At the intersection of marketisation, diversity and migration: reshaping the provision of paid family eldercare in Sweden?

ABSTRACT

This article explores how paid family eldercare in Sweden is reshaped at the intersection of marketisation, accommodation to ethnic diversity and globalisation of international migration. Using a mixed-methods case study approach, the paper examines how implementation of customer choice in publicly funded homecare services to older adults in the city of Stockholm interacts with paid family care. The results show that some private homecare companies employ family caregivers as a business strategy; moreover, that the majority of employed family caregivers are foreign-born women coming primarily from non-European countries. The findings point towards gains but also risks for all parties involved. Though the family caregiver is ensured an income, the employment is generally associated with low wages and weak social security. In addition, employed family carers often lack formal training, which affects documentation procedures and monitoring of the daily care work. It is therefore difficult to evaluate the quality of care services performed by employed family carers. The results indicate a need for policy-makers to reconsider how customer choice in eldercare interacts with paid family care. Otherwise, unintended consequences may result in negative effects for integration as well as social work practice with foreign-born older adults.

ABSTRAKT

Den här artikeln utforskar hur bruket av anhöriganställningar inom äldreomsorgen i Sverige omvandlas i mötet mellan marknadslösningar, anpassningar till etnisk mångfald och den internationella migrationens gobalisering. Med hjälp av en mixad metodologisk ansats undersöker artikeln hur implementeringen av kundval i den offentligt finansierade hemtjänsten för äldre personer i Stockholm samspelar med bruket av anhöriganställningar. Resultaten visar att en del privata hemtjänstutförare använder anhöriganställningar som en affärsstrategi. Vidare är majoriteten av de anhöriganställda utrikes födda kvinnor, främst i länder utanför Europa. Resultaten pekar på fördelar men också risker med anhöriganställningar för alla inblandade parter. Även om anhöriga får lön för den omsorg de utför är anställningsformen förknippad med låga löner och otrygga anställningsvillkor. Dessutom saknar många anhöriganställda formell omsorgsutbildning, vilket påverkar dokumentationen och insynen i det dagliga omsorgsarbetet. Det är därför svårt att utvärdera kvaliteten i de insatser som utförs av anhöriganställda. Resultaten indikerar att politiker och tjänstemän måste ta hänsyn till hur bruket av anhöriganställningar samspelar med kundval i hemtjänsten. Annars finns det risk för att oavsiktliga konsekvenser resulterar i negativa effekter för integration och socialt arbete med utrikes födda äldre personer.

KEYWORDS:

• Older people
• caregivers
• equality/diversity
• gender/feminism
• migration/immigration

NYCKELORD:

• äldre personer
• omsorgsgivare
• jämlikhet/mångfald
• genus/feminism
• migration/immigration

Acknowledgements

The author thanks the anonymous reviewers and Gabrielle Meagher and Marta Szebehely for helpful comments.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Helene Brodin is researcher and senior lecturer in Social Work, Stockholm University. She leads the project Sustainable care in a customer choice model: dilemmas and possibilities of small homecare enterprises, which investigates the challenges of implementing customer choice in publicly funded homecare for older adults. She also participates in the international interdisciplinary research programme Individualised care and universal welfare: dilemmas in an era of marketisation led by Prof. Marta Szebehely, Stockholm University.

Notes

1 The number of homecare providers is actually higher than the sum of all private homecare companies and public providers in the city. This depends on the fact that both the large private homecare companies and public providers have multiple units, which operate as independent providers.

Additional information

Funding

This work was supported by Forskningsrådet om Hälsa, Arbetsliv och Välfärd (Forte) under the grants ‘Transformations of care – living the consequences of changing public policies’ (Dnr 2006-1635) and ‘Individualised care and universal welfare: dilemmas in an era of marketisation’ (Dnr 2013-2296)), both led by Professor Marta Szebehely.