Caring about competition in eldercare? Staff groups, nursing homes, and Swedish market-inspired reforms

Abstract

ABSTRACT During the past 30 years, Swedish eldercare has undergone extensive reforms featuring, among others, far-reaching efforts to construct municipal markets characterised by competition between nursing homes for service provision. Our aim in this paper is to develop new knowledge about how eldercare professionals currently approach the role of competition after it has been present for three decades as a key idea throughout Sweden’s market-inspired reforms. To address that aim, we build on insights from organisational theory, and conduct a study consisting of 39 interviews with professionals working as frontline or management staff in publicly or privately operated homes. Our findings show how competition was similarly perceived across public and private nursing homes: eldercare professionals regarded it as a phenomenon primarily affecting their work in relation to tendering periods. Important differences, nonetheless, existed between staff groups in homes. Thus, the findings of our study also indicate that perceptions of competition ranged from a more employment-focused and episodically occurring phenomenon among frontline staff, to a more visibility-focused and continuously occurring phenomenon among management staff. We finish by discussing competition as a central and peripheral phenomenon in nursing homes, and by highlighting the relevance of our findings for additional eldercare contexts across Europe.