Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation

Scand J Caring Sci; 2013; 27; 414–421 Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation Objectives:  This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser–provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers’ needs, and cooperation between provider and purchasers are indicators of good quality of care. Data and Methods:  Data were collected through semi‐structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008–2009. The study has been approved by the Norwegian Social Science Data Services. Findings:  We identified four different ways of organising home care services under a purchaser–provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Conclusions:  Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser–provider split models implies. Ironically, in provider units where the ‘rules were undermined’, the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered.