Can state supervision improve eldercare? An analysis of the assumptions of the Swedish supervision model
Background: Lately the supervision of Swedish eldercare has been reinforced to ensure better compliance with laws and regulations. Policy-makers express high expectation that this reform will improve quality in eldercare, and ensure older citizens a good and equal distribution of eldercare.
Purpose: The aim of this paper is to unfold the underlying assumptions of how the supervision model (inspectorate) is intended to work to ensure and improve quality in Swedish eldercare, and to probe the validity of the assumptions.
Method: A program theory analysis is carried out to describe how state supervision is assumed to work to achieve intended effects. These assumptions are referred to as the supervision’s program theory. A policy scientific method is applied to reconstruct the program theory. Once the program theory is described its consistence is analyzed and the validity is assessed against supervision theory and caring theory.
Results: The assumption that the supervised will improve compliance with laws and regulations has some validity but confined to aspects of eldercare being supervised. The theories we used provide no support that supervision is an effective tool for improving quality in eldercare.
Conclusions: Reinforced supervision cannot be justified with reference to supervision being an effective tool or mechanism to enhance quality in eldercare. However, some kind of supervision is necessary for transparency and holding local governments, and public and private service providers to account for compliance with the statues. Supervision also reinforce the national objectives and standards that should guide social service committees and eldercare service providers.