Gender equality in Botkyrka home-help service

‘The report is very interesting, and gives us a hint of what we need to look at more closely,’ comments Lillemor Thorsén, head of operations. ‘What does getting more service inputs mean? What does it mean that women with major care needs don’t apply for service inputs?’

For several years, Botkyrka has been working to integrate a gender-equality perspective into its activities. This perspective is intended to permeate all services encountered by local residents and users.

Employees in the municipal health and social care department have received training in gender-equal response and assessment. In this training, the administrators have deliberately focused on applicants’ needs instead of their sex. The distribution of inputs has now been examined in terms of gender and gender equality.

‘We see things in the report that make us curious. We want to carry on with a larger set of material so that we can perform a more in-depth analysis and find out more about how we can change,’ says Lillemor Thorsén.

Gender budgeting
The authors of the report surveyed the distribution of home-help service among the various categories of male and female users.

‘We applied a cost perspective — gender-budgeting analysis, as it’s called — to reveal the gender aspects of resource allocation. This is the first time we have studied a municipal activity closely. Previously, we’ve looked at activities in the county council and at the government budget.’

The investigators used 28 randomly chosen personal files from the municipal home-help service. Half of these files represented female and half male clients.

The study showed clear gender patterns. The results tally well with national surveys of elderly care and unpaid care of family members.

Nursing care for women, services for men
Ill-health and frailty are the factors that mainly determine eligibility for the home-help service. Women are in generally worse health and, in terms of hours, get more home-help service than men.

What, then, do women and men get help with? Women received considerably more help with personal care — actions like taking a shower and getting dressed. Men, on the other hand, were given more help with housework, i.e. actual ‘service’: assistance with breakfast, making beds, washing up, preparing meals, laying the table, taking out the rubbish, doing the laundry, shopping, errands, changing the bedclothes, cleaning, dusting and window-cleaning.

This was remarkable, the researchers thought. If women are in inferior health and have extensive help needs when it comes to personal hygiene, then they should also need more assistance with housework. Is it more difficult for the home-help staff to carry out tasks that are traditionally women’s work?

The authors of the report also analysed the distribution of municipal food deliveries. More food was delivered to women, who thus received more mass-produced food than men. Was this one reason why women received less help from the home-help service with housework — cooking, washing-up and shopping — and, by the same token, food of an inferior quality?

Where cohabiting heterosexual men are concerned, the results suggest that they get their meals prepared by their partners to a higher degree.

The report findings also show that it makes a difference whether the home-help service user has a live-in partner or lives alone. Cohabiting men have housework done by their wives to a greater extent. Cohabiting women, instead, have to get help with housework from the home-help service.

Compared with women, men also receive more help from both sons and daughters, especially their daughters.

‘In the category found to be in the worst health, cohabiting women received more help with housework than the single women. This prompts the question: “Who carries out the housework for the most poorly single women?”’

Skewed distribution
Another finding that surprised both the investigators and the municipal department was that decisions on home-help service regarding women were, on average, more short-term and required earlier review than the decisions applying to men.

The conventional gender-role patterns are recognisable from research relating to Sweden as a whole. How, then, are costs distributed between women and men?

‘After we had priced the home-help service hours, it became clear that the women in our data were getting a substantially larger share. Of all the service resources, 64 per cent went to the women and 36 per cent to the men. The women received home-help service for just under SEK 90 000 more a month than the men.’

Home-help service users do not pay the whole of this sum themselves. The charge is calculated on the basis of the individual’s financial situation.

Care of the spouse at home
Elderly female pensioners are in a weaker financial position than elderly male pensioners. In 2007, the women’s median pension was 63 per cent of the men’s median pension in heterosexual couples when both are drawing their pension.

National research shows that unpaid elderly care provided by family members, relatives or others close to the recipients accounts for approximately 70 per cent of social care for elderly people living in their own homes.

Unpaid elderly care is thus a large — and, it may be added, little discussed — occupational area in society. Previous work shows that 70 per cent of the older people who receive help from relatives get it from a woman, usually the wife or a daughter, while 30 per cent get this help from a man. The elderly care received by men is largely provided by their wives.

When the women, who are often younger and healthier, incur greater care needs they are obliged to make more use of municipal elderly care and other (female) relatives.

Elderly women who look after their husbands are often alone in bearing this care responsibility. A man who looks after his wife, on the other hand, more often has both the home-help service and daughters or other relatives as back-up.

Value and costs
To determine the value of the unpaid care provided, the researchers performed a standardised calculation for the whole municipality of Botkyrka. Based on the cost of the municipal home-help service, a total value of some SEK 355 million a year has been estimated.

The municipal home-help service costs some 30 per cent of the above figure, i.e. SEK 110m.

If the unpaid care provided by relatives is divided among women and men according to the 70/30 principle, women are found to provide unpaid care in the home valued at SEK 174m, while the care provided by men is valued at SEK 75m.

Women’s unpaid work: SEK 100m
Women are thus estimated to carry out more unpaid care of family members than men do — SEK 100 million more a year in the municipality of Botkyrka.
Research at national level has emphasised the fact that women’s large-scale unpaid work in elderly care has an adverse impact on their position in the labour market. Given the above background, this conclusion is not difficult to understand.

How, then, should Botkyrka and other Swedish municipalities remedy the skewed distribution of unpaid elderly care?

The prevailing situation does not correspond at all well with the national interim policy target (since 2006) for gender equality: that there should be an even distribution of unpaid housework and social care. Women and men are intended to assume the same responsibility for the work of running a home, and to enjoy the same scope for giving and receiving social care on equal terms.

The authors of the report propose: ‘One solution would perhaps be to introduce a training course in nursing and housekeeping for men who have (major) care needs.’

Solving the problem: diet for men, gym for women?

Bo Johansson, chairman of the municipal health and social care committee, agrees with the report.

‘But I can also imagine one or more forms of activity as part of a popular movement. In Botkyrka, we’re developing venues for elderly people, and people with disabilities, to meet. The municipality’s role consists of being the coordinator and arranging premises.’

Johansson continues: ‘The purpose of the meeting places is to build on all things healthy — to offer cookery classes, water gymnastics, Qigong and so on.

‘Our experience is that it is mainly single men who have developed their social networks thanks to our meeting places. For women, it’s about exercise and physical fitness. Going to the gym, doing aquafit exercises and the rest have become a boost that helps them improve their health. There are women aged 75 to 80 who have gone to the gym for the first time and think it’s great fun.

‘If we start a range of processes with high attendance rates it’s probably possible to develop most of what’s needed in terms of “unpaid elderly care”. But of course there has to be a strong focus on the national objectives.”

TEXT: Lisa Gålmark

TRANSLATION: Clare James

PHOTOS: Swedish Association of Local Authorities and Regions, municipality of Botkyrka, private sources