Tradition, Change and Variation : Past and Present Trends in Public Old-age Care

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.

Den utvärdera(n)de staten : Utvärderingens institutionalisering på den högre utbildningens område

In recent years evaluation has become a very important element in the public administration. The Swedish state administration to a significant extent both evaluates and is evaluated. This means that the evaluating state is at the same time the evaluated state. In this dissertation the institutionalization of evaluation is studied in a field within which this development has been particularly lively and interesting, namely the field of higher education. The dissertation focuses on evaluation activity that has been carried out in conjunction with central public authorities within higher education: the Office of the Chancellor of the Universities and Colleges in Sweden, the National Swedish Board of Universities and Colleges, and the Office of the University Chancellor, and encompasses the period 1964-1995. A newly revived research tradition within political science – historical institutionalism – is used as a perspective and a methodology. Since the application of this tradition has not yet been fully tested, another purpose is to examine the practical utility of this analytical tool and the kind of knowledge that it produces. The dissertation thereby combines the fields of education policy, evaluation research and institutional theory. The beginning of the institution has been dated to the end of the 1960s and beginning of the 1970s. In the dissertation the forces behind the initiation of the institution are taken up. Events and developments in the field that have influenced the further development of the institution have been identified and analyzed. Developments reveal that the institution has been stable during the entire period of time under study, despite some changes. The use of historical institutionalism as a perspective and methodology has proven satisfactory on a general level. However, special solutions have been required as problems and ambiguities have arisen. The dissertation concludes with reflections on the practical utility of historical institutionalism in political science research.