The Unrecognized Partners in Home Care Provision: How Older Adults Engage in Unintended Co-Production

Background and purpose

Conventional understandings of dependency in eldercare often view older adults as passive and powerless. This study challenges such narratives by exploring how care users are actively involved in co-producing the services they use, even in formal home care contexts in a Nordic welfare state. Applying a conceptual lens of agency in care relationships, it unveils how formal care provision involves significant - if often unacknowledged - contributions from the care users themselves.

This study’s aim is to explore how care recipients act to ensure a sufficient level of quality in the care provision.

Methods

Data were collected through 34 qualitative interviews with 36 Swedish home care users aged 68 to 96, and 15 observations of home care delivery. Respondents represented diverse socioeconomic backgrounds and were users of both public and private care. The ensuing thematic analysis was theory-driven, focusing on care users’ activity.

Results

Users are found to engage in the care provision, compensating for systemic deficiencies. These contributions include planning and coordinating services, emotionally supporting strained and under-paid staff, as well as performing more – often decisive – practical and preparatory work. Despite themselves needing support in everyday life, participants are profoundly involved and are crucial, though unacknowledged, partners in the service production.

Conclusions and implications

Care users’ efforts can be interpreted as a form of unintended co-production, highlighting a paradox in which individuals assessed as less capable of independent self-care play an essential role in the care provision.

Recognising this coerced involvement enables the acknowledgement of a hitherto underexplored dynamics in elder care and encourages addressing systemic shortcomings in formal welfare services. Viewing older care users as de-facto co-producers of domiciliary care in an advanced Nordic welfare state can contribute to understanding older adults’ agency and competencies across welfare regimes and care traditions.