<p>The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I).</p><p>Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II).</p><p>The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II).</p><p>The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84.</p><p>In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III).</p><p>Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV).</p><p>In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm.</p><p>In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.</p>

The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

<p>Making the work in the public sector more efficient is something that has been seen as necessary during the later years. One way to do this on municipal level has been to apply solutions former used mostly by private companies. The organisational parts have also been adjusted to existing conditions in this work of change. For example more and more municipalities have come to use the purchaser-supplier model since the beginning of the 1990's. Norrköping, Linköping and Motala have been chosen in this essay for a closer study of the effects of the changes of the 90's, from an efficiency point of view. Even the process whereby the changes have been performed has been studied. The result that is being presented is that the purchaser-supplier model in many ways has contributed to an increased consciousness about the existing problems in the work and organisation in the municipalities. At the same time there is critics about the way the model is being used, and about the fact that the application isn't always adjusted to the existing reality.</p>

<p>The Swedish old-age care will in the near future face an extensive need to recruit enrolled nurses by virtues of the demographical development. The generation born in the 1940s will soon retire, and at the same time the rest of the population is growing older. One thing that becomes more important in how to draw more people to the old-age care, is to understand how the ones who allready work there experience their own worksituation.</p><p>The purpose of this study was to find out how enrolled nurses from two different generations experienced their own occupational role and make similarities and differences between the two generations experiences visible. The topics of interest in our study are the respondents own thoughts about their education, their worksituation today, what they think of the future and how they believe others regard their work. To fulfill the purpose of our study we used qualitative interviews. We have performed interviews with three enrolled nurses between 50 and 57 years of age and four enrolled nurses between 20 and 25 years of age.</p><p>The result was then analyzed with the help of Ingleharts theory “The silent revolution” and the concept of generations. The results showed that there were differences between the two generations. We can´t either on the basis of the small selection of respondents in our study draw any general conclusions. But some differences that show is that the older generation in a larger extent identify with their own occupational role. We also experience that the older are more satisfied with their work situation. They see possibilities to develop in their profession, which the younger don´t. The younger make demands on more possibilities and are more restless then the older generation. From the result we can also see that eatch generation is relative homogeneous. When their is differences between the generations their is often similarites within the own generation. One thing that both generations have in common and that shows clear in the interviews are the importens of empathy and good treatment.</p>

Making the work in the public sector more efficient is something that has been seen as necessary during the later years. One way to do this on municipal level has been to apply solutions former used mostly by private companies. The organisational parts have also been adjusted to existing conditions in this work of change. For example more and more municipalities have come to use the purchaser-supplier model since the beginning of the 1990's. Norrköping, Linköping and Motala have been chosen in this essay for a closer study of the effects of the changes of the 90's, from an efficiency point of view. Even the process whereby the changes have been performed has been studied. The result that is being presented is that the purchaser-supplier model in many ways has contributed to an increased consciousness about the existing problems in the work and organisation in the municipalities. At the same time there is critics about the way the model is being used, and about the fact that the application isn't always adjusted to the existing reality.

The Swedish old-age care will in the near future face an extensive need to recruit enrolled nurses by virtues of the demographical development. The generation born in the 1940s will soon retire, and at the same time the rest of the population is growing older. One thing that becomes more important in how to draw more people to the old-age care, is to understand how the ones who allready work there experience their own worksituation. The purpose of this study was to find out how enrolled nurses from two different generations experienced their own occupational role and make similarities and differences between the two generations experiences visible. The topics of interest in our study are the respondents own thoughts about their education, their worksituation today, what they think of the future and how they believe others regard their work. To fulfill the purpose of our study we used qualitative interviews. We have performed interviews with three enrolled nurses between 50 and 57 years of age and four enrolled nurses between 20 and 25 years of age. The result was then analyzed with the help of Ingleharts theory “The silent revolution” and the concept of generations. The results showed that there were differences between the two generations. We can´t either on the basis of the small selection of respondents in our study draw any general conclusions. But some differences that show is that the older generation in a larger extent identify with their own occupational role. We also experience that the older are more satisfied with their work situation. They see possibilities to develop in their profession, which the younger don´t. The younger make demands on more possibilities and are more restless then the older generation. From the result we can also see that eatch generation is relative homogeneous. When their is differences between the generations their is often similarites within the own generation. One thing that both generations have in common and that shows clear in the interviews are the importens of empathy and good treatment.

In Sweden, limited research has been carried out to examine how the combination of aging and gender affects the needs assessments for older clients in social work. This study aims to explore how conceptualizations of aging and gender is expressed by care managers in old age care, and how this affects their obligation to conduct individual needs assessments. The methods are focus group interviews with care managers and observations of staff meetings among care managers in three Swedish municipalities. The theoretical framework draws upon a combination of ageism, gender theory, the concepts of geras and elderhood, and the concepts of the third and fourth age. The results show that individual needs assessments can be affected in different ways, depending on factors such as context, the circumstances of the meeting with the client, as well as the care managers’ work conditions and the time available for reflection. In conclusion, the study highlights the need to increase care managers’ knowledge of how conceptualizations of aging and gender affect their approaches towards older clients’ needs, and to develop tools to manage these, in order to reduce the risk for biases in individual needs assessments.

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.

<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>

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>