Abstract
Cutbacks and austerity measures were in 2019 estimated in a quarter of the Swedish municipalities because of financial deficit. Due to the urbanization the conditions of the municipalities vary, creating different challenges and possibilities to provide for the necessary welfare service such as elder care. Despite a growing population of older people, previous research shows a decline in residential homes since 1980 as well as a decrease in caretakers receiving home help services. According to an inspection of the Health and Social Care Inspectorate (Inspektionen för vård och omsorg) local policy guidelines, for elder care assessment, are being used to reduce the dissimilarities in decision-making within the municipalities and to control the financial costs by adapting criteria and care limits for the needs assessment. Criticism has, by the Swedish Ombudsman, been directed towards the use of municipal guidelines for not complying with the law and case-law. Despite previous research indicating the usage of municipal guidelines in the needs assessment and decision-making process, municipal guidelines are still a relatively unexplored field. The aim of this thesis is therefore to understand the role of municipal guidelines, for elder care assessment, with regard to the law and the application of the law as well as the role municipal guidelines play according to politicians. In order to achieve this, the following has been examined: 1) the spread and content of the municipal guidelines, 2) the creation and political motives for establishing the guidelines and 3) how the care managers view their impact on the decision-making process. The methods used are semi-structured interviews, a survey, and a documentation review. The result shows that municipal guidelines are politically established, that they are widely spread and can be found in 274 out of 290 Swedish municipalities. According to the survey the guidelines contain guidance of law, case-law, and the like, as well as criteria and limits for the needs assessment and decision-making of elder care service. The result indicates that the local guidelines compensate for the ambiguity of the Social Services Act (Socialtjänstlagen 2001:453) by reinstating bureaucracy. By limiting the discretion, the guidelines aim to compensate for the lack of competence as well as create certainty and enable political responsibility for the usage of municipal resources as well as accountability between politicians, care managers and citizens. By standardizing, the aim is to achieve equality and legal certainty despite risking the fundamental intentions of the Social Service Act as a framework law designed for individual needs assessment. This study highlights the need to invest necessary resources into creating guidelines in order to make them more accessible, lawful and ensure legal certainty. The conditions, however, vary noteworthy between the municipalities. As a solution, the National Board of Health and Welfare, or some other authority, could be held responsible for developing national guidelines – regularly up to date and based on current law and case-law. In summary, this study shows that municipal guidelines have a widespread impact on the decision-making of care managers. The municipal guidelines thereby have a central role in the application of the law with a noteworthy potential impact on individuals and the help warranted to older people as a consequence.
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