How do local guidelines delimit the municipal responsibility to meet the needs of older people?

Abstract

According to the Social Services Act (SSA), the municipality is ultimately responsible for ensuring that persons staying within its boundaries receive the services they need in order to be assured of a reasonable standard of living. Although municipal guidelines are acknowledged as decisive for how welfare services are implemented at the local level, there are few studies on how these documents are designed. The aim of this article is to show how the municipal responsibility to meet individual needs is circumscribed in guidelines for need assessment in elder care. The purpose is to increase understanding of the possibilities for care managers to meet individual needs while following local guidelines – and to provide a basis for discussions about the governance of Swedish eldercare. The paper applies the theory of framing in the analysis of guidelines in 51 strategically chosen municipalities and maps the frequency of guidelines.

According to the analysis, local guidelines frame the municipal responsibility as having to provide certain services rather than having to meet individual needs. Designation of a limited range of services is legitimized by SSA being a frame law, leaving discretion for local variations. Limitations of responsibility are also legitimized by accurate, and inaccurate, references to case law and by shifting responsibility for meeting needs onto relatives, which is legally questionable. In 2019, 274 of Sweden’s 290 municipalities had guidelines for needs assessment in eldercare. If applied, guidelines risk having a negative impact on legal security as they establish a normative assessment standard which is difficult to combine with individual need assessment. Furthermore, by having to follow both SSA and local guidelines, which are often contradictory, the hands of the care managers