Developing Eldercare in Ageing Societies: A Qualitative Study on Misaligned Visions and Caged Change Agents

Abstract

Eldercare is facing current demands to develop due to changing demographics with increasing populations of elderly over the age of 85 combined with smaller populations of young people able to provide care and contribute to care via their taxes. The need for development of quality and safety was highlighted during the COVID-19 pandemic. Swedish government subsidies aimed at developing municipalities responsible for publicly managed eldercare have only been evaluated to a limited extent and the realisation of visions of future eldercare is shrouded in mystery. The study aims to explore the development work and strategies in Swedish municipal eldercare organisations, specifically in terms of alignment between democratic visions at political and strategic levels and operationalisation at operational levels. 28 interviews with development leaders were conducted in 14 Swedish municipality organisations between March and October 2021. The interviews focused on supporting roles and functions, responsibilities and collaborations, visions and operationalisations, and the follow-up and evaluation of eldercare development. A thematic analysis resulted in the main theme “top-down handling of unmanageable alignment” and the subthemes “shaping a high road for change;” “sticking to visions, hopes, and respect for practice;” and “self-serving focus on politics.” The quality of alignment strategies and putting the strategic vision into practice were related to organisation size and resources. A gap between strategic and operational levels was accentuated in terms of inconsistent responsibilities in following through with development projects and development being characterised by top-down initiatives and resources at the strategic level but strained implementation abilities at operational levels. Peripherally located change agents with legitimacy at multiple organisational levels are suggested to ease top-down as well as bottom-up drive, which could increase a vertical alignment of visions and practice.