Historically, care services and coordinating housing services to meet a changing society have been an evolving issue. These are critical issues to the welfare state and policy more generally.

In 1989, the white paper “Caring for People: Community Care in the Next Decade and Beyond” argued for a neoliberal and marketisation approach. This included six key objectives. Promotion of the development of domiciliary care: care assessments; enabling agencies to make maximum possible use of private and voluntary resources to increase the available range of options and consumer choice; accountability of services and better value for the taxpayer; incentives in favour of residential and nursing home care (1). This resulted in the implementation of the NHS and Community Care Act of 1990 (2).  The Community Care act is a significant piece of legislation  when looking at care reform (3).

A study conducted on six local authorities within England, focused on the marketisation of people’s services through the NHS and Community Care Act in 1990. The study concluded that the  aim of a client-centred approach envisaged within professional social work – is at best secondary to the core objective.The act instead reduced the cost and at worst no more than a myth of potential progressive dimensions of knave-oriented policy (4),In contrast, a study conducted by Johnsen & Boswell examined the implementation of the act and then  repeated the same study two years later. For patients it was generally viewed as successful; however, bed blockages were still a major problem. Clinicians suggested it had deteriorated within two years of implementation with inadequate home care services, and one county in Wales reporting a dramatic deterioration in the provision of services based at home (5).

Furthermore, the NHS and Community Care Act highlights how individuals who are self-funding care can look for alternative accommodation themselves and have the right to request that their local authority takes action. Neither the Rent Act of 1977 or the Housing Act of 1988 improve rights for vulnerable or elderly tenants. In hindsight, vulnerable and elderly tenants rights within care homes, council properties, and private properties were not scrutinised enough to ensure a good standard of living. The rights of tenants were not properly protected and instead focused too much on reducing the cost for local authorities and the government, which damages any attempts at a single approach to vulnerable and elderly housing rights.

Currently within the UK 5,871 care home residents were served an eviction notice in England during 2021–2022, with a staggering 253  homes serving four or more notices during a single year. One study found that ‘notices to quit’ cause significant strains between relatives, care homes, and families. Many care homes do have an appeals process, in which a relative or advocate could raise a complaint about a ‘notice to quit’. However, the ombudsman has to look into it independently during a notice to quit.   It can also be difficult to find alternative accommodation during this period for a relative, and there is a legal way to challenge the notice. Many individuals and families can’t due to the stress and financial costs associated with civil proceedings within the UK (8). Individuals that are moved,  may face a significant impact on their health and wellbeing during this period (9).

It is possible to exhibit ageism when you generalise and oversimplify evictions for elderly individuals in society. Further research on evictions and care homes must be conducted. To ensure full understanding of the complexity of these issues. A universalistic approach to housing vulnerable and elderly individuals should be reflected in the policy. From cradle to grave, ensuring tenants are protected in the UK.

Sweden’s Approach

Sweden’s welfare system  is similar to the welfare systems of other nordic countries.These countries prioritise a universal and citizenship-based model with a high level of generosity (11). Virtually all care services for the elderly were provided by the public sector until the end of the1980s, Swedish care for the elderly has been largely influenced by the New Public Management approach (12).

The concept of ‘ageing in place’ is the idea that older individuals should be able to live in their homes and receive care from home for as long as possible, until individuals are placed into residential based care which differs from the UK. Sweden’s long-term care units have changed to provide more rehabilitation with discharge back into the community. Nursing homes, however, are similarly reserved for end-stage care and palliative care (13).

The Act on Sweden Municipalities’ ensures good housing and promotes appropriate measures for housing applications (14).

Within the Social Services Act, an individual’s fees may be no more than  a twelfth of the base amount for special accommodation. Municipalities have a significant influence on cost management while supporting individuals. Within The Social Services Act, the cost of special accommodation is included with the fee or rent of the housing (15). Legislation and policies tend to portray Sweden as protecting tenants, either through the Municipality having significant control or through multiple shareholders influencing the needs of elderly individuals.

In contrast, a study on the lived experiences of elderly individuals in Sweden disclosed how they had little or no control over changes in the home care services they received. Individuals were often not informed about sudden changes in services (16).  These concerns had resulted in individuals feeling insecure and anxious about the services provided for a variety of reasons (16).

The earner-career model which is an egalitarian approach to both men and women equally engaging in both caregiving and paid employment. Which is a crucial element of the Swedish welfare state and the perception of gender equality. While the egalitarian family is a policy goal, the economic vulnerability of single-parent households is often overlooked in policy debate within Sweden (17). Future generations will certainly be harmed by this process of overshadowing the issues faced by current vulnerable individuals.

Peterson argues we need to continuously examine normative assumptions on policy issues in relation to the welfare state. If not, welfare state retrenchment and increasing social inequality could harm older women and women carers particularly. The needs and lives of vulnerable groups must be front and centre when speaking about the sustainability of care (17).

In comparison with the UK, there is only a limited amount of literature on the rights of tenants in care homes, institutions, and special accommodations in Sweden. However, it tends to portray elderly and vulnerable individuals as more protected under legislation compared to the UK, although a mixed perspective remains on care services.

Recommendations

Similar to the recommendations proposed by Emmer De Albuquerque Green & Manthorpe:

• The Care Quality Commission needs to offer any support to families and individuals who are facing a notice, it is crucial to reduce the impact and trauma caused by a notice to quit. These resources need to be comprehensive and accessible at all points of access. The Care Quality Commission is a regulator of health and social care in the UK, it should guide the legality of procedures and processes associated with notices to quit.
• Local authorities and the Care Quality Commission need to provide resources regarding dealing with rejection from care homes and constructively arranging re-assessment during a difficult period of distress for all individuals involved.
• Policy reform must also include better rights for tenants. A relevant meeting should be held if served notice. Extensions of the 28-day notice to quit must be included if a care provider or new housing is not found within the notice to quit period. Individuals must be informed by written notice with evidence in regards to a notice to quit. The tenant must be able to choose communication of choice during this period. Regardless of choice, Verbal communication is insufficient, which is detrimental to all involved in this process.
• If repeated notice to quit is served to individuals within one residency. Local authorities and the Care Quality Commission should review the quality of care and facilities that provide social and health care to ensure they are suitable to be providers of care.
• Current research lacks the lived experience of care home professionals, care entrepreneurs, and social care staff. The involvement of independent mediators, social workers, and advocates should work in partnerships to help resolve or manage any disagreements that lead to a notice to quit for individuals. These meetings need to be constructive and mediate the power imbalance between the tenant and the housing provider.

References

1. Department of Health (1989) Caring for People: Community Care in the Next Decade and Beyond London: HMSO.
2. UK Government. (1990). National Health Service and Community Care Act 1990. https://www.legislation.gov.uk/ukpga/1990/19/contents
3. Adams, R. (2007). Foundations of health and social care Bloomsbury Publishing.
4. Martin, G. P., Phelps, K., & Katbamna, S. (2004). Human Motivation and Professional Practice: Of Knights, Knaves and Social Workers. Social Policy and Administration, 38(5), 470–487. https://doi.org/10.1111/j.1467-9515.2004.00402.x 
5. Johnsen, A., & Boswell, G. (1997). The 1990 NHS and Community Care Act: A 2 year Follow-up Survey of its Effects on Hospital Services for the Elderly in Wales. Age and Ageing, 26(1). https://doi.org/10.1093/ageing/26.suppl_1.p31-a
6. UK Government. (1977). Rent Act 1977.https://www.legislation.gov.uk/ukpga/1977/42/contents
7. UK Government. (1988). Housing Act 1988. https://www.legislation.gov.uk/ukpga/1988/50/contents
8. Emmer De Albuquerque Green, C., & Manthorpe, J. (2023). ‘Angry, Relieved, Forever Traumatised’: A Report into the Experiences of Families of Care Home Residents who Were Served a ‘Notice to Quit’. NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London https://doi.org/10.18742/pub01-113
9. Competition and Market Authority. (2017). Care Homes Market Study Final Report.
10. https://assets.publishing.service.gov.uk/media/5a1fdf30e5274a750b82533a/care-homes-market-study-final-report.pdf
11. Greve, B. (2004). Denmark: Universal or not so Universal Welfare State. Social Policy and Administration, 38(2), 156–169. doi:10.1111/j.1467-9515.2004.00383.x
12. Meagher, G., & Szebehely, M. (2013). Marketisation in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences Department of Social Work, Stockholm University. http://www.diva-portal.org/smash/get/diva2:667185/FULLTEXT01.pdf
13. Davey, A., Malmberg, B., & Sundström, G. (2014). Ageing in Sweden: local variation, local control. The Gerontologist, 54(4), 525–532. https://doi.org/10.1093/geront/gnt124
14. Sveriges Riksdag. (2023A). Socialtjänstlag ‘Social Services Act’. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/lag-20001383-om-kommunernas_sfs-2000-1383/
15. Sveriges Riksdag. (2023B). Leg om Kommunernas Bodstadförsörjningsansvar ‘Law on the libaility of the muciipalities of housiong provision’. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/socialtjanstlag-2001453_sfs-2001-453/
16. Olsen, M., Udo, C., Dahlberg, L., & Boström, A, M. (2022). Older Persons’ Views on Important Values in Swedish Home Care Service: A Semi-Structured Interview Study. Journal of Multidisciplinary Healthcare, Volume 15, 967–977. https://doi.org/10.2147/jmdh.s347886
17. Peterson, E. (2022). A Caring State? Welfare State Retrenchment, the Effects on Women, and Feminist Responses in Sweden Rosa Luxemburg Stiftung Brussels Office.