I artikeln granskas och diskuteras fem decenniers forskning om arbetssituationen i den svenska hemtjänsten. I granskningen ingår doktorsavhandlingar och annan akademisk forskning men också forskningsrapporter och annan ”grå litteratur”. Analysen visar att det knappast har funnits en guldålder där arbetet har präglats av goda arbetsvillkor. Även om anställningsförhållandena klart har förbättrats sedan 1970-talet, är deltidsarbete och temporära anställningar fortfarande är vanligare i hemtjänsten än på arbetsmarknaden i stort. Samtidigt har arbetsvillkoren på många sätt försämrats. Den traditionella hemtjänstens organisationsmodell med fasta relationer mellan personal och hjälptagare och ett relativt stort handlingsutrymme för såväl hjälptagare som hjälpgivare har ersatts av olika försök att rationalisera och effektivisera arbetet, med knappare biståndsbeslut och en mer detaljerad förhandsstyrning av arbetet. Arbetet har blivit mer tidspressat och handlingsutrymmet har minskat vilket riskerar att minska utrymmet för omsorgens relationella aspekter. Samtidigt har de politiska ambitionerna höjts med betoning av värdegrund och individanpassning, och marknadsinspirerade organisationsmodeller som betonar konkurrens och valfrihet har införts. Sammantaget präglas hemtjänstens arbetsvillkor av ett ökat korstryck mellan kolliderande logiker: en relationsinriktad omsorgslogik som sedan början av 1980-talet alltmer befinner sig på koalitionskurs med en ekonomistisk och marknadsorienterad logik.

I detta kapitel undersöks hur hemtjänstpersonal i Sverige upplever sina förutsättningar att ge individanpassad omsorg i relation till arbetets organisatoriska villkor. Rätten till individanpassning inom äldreomsorgen har stärkts under de senaste decennierna samtidigt som verksamheten genomgått omfattande förändringar karaktäriserade av åtstramningar, effektiviseringsträvanden samt nya styr- och organisationsmodeller. I denna kontext framställs omsorgspersonalen som den främsta garanten att realisera lagstiftningens ambitioner om en individanpassad omsorg samtidigt som deras arbetssituation kraftigt har försämrats med minskat handlingsutrymme och ökad tidspress.

Studien baseras på tretton gruppintervjuer med hemtjänstpersonal med totalt 64 personer och materialet har analyserats med hjälp av kvalitativ innehållsanalys. Resultatet visar att hemtjänstpersonalen upplever hur arbetets organisatoriska villkor som biståndsbedömning, strikt tidsstyrning samt verksamhetens ramar och rutiner påverkar möjligheterna att arbeta individanpassat. Analysen synliggör en spänning i omsorgsarbetet mellan en ekonomistisk logik - präglad av tidsstyrning och effektivisering - och en relationsorienterad omsorgslogik som betonar flexibilitet och lyhördhet. Samtidigt identifierar informanterna i den här studien potentialen i verktyg som ramtid och genomförandeplaner att främja individanpassning, men att de organisatoriska villkoren utgör ett hinder för detta.

In most Western countries, the eldercare sector has undergone transformations to obtain cost containment and more efficient service provision, changing the temporal framing of homecare. Time pressure is a salient issue in homecare, but little is known about how homecare workers experience the temporal conditions of their work. Based on 13 group interviews with homecare workers in Sweden, this study examined how the staff experience temporal conditions and handle time pressure in their everyday work in a context of marketisation and increased use of 'information and communication technology'. The analysis showed that the workers attributed their experiences of time pressure to the compression of time, the control of time and the unpredictability of time. Strategies adopted to handle time pressure included working unpaid hours, maximising efficiency and reallocating time. It is concluded that the homecare workers primarily adopted individual short-term strategies to deal with structural and organisational temporal issues.

Although international research has shown an increase in precarious work in recent decades, few of these studies have been devoted to paid care work. This article joins feminist research on care work with work–life balance-oriented research on precarious work to study the work situation of Swedish homecare workers. The results show a high prevalence of multidimensional precariousness among the care workers and reveal how several indicators of job precariousness are associated with physical and mental strain, poor work–life balance, and intentions to quit the job, including time pressure, lack of job control and limited possibilities to develop and use skills, as well as to create and keep relations with users.

The purpose of this thesis is to analyse the work situation in Swedish homecare from the perspective of care workers. In recent decades, the eldercare sector has faced challenges related to organisational changes and difficulties with retaining and recruiting staff. Due to an ageing population, increasing needs for care and a decline in residential care there has been an increased focus on ageing-in-place policies. Homecare is thus an increasingly important part of eldercare, both in Sweden and in other Western countries.

The thesis consists of four studies that explore and analyse different aspects of the work situation in Swedish homecare. The empirical material consists of both quantitative and qualitative data. The quantitative part of the thesis derives from survey-data (Nordcare) from 2005 and 2015, whilst the qualitative material consists of 11 group interviews with 64 homecare workers. Theoretically, the thesis draws upon feminist perspectives on care work. In order to deepen the analysis of the work situation in homecare, the thesis joins work-life oriented research with feminist care research. The results are related to and analysed against the backdrop of recent structural changes and reorganisations in the eldercare sector.

Study I shows that the work situation in Swedish home care has deteriorated between 2005 and 2015, both regarding intensification of work and the occurrence of work-related problems. For example, workers in 2015 reported meeting a larger number of recipients per day, receiving less support from their supervisor and colleagues, and having considerably less autonomy to affect the planning of their daily work. Study II illustrates geographical differences regarding homecare workers experiences of their work situation. Staff in larger cities experience worse working conditions and more mental strain, but better employments conditions, work-time arrangements and work-life balance, compared to those working in rural areas. Study III shows that homecare workers in Sweden experience a high level of multidimensional precariousness, and that several of the problematic working conditions are associated with physical strain, mental strain, poor work-life balance and considerations to quit the job. The main results of study IV are that the workers attribute their experiences of time pressure to the compression of time, the control of time and the unpredictability of time. Strategies adopted by the workers to handle time pressure include working unpaid hours, maximising efficiency, and reallocating time. Thus, the workers mainly adopt individual and short-term strategies to deal with time pressure, with potential negative consequences for both the workers and the care recipients.

Overall, this thesis shows that the work situation in Swedish homecare has deteriorated over time and is characterised by several problematic employment- and working conditions, over a range of dimensions, with negative consequences for the workers’ health and wellbeing. The accumulation of work-related problems and multidimensional precariousness experienced by the workers strongly indicate that there is no easy solution to the issues experienced by the homecare workers, calling for wide-ranging political and organisational responses.

As in many Western countries, eldercare services in Sweden have changed dramatically over recent decades. Population ageing, ageing-in-place policies, pressures to contain costs and organisational reforms linked to New Public Management are challenging public home care. There is, however, limited knowledge about how the job content and working conditions have changed in the Swedish home care across this period. This article aims to analyse and compare the work situation in the Swedish home care in 2005 and 2015. The analysis is based on the international Nordcare survey and draws on the subsample of respondents working in Swedish home care 2005 and 2015 (n = 371). The data were analysed with bivariate and multivariate methods. The results suggest that, overall, the work situation of home-care workers was worse in 2015 compared to 2005. For example, those surveyed in 2015 reported meeting a larger number of clients per day, receiving less support from their supervisors, and having less time to discuss difficult situations with colleagues and considerably less scope to affect the planning of their daily work. Care workers in 2015 were also more mentally exhausted than those surveyed in 2005. In addition, the workers in 2015 experienced an accumulation of work-related problems. Deteriorating working conditions could be related to cutbacks and organisational reforms, and evidence suggests that home-care workers are paying a high price for ageing-in-place policies. Improvements of the work situation in home care are necessary not only to ensure the quality of care for older people, but also to ensure workers' well-being and to recruit and retain care workers, and thus, to meet the future needs for home care in an ageing society.

I Japan räknar en dator ut vilken nivå av äldreomsorg en person är berättigad till. Men den mänskliga kontakten med hemtjänstens personal spelar fortfarande en stor roll för åldrande japaner.