Choice, needs or equality? Discursive struggles about defining home care for older people in Sweden

Elin Peterson,Helene Brodin

doi:10.1017/s0144686x21000131

Abstract

AbstractFocusing on Swedish home care for older people, this article explores the discursive (re)production of home care as an institution. Equality and universal service provision have been described as defining features of the Nordic care regime. At the same time, Nordic research has highlighted a shift in social care policy, from a focus on universalism and egalitarian ideals towards a focus on freedom of choice, diversity and individualised services. This article takes as a starting point that home care for older people is formed by different and potentially conflicting ideas. We understand home care as a contested formation and define institutional change in terms of ongoing discursive struggles. The analysis draws on qualitative semi-structured interviews with key informants, including politicians, local authority officials and representatives of interest organisations. Informants were engaged in policy making, implementation or advocacy related to care for older people. We examine the meanings attached to home care for older people and the analysis reveals three different discourses – on choice, needs and equality. By comparing and contrasting discourses, we reveal silences, conflicts and tensions, and highlight the politics involved in (re)creating home care as an institution.

Highlights

Focusing on Swedish home care for older people, this article explores the discursiveproduction of home care as an institution
The analytical approach assumes that subjects are produced in discourse and we explore the subject positions made available for older people with home care in the different discourses
While the informants generally articulated more than one discourse, we present key bearers of each discourse, identified by scrutinising whether the majority of the answers were related to choice, needs or equality

Summary

Introduction

Focusing on Swedish home care for older people, this article explores the discursive (re)production of home care as an institution. The question of ‘sustainable’ financing of welfare services has been on the political agenda for some time, including debates about increasing private financing (e.g. through RUT) and excluding cleaning from publicly funded home care (Meagher and Szebehely, 2010) In this context, it can be noted that 15 per cent of women aged 65+ and 7 per cent of men 65+ have an income that is below the limit of relative poverty Research has indicated that provider choice together with tax deductions for domestic services risk reinforcing structural inequalities (Szebehely and Trydegård, 2012; Vabø and Szebehely, 2012; Ulmanen and Szebehely, 2015; Moberg, 2017; Szebehely and Meagher, 2018) If those who can afford it get more and better care while the rest receive meagre basic services, universalism is threatened. Studies have not yet analysed the discursive struggles involved in the formation of home care as an institution in the context of the implementation of choice

Methods and analytical framework

Findings

Concluding discussion