Structural differences
affect quality of care
for the elderly

What can we do to increase quality in municipal elder care? In a new thesis from Jönköping University, Dan Lundgren investigates the link between leadership, the psychosocial environment and satisfaction of those receiving care at home and in nursing homes.

Dan Lundgren works as a process manager in social services for the municipality of Jönköping. The subject of his doctoral dissertation was chosen as a consequence of the challenges and issues he meets in his professional life.

"Sweden is facing a major population decline of people of a working age, creating new challenges for recruiting and retaining competence,” says Dan Lundgren.

The number of people of 80 years and older will increase by approximately 75 percent until 2035. During the same period, the numbers of nursing assistants are likely to decrease. Earlier research has also shown that one in two employees in this sector has considered leaving their job. Furthermore, health and social care services have the highest rates of sick leave in Sweden. Preliminary estimates show that there will be a shortfall of 160,000 employees in the coming decade.

”Good leadership and a good psychosocial work environment are of great importance for reducing sick leave. When the staff are doing well, the recipients are more likely to be more satisfied with their care.”

In his thesis, Dan Lundgren has analyzed the importance of leadership and the psychosocial work environment for the recipient’s perceived quality in elderly care. The results show that there are structural differences between home care and nursing homes that directly and indirectly affect the assistant nurses’ experienced work situation and the satisfaction of the recipients.

”Home care and nursing homes are two separate contexts with completely different structures and working methods. The structural differences between nursing homes and home care suggests that there are different requirements for leadership and the psychosocial work environment.”

What surprised Dan Lundgren most, was the limited potential for impact in home care.

"The managers could influence the staff but had almost no impact at all on the satisfaction of the those receiving the care. In nursing homes, the situation was different as leaders, assistant nurses, recipients and relatives all interact in a completely different way in a common environment."

“There is also a trend for older adults to receive care in their own homes. And home care in its current form has not adapted to the changes regarding the need for a close and direct leadership and a psychosocial work environment that enables interaction with leaders, colleagues and care recipients.”

The conclusion is that better leadership and a psychosocial work environment, especially in nursing homes but also in home care, contribute to greater satisfaction among the recipients. In order to meet the challenges of the future, leadership and psychosocial work environment need to be adapted to the organisational conditions.

Dan Lundgren. (photo: private)

"We have to take into account the structural differences between the different types of care. Or we'll have to radically rethink. For example; nursing homes and home services could be transformed into one financial unit with a common use of resources.”

Dan Lundgren successfully defended his thesis "Leadership, psychosocial work environment and satisfaction with elder care among care recipients" External link, opens in new window. at the School of Health and Welfare, Jönköping University, on December 14th. For more information, you are welcome to contact Dan Lundgren on phone 036-10 24 80 or by e-mail: