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.

Travel behaviour change in old age : the role of critical incidents in public transport

Older people’s travel behaviour is affected by negative or positive critical incidents in the public transport environment. With the objective of identifying such inci- dents during whole trips and examining how travel beha- viour had changed, we have conducted in-depth interviews with 30 participants aged 65–91 years in the County of Stockholm, Sweden. Out of 469 incidents identified, 77 were reported to have resulted in travel behaviour change, 67 of them in a negative way. Most critical incidents were encountered in the physical environment on-board vehicles and at stations/stops as well as in pricing/ticketing. The findings show that more personal assistance, better driving behaviour, and swift maintenance of elevators and escala- tors are key facilitators that would improve predictability in travelling and enhance vulnerable older travellers’ feeling of security. The results demonstrate the benefit of involving different groups of end users in future planning and design, such that transport systems would meet the various needs of its end users.

E-Government Collaboration in the Swedish Public Sector : Multiple Studies on Collaboration Facilitators and Collaboration Modes

Collaboration in the public sector is imperative to achieve e-government objectives such as improved efficiency and effectiveness of public administration and improved quality of public services. Collaboration across organizational and institutional boundaries requires public organizations to share e-government systems and services through for instance, interoperable information technology and processes. Demands on public organizations to become more open also require that public organizations adopt new collaborative approaches for inviting and engaging citizens in governmental activities. E-government related collaboration in the public sector is challenging, however, and collaboration initiatives often fail. Public organizations need to learn how to collaborate since forms of e-government collaboration and expected outcomes are mostly unknown. How public organizations can collaborate and the expected outcomes are thus investigated in this thesis by studying multiple collaboration cases on the acquisition and implementation of a particular e-government investment (digital archive). This thesis also investigates how e-government collaboration can be facilitated through artifacts. It is done through a case study, where objects that cross boundaries between collaborating communities in the public sector are studied, and by designing a configurable process model integrating several processes for social services. By using design science, this thesis also investigates how an m-government solution that facilitates collaboration between citizens and public organizations can be designed. The thesis contributes to literature through describing five different modes of interorganizational collaboration in the public sector and the expected benefits from each mode. It also contributes with an instantiation of a configurable process model supporting three open social e-services and with evidence of how it can facilitate collaboration. This thesis further describes how boundary objects facilitate collaboration between different communities in an open government design initiative. It contributes with a designed mobile government solution, thereby providing proof of concept and initial design implications for enabling collaboration with citizens through citizen sourcing (outsourcing a governmental activity to citizens through an open call). This thesis also identifies research streams within e-government collaboration research through a literature review and the thesis contributions are related to the identified research streams. This thesis gives directions for future research by suggesting that future research should focus further on understanding e-government collaboration and how information and communication technology can facilitate collaboration in the public sector. It is suggested that further research should investigate m-government solutions to form design theories. Future research should also examine how value can be co-created in e-government collaboration.