Variations in user-oriented elderly care: a multilevel approach

Purpose National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality). Design/methodology/approach Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM). Findings The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance. Practical implications Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level. Originality/value The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.