Paradoxernas marknad En studie om företagande i hemtjänsten

Sammanfattning: The aim of this study is to understand how individuals who run a private business in the publicly financed elderly care sector experience their conditions and opportunities as owners and managers of a business in a quasi-market.  The focus is on what happens when the home care service actor’s intentions and conceptions about how home care should be provided encounter the public realm of financing and regulation.The research was conducted as a qualitative interview study of individuals who had started and were running a small or medium-sized business in home care for the elderly. Theories of rationality as well as of actor’s embeddedness in social networks and institutions were used as tools of interpretation and analysis. I also draw on theories of trust and institutionalized distrust as mechanisms for reducing complexity in social systems.The results demonstrate that the reasons for starting a business were multifaceted and thus cannot be understood in terms of dichotomies such as egotism or altruism. Increasing the professional scope of action and the power to make decisions was a central incentive for providers with professional training and experience of previous employment in large health and social care organizations. However, realizing the intentions proved difficult because of the restrictions typically associated with quasi-markets in the elderly care sector. The restrictions involve, for example, relations to the municipal home care service assessor and the elderly client as two different customer categories, the relation between the time allotted for care provision and the remuneration from the municipal authorities, and the tension between trust and distrust in the business relations between care providers and the representatives of the municipal organizations.  Still, the results also show that managing a business in home care can be a positive and rewarding experience.