Title: Care managers between the citizens, the law and the governing

The bureaucrat has three different demands to consider in his role as a public serviceman. The demands are firstly to obey the law, secondly to be loyal to the politicians and lastly to consider the demands from the citizens. These demands from the citizens can differ depending if they demand them as a part of a larger collective or as solely individuals. I have conducted a qualitative study in which have interviewed seven care managers in three municipalities. The aim of this study is firstly to portray a picture how the care managers regard these demands. Secondly to evaluate the extent of their autonomy and when they encounter ethical dilemmas and conflicts. I have used theories in my study, which focus on autonomy, ethical responsibility, loyalty, and the relationship with the citizens and lastly ethic for the public service. When studying the care managers I evaluated the extent of their autonomy and in which situations they encounter ethical dilemmas and conflicts. I found that the integrated care managers’ autonomy differs from the specialised care managers. The reason behind this is firstly that the integrated care manager’s role constrains its freedom of action. This is due to the responsibilities as both being the person assessing the aid and being in charge of the care staff. For example laws that affects the care manager as a leader of a care staff and as a person of assessing aid can come in conflict with each other. Secondly this role also constrains its ability in the assessing process. The specialist care managers autonomy are also constrained mainly because it is much harder for them to check how their decisions are implemented by the care staff. They do not have daily contacts with the care staff. Neither do they have the time to control their decisions. The two types of care managers are also constrained by local guidelines, which sometimes can come in conflicts with the law. The differences in the construction of the two types of care managers’ role causes that the ethical dilemmas and conflicts sometimes differ. The integrated care managers can encounter ethical dilemmas due to they are in charge of both assessing aid and the care staff. The specialised care managers encounter ethical conflicts in the relationship with those who are in charge of carrying out their decisions. Both types encounter ethical conflicts with other parts of the public administration. An ethical conflict can also arouse between the demands of obeying the law and being loyal.

Keywords: specialised care managers, integrated care managers, law, autonomy, public ethics and loyalty