ABSTRACT
Governments in many countries have developed policies aimed at encouraging and helping the elderly and those who suffer from long-term illness to continue to live in their own homes for as long as possible. As a result of this, home care has become of key importance in welfare services of the 21st century. At the same time, home care has often been described as a contested area of practice, particularly during periods of economic retrenchment. In fi nancially constrained environments, home care clients’ needs for assistance tend to be defi ned as low priority and not eligible for public support. This is of particular concern to the frail elderly, who often have complex but diffuse health and social needs that call for services that must be tailored to individual circumstances. Studies from different countries have demonstrated how home care services have been restructured in such a way that opportunities to provide fl exible and patient-centered care are seriously limited (Aronson 2001, 2002; Aronson and Sinding 2000; Ceci 2006a, 2006b; Ceci and Purkis 2009; Dahl and Eriksen 2005; Purkis 2001). This trend is commonly attributed to the infi ltration of ideas around market-driven operations, such as managed care, in public welfare services (Aronson 2001; Björnsdóttir 2009; Dahl and Eriksen 2005). In policy documents, services are characterized by demands for standardization and a demonstration of measurable outcomes, while questions of what might constitute good and ethically valid care are often left unattended.
