The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians
Abstract
:1. Introduction
- how politicians accountable for elderly care view their assignment for elderly care;
- politicians’ beliefs and knowledge regarding the psychosocial work environment for elderly care employees and the factors affecting their work environment; and
- how the politicians viewed elderly care during the pandemic.
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Data Collection
2.4. Analysis
2.5. Ethics
3. Results
3.1. Interpretation of the Assignment Directs the Focus
3.1.1. Delivering Good Care When Needed
“I have always viewed it to be my assignment to deliver as good care as possible for those who need care and nursing … We must always make sure that we deliver the best there is. The best depends on what one thinks is the best based on what kind of values one has.”Participant 24
“It becomes a bit of an ideological issue, but somewhere it is to do the minimum. We must at least do what the law requires….”Participant 28
“We [politicians] should monitor the decisions in accordance with laws and the legal requirements that affect the area [elderly care], and there you can say that it feels a bit comical because none of the politicians who sit on the board have even looked in the law book and seen if the proposal that the civil servants invoke is correct. It’s a bit comical at the same time as it is very serious.”Participant 18
3.1.2. Setting Goals and Directions
“We are responsible for these overall big issues; what are the focus goals, where are we going, what are the visions for nursing […].”Participant 7
“Politicians must paint the big brush strokes when it comes to elderly care ….”Participant 2
“If you put it simply, what we as politicians are responsible for is to set goals: the focus, scope, and quality. The actual leading, the concrete measures to meet politicians’ expectations, it’s the civil servants’ responsibility. It’s difficult to draw boundaries there. Sometimes I think you get too involved and sometimes not involved enough.”Participant 3
3.1.3. Being Responsible for the Employees’ Work Environment
“We as politicians have absolute employer responsibility. This is an issue that has been discussed a lot. It’s a politically controlled organization, not a civil servants’ organization. That is very important to know.”Participant 34
“Ultimately it’s politicians who are responsible for the work environment…. We delegate that task, but that is based on that we follow up that delegation…. We have a work environment responsibility for the staff even if we delegate it to the first line managers.”Participant 20
3.2. Recognizing Shortfalls in the Employee Work Environment
3.2.1. Sick Leave Being a Major Problem
“We have an average of 10% sick leave and I felt when I came in [to the board] that cannot be acceptable. I cannot run an organization where every tenth employee is not at work—then something is wrong. We [the board] have a work environment responsibility and should make sure the staff are well.”Participant 12
“The sick leave rate was at 30% a few years ago in a team, which was completely horrendous. The explanation we got [from the civil servants] when discussing the sick leave rate was that it was stomach ailments or the flu, but, I mean, that comes around every year, so that is a poor explanation.”Participant 14
“It’s between 15 and 20 percent I think, it has gotten better.”Participant 27
“There is a high level of sick leave in home care, but I don’t know why that is. It could be that they are not happy with their boss. It could be that they are very ill. I don’t know, but there is a high level of sick leave and I cannot believe that it’s due to the work environment.”Participant 17
3.2.2. Lacking the Prerequisites for Work
“There can be very ill individuals who need a lot of help, and how do you calculate that? I have asked it, tell me how to calculate a shower aid? They (elderly) should undress, shower, and have help with this in 15 min….”Participant 9
“There is a shortage of staff. There are no people to get a hold of, for example, during the summer…. I got the comment [from a staff] that you cannot hire a person just because they have two arms and two legs. They must understand what you are saying, too.”Participant 41
“Who wants to work with elderly care when you know that you have every other weekend, and shared shifts, low pay and a stressful job that makes you sick? Yep, I want that job! Probably not!”Participant 31
“If staff who are completely uneducated come home to my mother, it’s clear I’m not happy. But if we do not have anyone else (to work) that day, what do we do then? It’s perhaps better that a person comes even if they are completely uneducated than nobody at all.”Participant 12
3.2.3. Excessive Workload and Inadequate Support to Managers
“They have a large group of employees, and then they also have to deal with all the substitutes and hourly paid employees, which can be almost twice as many….”Participant 20
3.3. Exposing Deficiencies Due to the COVID-19 Pandemic
3.3.1. Deficient Work Environment during the COVID-19 Pandemic
“We have had a nursing home, a large nursing home, where we have been hit hard [by COVID-19], and not just among the elderly residents. The big problem now is the lack of staff. The staff are sick.”Participant 11
“Many have died, tragically…. Now we have examined the whole process, and what we have done and what we have not done, medical equipment and knowledge and everything, we can’t see that what happened was due to shortages of equipment, that they [staff] did not follow routines, that there was a lack of knowledge, that there was no protective equipment. We cannot see that these were the reasons.”Participant 19
“Of course, many of the older, fragile people have been sacrificed, and that feels very difficult.”Participant 14
“… those who did not have an education did not have a clue of even basic hygiene routines…”Participant 26
3.3.2. Considering the Substantial Staff Responsibility
“Of course, I belong to those who think that the municipality should hire its own doctors to deliver the whole chain [of health care] and corona has shown that this is what is needed. Of course, it is not possible to assess all patients on the phone. It’s not possible.”Participant 14
“Nurses often do duties that would be performed by a specialist in a hospital.”Participant 37
4. Discussion
4.1. Implications for Practice and Research
4.2. Strength and Limitations
4.3. Further Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Interview Questions
- How would you describe the assignment you have as a politician for the care of the elderly?
- Can you describe who is responsible for the staff’s work environment?
- How would you describe the psychosocial work environment for staff in elderly care?
- How do you view the staff work conditions for carrying out their work?
- How would you view the staff qualifications to carry out their jobs?
- How do you feel about sick leave in home services and nursing homes?
- Do you know why staff are on sick leave, if it is due to physical or mental health problems?
- How can you, as a politician responsible for elderly care, affect the staff’s work environment?
- Can you describe your collaboration with the first line managers in nursing? Is there a support function for them?
- Have you received signals that there is a lack of resources in elderly care?
- Have you, in the role as a politician, visited a nursing home and met the staff at their workplace? If so, what do the staff tell you?
- In your view, how has your municipality handled the pandemic?
- How have the staff coped during the pandemic?
- Have the staff had the right training to care for the ill elderly suffering from COVID-19?
- How have the nurses coped during the pandemic?
- What is your view of doctors not visiting nursing homes, but instead receiving a handover by the responsible nurse?
Appendix B
Characteristics | N |
---|---|
Politicians contacted via email (between 1 and 4 in each municipality) | 456 |
No reply | 401 |
Replied and accepted | 41 |
Replied and declined to participate Women/men | 14 12/2 |
Replied and declined, and stated a reason for not to participating Women/men | 8 6/2 |
High workload | 2 |
Personal reasons | 2 |
New at the job | 1 |
On paternity leave | 2 |
Not suitable due to too much knowledge in the field | 1 |
Appendix C
Political Party | n | Female/Male | Governing Mode in the Municipality | n |
---|---|---|---|---|
The Social Democrats | 13 | 7/8 | Majority/Minority Government Coalition/Opposition | 3/2 6/2 |
The Moderates | 8 | 3/5 | Majority/Minority Government Coalition/Opposition | 3/1 2/2 |
The Centre Party | 4 | 0/4 | Coalition/Opposition | 2/2 |
The Christian Democrats | 3 | 2/1 | Coalition | 3 |
The Liberals | 3 | 2/1 | Coalition/Opposition | 1/2 |
The Swedish Democrats | 3 | 2/1 | Opposition | 3 |
The Green Party | 3 | 3/0 | Opposition | 3 |
The Left Party | 2 | 1/1 | Opposition | 2 |
Local Independents | 2 | 1/1 | Coalition | 2 |
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Characteristics | n | Female/Male | |
---|---|---|---|
Sex | 18/23 | ||
Mean age in years (range) | 61.7 (27–79) | ||
Education level in years | Upper secondary > 16 | 8 | |
University > 18 | 33 | ||
Professions n = 51 1 | Nurse/Midwife | 6/2 | |
Physiotherapist/Medical doctor | 1/1 | ||
Nursing assistant | 3 | ||
Social Worker/Psychologist | 2/1 | ||
Engineer/Finance | 3/6/ | ||
Legal/Mathematician/ Statistician | 1/1/1 | ||
Police/Military | 1/1 | ||
Teacher/Headteacher | 1/3 | ||
Special educator/Caseworker Social insurance agency | 3/1 | ||
Fire/Environmental inspector | 1/1 | ||
Political science/Health science | 1/1 | ||
Humanities/Agriculture | 1/1 | ||
High school education 2 | Technology/Social science/Natural sciences | 5/1/2 | |
Political assignment with responsibility for the care of the elderly | Board Chair | 13 | 3/10 |
Board Vice & Deputy Vice Chair | 6 | 5/1 | |
Board member | 17 | 8/9 | |
Deputy board member | 1 | 1/0 | |
Committee Chair | 1 | 0/1 | |
Committee Vice Chair | 1 | 1/0 | |
Committee member | 2 | 0/2 | |
Mean years politically engaged (range) | 17.3 (2–55) | ||
Mean years responsible for elderly care (range) | 6.8 (0.6–25) | ||
Own experience of working with elderly individuals (yes/no) | 21/20 | ||
Education in work environment (yes/no) | 30/11 |
Categories | Sub-Categories |
---|---|
Interpretation of the assignment directs the focus | Delivering good care when needed. Setting goals and directions. Being responsible for the employees’ work environment. |
Recognizing shortfalls in the employees’ work environment | Sick leave being a major problem. Lacking the prerequisites for the work. Excessive workload and inadequate support to managers. |
Exposing deficiencies due to the COVID-19 pandemic | Deficient work environment during the COVID-19 pandemic. Considering the substantial staff responsibility. |
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Porter, S.; Muhonen, T. The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians. Int. J. Environ. Res. Public Health 2021, 18, 12350. https://doi.org/10.3390/ijerph182312350
Porter S, Muhonen T. The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians. International Journal of Environmental Research and Public Health. 2021; 18(23):12350. https://doi.org/10.3390/ijerph182312350
Chicago/Turabian StylePorter, Susann, and Tuija Muhonen. 2021. "The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians" International Journal of Environmental Research and Public Health 18, no. 23: 12350. https://doi.org/10.3390/ijerph182312350