Organising Auditing, Person-Centred Care and Competence in Swedish Residential Care Homes

Since the 1980s, research on care has stressed that the organisational conditions of work are crucial for workers’ and care receivers’ experiences of care quality. Working conditions in eldercare have been challenged by New Public Management (NPM) reforms, which emphasise standardised managerial control functions. Based on interviews conducted in two Swedish residential care homes we analyse how auditing, person-centred care and competence are implemented in everyday work. The dimensions studied are described with ambivalence: Both positive and negative aspects are linked to three dimensions of work. But, to foster a practice where logic of caring get more space in relation to the rationality of marketisation, there is need for organisational changes that promotes development where the aim of documentation is transparent in everyday work. Further, to achieve person-centred care, workers require conditions enabling them to respond to the person’s needs and not only what is written in care plans. The results show tensions between formal education and experience-based skills that contributed to make the relational and emotional aspects of care invisible and unrecognised. These struggles highlight tensions between two organisational logics—rationality of caring and marketisation—where one, rationality of caring, is devalued by the organisation but not in the everyday work.