Home help services in Sweden: responsiveness to changing demographics and needs.

Decreases in Swedish home help services have not resulted in increased rates of unmet need. To understand these changes, we identified predictors of home help services and rates of institutional care and how these effects changed over time using longitudinal data (1994-2000) from 286 Swedish municipalities. Outcomes were home help coverage rates, intensity of home help per recipient, and rates of institutional living. Predictors reflected availability and need for services. Services decreased over time, but not uniformly. Coverage rates were higher in municipalities with a greater proportion of population 65 and older and greater proportion of unmarried elders. Decreases in coverage rates were greater in municipalities with a higher proportion of unmarried elders, greater ratio of older women to men, with more home help staff workers, and more expensive services. Home help was provided more intensively in municipalities with higher median incomes, higher unemployment rates and municipalities spending more per inhabitant on child care. Decreases in intensity were greater in municipalities with lower proportions of unmarried elders and fewer home help staff workers. Rates of institutional living were higher in municipalities that spent more on old age services and with a greater proportion of unmarried elders. Decreases in institutionalization were greater in municipalities with a greater proportion of unmarried elders and lower ratio of older women to men. Variability in how municipalities responded to these changes may explain continued low rates of unmet need. Results are consistent with both increased efficiency and more effective targeting, but cannot capture service quality.