Discretion for whom? Local policies and the agency problem between politicians and care managers in Swedish social service

Figures & data

Table 1. Different types of delegation.

	Type of delegation afforded to care managers	Explanation
1	No delegation	No delegation from politicians to care managers to decide on elder care service. Delegation is moved higher up in the hierarchy to supervisors, managers, and politicians
2	Levels of delegation	Delegation is given to make decision about service up to a certain amount of time (hours, days, or weeks, depending on the type of service)
3	Delegation according to local guidelines	Delegation according to assessment/eligibility criteria in local guidelines for decision-making within elder care
4	Delegation after consultation	Delegation is given on the condition that the care manager consults a supervisor or manager – someone in a leading position (who consults, leads, and distributes the work)
5	Delegation other	E.g. when delegation for a certain service is given to social workers in a specific district within the municipality
6	Delegation	Delegation is given without any specified limit
7	Not mentioned	Delegation for the type of services coded are not mentioned in the document

Table 2. Restrictiveness in delegation in the Swedish social services for older people – overall and for the main types of service (home care, residential care, temporary respite care, reoccurring respite care and day care).

	Overall delegation services		Delegation of five main types of service
	Count	Percent	Count	Percent
Restricted	194	62.4	164	53.4
Not restricted	117	37.6	145	46.6

Table 3. Types of delegation for making decisions about the five main types of social services.

	Home care		Residential care home		Temporary respite care		Reoccurring respite care		Day care
	Number	Percent	Number	Percent	Number	Percent	Number	Percent	Number	Percent
No delegation	0	0.0	71	22.8	27	8.7	19	6.1	3	1.0
Levels of delegation	62	19.9	0	0.0	16	5.1	8	2.6	0	0.0
Delegation according to local guidelines	47	15.1	25	8.0	28	9.0	15	4.8	21	6.8
Delegation after consultation	3	1.0	7	2.3	10	3.2	3	1.0	2	0.6
Delegation other	3	0.9	7	2.3	2	0.6	0	0.0	8	2.6
Delegation	187	60.1	193	62.1	184	59.2	140	45.0	229	73.6
Not mentioned	9	2.9	8	2.6	44	14.1	126	40.5	48	15.4

COMMENT: Delegation after consultation and Delegation other are both 2.25%; both values have been rounded up.

Figure 1. Care managers’ level of delegation for home care services. Comment: Interval of hours as levels of delegation for the decision-making by care managers about home care services for older people. In total 62 municipalities in Sweden (approximately 19.9%) have chosen to use number of hours to limit discretion.