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Abstract
PurposeNational Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality).Design/methodology/approachAddressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM).FindingsThe results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance.Practical implicationsDeveloping care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level.Originality/valueThe present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.
Highlights
In a majority of Western welfare states, the dominant and growing approach in contemporary elderly care is user-oriented care, called individualized care (National Board of Health and Welfare, 2007, 2012)
Sweden is known for being one of the most successful European countries in providing elderly care services, which besides other indicators is evident in the number of satisfied older persons using these services (Genet et al, 2011; Statistics Sweden, 2013)
In analyses of national elderly care surveys in Sweden, structural variables such as budget per older person and care personnel certification have revealed no relationships with satisfaction, whereas staffing and budget per capita have been shown to be weakly associated with satisfaction
Summary
In a majority of Western welfare states, the dominant and growing approach in contemporary elderly care is user-oriented care, called individualized care (National Board of Health and Welfare, 2007, 2012). User-oriented care and satisfaction with care In Sweden, user-oriented care denotes an emerging ideology in elderly care (National Board of Health and Welfare 2008) Adopting this approach means putting the needs, wants, preferences and limitations of the older person (i.e. user) instead of the demands and administrative routines of the care system at the center of care planning and caregiving (Kajonius and Kazemi, 2016a; Kazemi and Kajonius, 2015). In analyses of national elderly care surveys in Sweden, structural variables such as budget per older person and care personnel certification have revealed no relationships with satisfaction, whereas staffing and budget per capita have been shown to be weakly associated with satisfaction This previous research has convincingly demonstrated that satisfaction with care is mainly predicted by the experience of the care process at the interpersonal level (Kajonius and Kazemi, 2016c). The relationship between interpersonal process quality care indicators and satisfaction with care has been confirmed by a number of empirical studies conducted in different countries and settings (Berglund, 2007; Murphy et al, 2007)
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