the social care contract. Extensive financial responsibilities
have been delegated to all home help unit managers
and home help units are viewed as profit centres with an
explicit demand on them to balance their budgets.
In addition to the respective internal tasks of the two
organisations, certain activities involved in the provision
of care to pensioners require inter-organisational cooperation
and coordination. Some tasks need to be done in
a certain order, for example giving insulin and breakfast
to pensioners with diabetes, as illustrated in the opening
quote of this paper. The framework laws from central
government do not provide any specific guidance or economic
incentives for cooperation in domestic care of the
elderly. Therefore, in 1994, the municipality and the county
in our investigation reached a formal agreement on cooperation
in elderly care. Overall goals in the agreement are
to use public financial resources efficiently and to increase
the quality of care. One part of the agreement is directly
related to the area of interest of this paper: It states that
home help units and health centres should cooperate and
that inter-organisational administrative controls, in the
form of authorisations, should be used. ‘Authorisation’ in
domestic elderly care refers to tasks which are given to a
person who does not have the formal competence, but does
have the actual competence, needed to perform the task.
Thus, home helps are required to perform certain health
care tasks, e.g. give medicine, and ear and eye-drops, in
pensioners’ homes. A nurse is responsible for writing the
authorisation for the home help. The idea is that authorisations
will increase quality and efficiency of domestic care
of the elderly as home helps can give medication when
they are in the pensioners’ homes providing social care.
The agreement states that home help units will not receive
any payment from health centres for the authorised tasks.
Besides guidelines on authorisations, the formal agreement
does not provide any additional guidelines for cooperation
between health centres and home help units; it is up to
these managers to develop a local structure and implement
routines to ensure well-functioning cooperation. There is
no systematic follow-up at the municipality and county
level of what local routines have been developed or how
the cooperation works.