Constant changes – on organization, leadership and work environment in elderly care

Swedish elderly care currently accounts for almost twenty percent of municipal expenses. Furthermore, an aging population means that these activities will face increasing pressure in the future. Despite the fact that several initiatives related to elderly care have been launched, a number of shortcomings are recurrently highlighted, most recently by the Swedish Corona Commission.

In a new SNS report, researchers Kristina Westerberg and Maria Nordin describe how the organization and work environment in elderly care have responded to changes over the past three decades. Their primary focus is on the economic crisis in the 1990s, the transfer of responsibility for elderly care from regions (at the time referred to as county councils) to municipalities in 1993 and the increased level of market adaptation in terms of managing public activities.

These changes led to more fragile and sicker elderly individuals entering elderly care at the same time as increased cost control led to more documentation and reporting. There was a shift in focus in elderly care resulting in more emphasis on individual care and a clear focus on the users. However, the researchers also argue that these changes resulted in less focus on the employees’ work environment.

“This is still visible today, 30 years later, when the Swedish Work Environment Authority performs inspections indicating that top management is not always aware of work environment problems or that this is part of their responsibilities,” says Kristina Westerberg, professor emerita of psychology at Umeå University.

The report compares Swedish elderly care with elderly care in other countries. A comparison between Spanish and Swedish elderly care shows that the former is organized in a more hierarchical fashion with more managers, smaller work teams and a clearer separation of roles among the employees. The Swedish employees to a greater extent report that they intend to look for another job. They also describe the quality of care as being lower and report more symptoms of poor health compared to their Spanish counterparts.

“The flat Swedish organizations do not seem to offer the expected benefits. Top management has a harder time reaching and influencing their employees at Swedish workplaces. In our material, Swedish managers could be in charge of up to 60 individuals, while the corresponding figure for Spanish managers was a maximum of 19 individuals,” says Maria Nordin, associate professor and senior lecturer of psychology at Umeå University.

The report also refers to a comparison with other Nordic countries, where employees working in Swedish elderly care report deteriorating working conditions between 2005 and 2015 not seen to the same extent in Finland, Norway and Denmark.

The authors point out that there are large variations in Sweden where many organizations work very well but that certain structures tend to reoccur and create problems. First and foremost, there is an imbalance between demands and resources in the form of, for instance, perceived support from the organization, proximity to the manager and opportunities to grow and develop. The report describes several development projects and initiatives having been carried out in the Swedish elderly care sector seeking to improve quality. In general, however, the long-term effects of these appear to be limited.

“In order for elderly care to move forward, work environment issues need to be raised to the highest level. Without a good working environment, there is a risk that commendable initiatives related to competence, training and development currently being discussed end up amounting to nothing,” says Kristina Westerberg, professor emerita of psychology at Umeå University.

This report is published within the framework of the SNS research project Health care in the 21st century.