Norwegian home care in transition - heading for accountability, off-loading responsibilities

Area of Science:

• Social Gerontology
• Public Health Policy
• Health Services Research

Background:

• Home-based care in Norway is a cornerstone of its universal welfare system.
• Evolved within a multi-level governance structure balancing local autonomy and central integration.
• Historically organized in collegial, flexible teams, home care has faced governance shifts towards transparency and accountability.

Purpose of the Study:

• To examine the justification and implementation of new governance trends in Norwegian home care.
• To analyze how accountability arrangements interact with cost-control efforts in local authorities.
• To understand the impact of these changes on home care organizations and service delivery.

Main Methods:

• Analysis of institutional history of home care in Norway.
• Drawing on existing case studies conducted at different time points.
• Qualitative assessment of organizational changes and their effects on responsibilities and service sensitivity.

Main Results:

• Accountability arrangements have become intertwined with cost-containment strategies.
• Home care organizations have been reshaped, leading to fragmented and reduced responsibilities.
• Increased transparency and reliability in service delivery were observed.
• Services may be less responsive to individual needs due to standardization.

Conclusions:

• While enhancing predictability, accountability reforms may disempower recipients lacking additional resources.
• Institutional changes risk undermining the enabling function of home care.
• There is a need to balance care rationing dilemmas with a situated approach to care and due process.