with overall goals and general guidelines. Municipalities
and counties were free to decide on their own internal
organisational structure, as well as the structure for interorganisational
cooperation. For the city investigated in this
study, the structure put in place for domestic care of the
elderly involves both the municipality and the county.
The municipality is responsible for providing the
domestic social care, which includes assistance with
personal hygiene, shopping for groceries, laundry and
cleaning. Many elderly people also need help with health
care, for example taking their medicine and eye-drops, and
caring for wounds. Employed by the health centre, assistant
nurses and nurses are those who primarily provide
domestic health care of the elderly. The nurse is the person
with the responsibility for planning and assigning the different
tasks while assistant nurses, for example, take pulse
and blood pressure measurements and conduct blood tests.
Nurses give injections, judge whether a pensioner needs to
be sent to hospital or not, prescribe aids and put medicine in
special medicine boxes to provide patients with the appropriate
doses for each day. The organisation of domestic care
of the elderly is summarised in Fig. 2.
Laughlin and Pallot (1998) describe Sweden as being
at the forefront of those adopting NPM changes, and the
municipality and county in our study are no exceptions. The
municipality’s structure for domestic social care was put in
place in 1993 in such a way that care was organised with a
purchaser–provider model, where purchaser and provider
units had separate budgets and income statements. People
responsible for determining the appropriate help for
pensioners, social care service purchasers, are organised
as a central unit called the purchaser unit. Social care service
purchasers discuss pensioners’ social care needs with
them and write social care contracts. Based on the contracts,
the purchaser buys services from the home help unit.
The payments made to home help units are calculated from
an estimate of the duration for each operational activity in