Prerequisites for empowerment: a study of procurement documents for the provision of care in Swedish nursing homes

Public sector reforms have expanded the number of subcontracted nursing homes in Europe. In Sweden, municipalities contract out nursing homes to various providers through procurement documents, while simultaneously striving for equality in care. This has placed increasing demands on caregivers, in hope of improving care recipients' empowerment and well-being. Consequently, this study has two aims: first, to investigate the prerequisites for empowering care recipients and caregivers in Swedish nursing homes, as expressed in procurement documents; second, to compare procurement documents between municipalities, to determine whether they are (dis)similar based on the objective of care equality. In total, we collected 7 procurement documents, with attachments, from three Swedish municipalities, from 2015 to 2020. Deductive content analysis, based on empowerment theory regarding care recipients and caregivers, was used to analyse the documents. The results indicated an emphasis on empowering the care recipients. The procurement documents placed multiple demands on the caregivers but barely touched on staff empowerment. The municipalities differed in how the providers competed to win the procurement. The result highlights a problematic aspect of the marketisation of nursing homes, namely combining the objective of equality with competition between providers.

Automated summary

Public sector reforms have led to an increase in subcontracted nursing homes in Sweden. Municipalities contract out these homes to various providers through procurement documents, aiming to achieve care equality. However, the demands on caregivers have increased while their empowerment is barely mentioned. Different municipalities have varying approaches to provider competition in the procurement process.