Abstract
Processes of privatization in home care for the elderly in Denmark have primarily taken the form of outsourcing public-care provisions. The content and quality of services have in principle remained the same, but the providers of services have changed. The welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. The major aim of outsourcing has been to empower the frail elderly by providing them with exit-opportunities through a construction of this group as consumers of welfare-state provisions. The central government in Denmark has produced the public-service reform, but the municipalities bear the administrative and financial responsibility for care for the elderly. Further, national policymakers have decided that local authorities (municipalities) must provide to individuals requiring care the opportunities to choose. With this background in mind, this article analyses how national, top-down ideas and the ‘politics of choice' have created tensions locally in the form of municipal resistance and blockages. The article draws on case studies in two Danish municipalities, whereby central politicians and administrative leaders have been interviewed. We have identified four areas of tensions: 1) those between liberal and libertarian ideas and values versus local political orientations and practices; 2) new tensions and lines of demarcation among political actors, where old political conflicts no longer holds; 3) tensions between promises and actual delivery, due to insufficient control of private contractors; and 4) those between market principles and the professional ethics of care providers.
Highlights
The organization of elderly care has changed dramatically in most Western countries in recent decades
Care while and at the same time of controlling the quality of services delivered by private and public home-care providers; (3) the head of the municipal elderly-care unit, who is the overall head of all municipal providers of elderly care; and (4) the municipal elderly-care unit is subdivided into sections and we have interviewed the head of a district organization
Since the early 2000s, the Danish right-of-centre government has supported the establishment of private home-care providers in order to help to shift the provision of care and resources from the public to the private sector
Summary
The organization of elderly care has changed dramatically in most Western countries in recent decades. As in other European countries (e.g., Knijn, 2000; Pavolini & Ranci, 2004; Whitfield, 2006), the elderly-care reform in Denmark was inspired by liberal and libertarian values, epitomized as the ‘freedom to choose’, which was believed to empower seniors by providing them with opportunities to choose This constructed them as the consumers of welfare services (cf Morris, 1997) while at the same time reinforcing the superiority of the market as a decisionmaking mechanism. Exit-opportunities, in the area of elderly care was imposed on autonomous local politicians and administration from above Such top-down imposed policies might have contributed to new tensions and contradictions, not least because the local level is able to resist or block ‘politics of choice’. We reflect upon the tensions, contradictions, and local reactions that have emerged from the top-down reform of public home-care services for seniors
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