The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians.

Susann Porter,Tuija Muhonen

doi:10.3390/ijerph182312350

Susann Porter, Tuija Muhonen

Open Access

https://doi.org/10.3390/ijerph182312350

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Abstract

The aims of this qualitative grounded theory study were to explore how politicians accountable for Swedish elderly care viewed their assignment, their beliefs and knowledge regarding the psychosocial work environment for elderly care employees, the factors affecting their work environment, and how these politicians regarded elderly care during the COVID-19 pandemic. This study consisted of 41 interviews with politicians in municipalities across Sweden. Three categories emerged from the analysis: (1) interpretation of the assignment directs the focus; (2) recognizing shortfalls in the employees’ work environment; and (3) exposing deficiencies due to the COVID-19 pandemic. The strongest category was identified as interpretation of the assignment directs the focus and was described as the delivery of good and quality care. Nevertheless, this study highlights shortfalls in the delivery of care services where the employees’ work environment, especially in the home care sector, was frequently described as stressful. The COVID-19 pandemic adversely affected the work situation for staff in elderly care. In that setting, staff shortage and lack of competency were common. Nurses were particularly affected by high workload and responsibility. Further research should explore civil servant roles in the elderly care sector and how these actors view their collaboration with municipality politicians.

Highlights

Severe deficiencies within elderly care in Sweden became visible and were widely discussed during the COVID-19 pandemic [1,2,3]
This study contributes to a deeper understanding of elderly care in Sweden from a new perspective, that of the accountable politicians
It is important that these politicians have a clear understanding of their assignment and of their responsibility as employers of the staff working within elderly care

Summary

Introduction

Severe deficiencies within elderly care in Sweden became visible and were widely discussed during the COVID-19 pandemic [1,2,3]. The Swedish health care sector consists of three levels, each governed by democratically elected politicians. These are the State (i.e., the central government), regions (i.e., the county councils), and municipalities. The role of the State is to establish principles and guidelines and set the overall political agenda for Swedish health care [10]. There are 290 municipalities within the regions, and they are responsible for providing services including elderly care. The municipality councils decide what specific areas boards and committees are accountable for, and a board can delegate an area of responsibility to a committee [11,12] boards and committees vary among the municipalities

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