How guidelines affect street-level bureaucrats : a qualitative study of care managers in eldercare

The aim of this study was to examine care managers and how they understand and use their discretion. We used a qualitative method and the data was gathered by semi-structured interviews. We interviewed eight care managers in four different municipalities in southern Sweden. The theoretical approach we used was Michael Lipsky’s theory about street-level bureaucracy. Roine Johansson has developed Lipsky’s theory and adapted it to Swedish conditions, so we used his adapted theory in order to understand our data. The data was divided into two different categories: firstly, how the municipal guidelines are designed; and secondly, how the care managers used the guidelines. We found that different care managers reacted differently depending on which municipality they worked for. We managed to distinguish differences in how the care managers’ use of the guidelines differed depending on the kind of support the elderly in their care required. The care managers use the guidelines as a support to help them in their work. However, our study showed that some of our interviewed subjects followed the guidelines more strictly than others. Our result shows that some care managers use their discretion more than other care managers. One of our findings was that the care managers often use experts from other professions such as doctors and occupational therapists. The main conclusion of our study is that the requests made by the elderly in their care were granted if their profile was in accordance with the guidelines. If the request was not in accordance with the guidelines the request would necessitate a justification, either medical or social, in order to be granted.