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In measuring the quality of home care services Margareta Lindelöf finds that users’ views are coloured by the belief that they should not expect too much of the service.

In order to measure the quality of care among the clients within the home help service in Sundsvall, I conducted telephone interviews with a random group of primarily older clients. We were unable to include a number of clients who had become ill or preferred not to participate. As a result the number fell from a total of 195 to 125 respondents, whom I talked to on the phone.

One aspect of quality was the link between the needs assessment completed earlier by home care co-ordinators and the resulting home care service actually delivered to the clients. Eighty per cent of the decisions corresponded exactly when comparing the assessments with the reality as described by the clients. The remaining 20 per cent either received more or less help than the assessment had recommended. However, this discrepancy can be seen as an expression of the continual need for the home help system to adapt to changing needs. 

Interestingly, three years earlier a similar survey showed that cleaning was the most frequent service provided. In the present survey cleaning had been replaced by personal care and the installation of security telephones.

Many clients felt that:

- They didn’t get help at the time agreed.

- The quality of service differed owing to who came to help.

- Help was provided by too many different home-helps.

Ninety-two per cent said that they were very politely treated by the home-helps. Eighty per cent were either content or very pleased with the help they received.

It was astonishing to discover the extent to which clients put up with home-helps sometimes having to hurry or not arriving at all. The recipients were seemingly very understanding that these disruptions in service were caused by other factors affecting the carers’ ability to do their work. They were aware that the staff were under pressure and doing what they could to help. It even seemed as if the recipients were in solidarity with the home-helps and were satisfied to a large extent.

However, if we look at the situation described above and that about 25 per cent told me that they did not get the help they needed, I would suggest that recipients were expressing a kind of “disciplined satisfaction”.

There has been an extensive discussion in the media about the economic strains both nationally during recent years and in the local newspapers concerning social work in Sundsvall. This debate may both create and lower the expectations on the home care service among people in general, especially the elderly in need of the home care service system. As a result it seems as if the lowered expectations create a better measure of quality in the eyes of the service users.

This perspective of service users who have learned to expect less and are therefore more satisfied is what I am referring to as a “disciplined satisfaction”. The question is whether the quality is better in reality?

Margareta Lindelöf is a social issues investigator working for social services in Sundsvall.