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The purpose of this paper is to describe three different approaches to work in elderly care (i.e. professional, market-oriented and person-centred) and examine whether these theoretically derived approaches can be confirmed empirically. Additional aims were to examine the endorsement of these approaches and whether there were differences in the endorsement of these approaches in nursing home vs home care and municipality vs privately run care units.

Data were collected using a cross-sectional survey study of frontline care staff (n=1,342). Exploratory factor analysis was used to investigate the empirical validity of the proposed approaches to work in elderly care. A series of paired and independent samples t-tests were conducted to analyse mean differences between the proposed approaches to work.

A principal axis factoring analysis yielded three theoretically meaningful factors as proposed. These results indicated that the respondents were able to differentiate between three distinct but related approaches to work with older persons. The results also showed that the professional care approach was the highest endorsed and the market-oriented the lowest endorsed approach. No notable differences in approaches to work were observed in nursing home vs home care and municipality vs privately run care units.

This is the first study to examine multiple approaches to work in elderly care as previous research studies mainly have investigated the person-centred care approach. Current findings indicate that these approaches to work often coexist in various combinations and that the care staff adopts all these approaches but to varying degrees. The approaches differ in several important respects (e.g. legitimacy and view of the older person) and most likely affect the way care staff treats the older person and how the older person perceives their relationship with the care staff. Knowledge about these differences facilitates management of the care staff’s work situation and helps to improve the quality of care.

Drawing on the organizational psychology literature and social resource theory, this research aimed to investigate how attitude toward the employer (i.e. loyalty) and attitude toward the client (i.e. approach to work: professional, market-oriented and person-centered) relate to the perceived importance of socio-emotional resources in providing care to older people.

Swedish frontline care staff members participated in an electronic survey using a cross-sectional design. Mediation analyses were conducted to examine proposed direct and indirect effects of loyalty on the perceived importance of socio-emotional resources in care through three different approaches to work in care settings.

In general, the results confirmed the hypotheses. Thus, the analyses showed a positive association between employee loyalty and the perceived value of socio-emotional resources in care, which was partially mediated by the person-centered and professional approaches to work. Moreover, the analyses showed that the person-centered approach was more strongly related to the perceived value of socio-emotional resources in care than the other two approaches, lending support to the superiority of the person-centered approach in this context.

The study highlights that there exist multiple approaches to work in care settings. Also, the insights about how loyalty toward the employer relates to approach to work in care settings and the perceived value of socio-emotional resources in care are novel and of crucial importance to practitioners and the outcomes of care.

As marketization has gained ground in elderly care, satisfaction with care has come to play a crucial role in designing for high-quality care. Inspired by the service-profit chain (SPC) model, the authors aimed to gain a deeper understanding of the intricate interplay between supportive leadership practices, organizational climate, job satisfaction and service quality in predicting satisfaction with care.

A Swedish sample of frontline elderly care staff (n = 1,342) participated in a cross-sectional questionnaire study. Mediation analyses were conducted to test the proposed model.

As predicted, engaging in supportive leadership practices was directly and positively associated with satisfaction with care. In addition, as predicted, this relationship was partially mediated by organizational climate and job satisfaction. Moreover, job satisfaction predicted satisfaction with care with service quality explaining a statistically significant part of this relationship.

Managers in elderly care services may improve satisfaction with care in multiple ways but primarily by showing that they care about the staff and ensuring that they are satisfied with their working conditions. Employee job satisfaction seems to be particularly crucial for satisfaction with care, beyond what can be accounted for by care service quality.

The authors proposed a novel service-outcome model. Adding to the original SPC model, the model in this study suggested previously unexplored relationships including a direct path between leadership practices and satisfaction with service and a multiple-mediator model explaining this relationship. Also, new measures of organizational climate and supportive leadership were developed for which satisfactory reliability estimates were obtained.