients; their needs are fitted within the framework of documentation and institutional categories. In the transfer of talk to text all the particulars are not reflected and two types of documentation was identified; a fact-oriented objective language or an event-oriented personal language. Care management models and a managerialist thinking has influenced the assessment process by bureaucratisation of older people trough people processing, which is in contradiction to the individual-centric perspective prescribed by the law. The introduction of care management models in gerontological social work has lead to an embedded contradiction and constitutes a welfare political dilemma. Improved communicative methods are needed in order to achieve a holistic assessment situation. / Studien tar sin utgångspunkt i de bedömningsprocesser äldre personer genomgår för att få tillgång till hjälp i hemmet. Bedömningsprocessen där äldre, deras anhö-riga och kommunala behovsbedömare deltog studerades ur ett kommunikativt perspektiv. Interaktionen vid behovsbedömningssamtalet fungerar som en pro-blemlösningsprocess. Den äldre personens redogörelse för behov förhandlas diskursivt i interaktionen och tre olika berättelselinjer identifierades, baserade på om de sökande betraktar hemtjänsten som ett intrång, som ett komplement och stöd eller som en rättighet. När olika åsikter uttrycks har de äldre sista ordet i enlighet med Socialtjänstlagens föreskrifter. En slutsats är att de anhörigas roll i behovsbedömningsprocessen inte är definierad och att ett familjeperspektiv sak-nas. I studien analyserades också bedömningsprocessens institutionella struktur. De äldre behovssökande processas till att bli klienter, deras behov anpassas till dokumentationens ramverk och kategoriseras i enlighet med institutionella kate-gorier. I transfereringen av tal till text redovisas inte samtliga element i samtalet. Två typer av utredningstext identifierades, den faktaorienterade och den händelse-orienterade. I studien diskuteras det marknadsekonomiska tänkande som kommit att påverka bedömningsprocessen genom byråkratisering vilket står i motsatsställ-ning till det individcentrerade perspektiv som lagen förespråkar. Introduktionen av marknadsmodeller i det gerontologiska sociala arbetet har medfört en inbyggd motsättning och utgör ett välfärdspolitiskt dilemma. Förbättrade kommunikativa metoder behövs för att uppnå en holistisk bedömningsprocess.

This thesis examines first-line managers' perceptions about their organizational prerequisites for trust-based governance and management through a case study within the municipality of Norrköping, focusing on the public home care organization. A qualitative research design was used in the thesis based on first-line managers perceptions of the organizational prerequisites for an ideal trust-based governance and management. The material has been analyzed through an ideal-type analysis based on central elements within the governing principles of market, bureaucracy, and trust. An overall picture gives the impression that the organizational prerequisites primarily is perceived as being well-functioning for the ideal of trust-based governance and management. It is also considered that certain organizational prerequisites are less well-functioning for the ideal. Furthermore, the thesis indicates certain organizational prerequisites which are seen as central to the ideal. This thesis provides some empirical evidence that a balance between the governing principles of market, bureaucracy, and trust is perceived as essential to achieve the ideal of trust-based governance and management in the given context. At the same time, the thesis indicates that a greater emphasis on trust as a governing principle is perceived as desirable to achieve the optimal balance for the ideal in the given context. In addition, the study depicts that there is some path dependence that affects the view of the organizational prerequisites for an ideal trust-based governance and management in the managerial role. This means that a legacy of market-inspired and bureaucratic instruments is perceived to prevent the trust-based management philosophy from having a greater impact on the organization.

Over the past few decades, the Swedish welfare system has undergone a process of marketization, characterized by the implementation of choice reforms. In order for citizens to be able to utilize their freedom of choice, a set of requirements have to be met. However, while it is argued in the literature that the conditions for choice reforms are worse in rural areas compared to urban areas, there is a lack of empirical studies examining these requirements in a rural Swedish context. Therefore, this study aims to investigate the market diversity requirement and the overproduction requirement in rural Swedish municipalities that have set up a system of choice for home care services in accordance with The Act on Systems of Choice (LOV). The results show that out of the sixteen municipalities included in the study, both requirements for functioning freedom of choice were fulfilled in four rural municipalities. Most commonly, the market diversity requirement was violated because of the absence of multiple established home care service providers. In some municipalities, the same requirement was also violated because providers failed to offer a variety of services. Further, the study shows that because some providers have restricted their operations to certain geographical areas within some municipalities, the ability for rural citizens to utilize their freedom of choice can differ within a municipality. All providers were able to accept new elderly clients, meaning that the overproduction requirement was fulfilled in all sixteen rural municipalities.

En god arbetsmiljö är avgörande för god hälsa. Sjukfrånvaron inom vårdrelaterade yrken blir allt högre samtidigt som antalet äldre personer i behov av hemtjänst förväntas öka med 76 procent till 2040 och antalet personer i yrkesverksam ålder förväntas öka med 9,4 procent. Därmed kan vi se att vård- och omsorgsorganisationer har en ökad risk för under bemanning och ökad personalomsättning på grund av den ökade belastningen inom yrkesgruppen. Utifrån detta ser vi att det är av vikt att studera första linjens chefer inom hemtjänsten och deras upplevelser kring den psykosociala arbetsmiljön. Syftet med denna studie är att undersöka hur första linjens chefer inom hemtjänsten handskas med den psykosociala arbetsmiljön genom att titta på chefernas förutsättningar för att arbeta med den psykosociala arbetsmiljön, studera deras upplevelser kring det stöd som de åtnjuter i arbetet med den psykosociala arbetsmiljön samt hur arbetet mot den ökande sjukfrånvaron ser ut. Datainsamling skedde via kvalitativ intervjustudie med induktiv ansats och data analyserades via tematisk analys. Resultatet visade att arbetet med den psykosociala arbetsmiljön i hemtjänsten är komplex och utmanande där första linjens chefer har stora personalgrupper som en försvårande faktor. Framgångsfaktorer som identifierades var närvarande ledarskap, låta medarbetare vara delaktiga i att planera tid för besök hos brukare, anpassning av arbetsuppgifter och fungerande stöd till chefer och medarbetare. Studiens resultat visar att första linjens chefer inom hemtjänsten har ett utmanande arbete med stora personalgrupper och höga krav på att hålla budget samtidigt som de ansvarar för arbetsmiljön och att det behövs omfattande arbete för att förbättra chefers förutsättningar och stöd. Studien bekräftar även tidigare forskning inom området och indikerar att det behövs ytterligare forskning inom området. / A good working environment is crucial for good health. The sick leave rate in healt care-related professions is increasing, while the number of elderly individuals in need of home care services is expected to increase by 76 percent, alongside a projected 9,4 percent increase in the working-age population. Consequently, we can observe that the healthcare organizations face an increased risk of understaffing and high turnover due to the growing demands in the profession. Based on this, it is important to study first-line managers in home care and their experiences with the psychosocial work environment. The aim of this study is to examine how first-line managers in home care manage the psychosocial work environment, by examining their prerequisites for addressing the psychosocial work environment, assessing how they experience the support they receive in this regard, and exploring the efforts made to combat increasing sick leave rates. Data collection was conducted through qualitative interviews using an inductive approach, and the data was analyzed using thematic analysis. The results revealed that the work concerning the psychosocial work in home care is complex and challenging, with the large size of the staff groups being a complicating factor. Success factors identified included present leadership, involving employees in planning time for client visits, task customization, and effective support for managers and employees. The result of the study shows that first-line managers in home care face challenging work with large staff groups and high demands to maintain the budget, while also being responsible for the work environment. There is a need for extensive efforts to improve managers conditions and support. The findings of the study also confirm previous research in the field and suggest the need for further research in this area.