The starting point
In Mörbylånga, a small Swedish municipality on the island of Öland, the leadership decided in 2021 to understand and improve home care from the outside in with the Vanguard Method: go out and see what actually happens, from the perspective of the person receiving care, and build better help on that knowledge. A group of home care staff were given the chance to do it thoroughly, full time.
What they learned will not surprise anyone who has worked in home care. On average, people received help from 22 different care workers in a month. For one person it was 38. Minute-by-minute scheduling produced situations where the care worker arrived at a time that did not fit what the person actually needed. Alarm calls from people receiving care were frequent. Staff were exhausted and frustrated at having to deliver something they could see for themselves did not work.
What they did
They did away with minute-by-minute scheduling and switched off the central planning system. The care workers now planned their own work. The checks on whether visits had been carried out were removed. The needs assessor no longer set exact tasks and times; she established a need. The rest was up to the care staff, who now had room to judge and adapt the help to the individual person.
It took deep trust between management and staff. Sofi Ludvigsson Ferm, head of elderly care, followed each team through the whole start-up, for more than a year, to make the trust real.
“Had I not been part of that whole process, I would probably have hesitated a few times over these years about whether this was the right way to go. But I haven’t needed to, because I have seen it.”
Sofi Ludvigsson Ferm (translated from Swedish)
The results after three years
- The number of different care workers per person fell from 22 to 12 a month.
- In SPF Seniorerna’s home care index, which compares home care across Sweden’s municipalities, the municipality went from 104th place in 2023 to 9th place in 2024. In 2025 it was 11th.
- Overtime costs were more than halved, from SEK 1.97 million in 2022 to SEK 753,000 in 2024.
- Total home care costs in 2024 were at the same level as in 2023, despite pay and price rises. The cost per inhabitant over 80 fell sharply from 2022 to 2024.
- The number of alarm calls fell, because when you know the person who helps you, and she knows you, anxiety gives way to a sense of security. One person went from 37 to nine alarm calls in a week.
- All the work teams say they are less stressed.
- Recruitment became easier: care workers heard about the Mörbylånga model and wanted to work there.
Sofi has put it this way: she did not count on the financial effects. That was not the goal. The goal was to do the right thing for the people receiving care. Better economics were the consequence.
Control did not give an overview
Before, staff registered when they arrived at and left each person’s home, and managers followed the times. It felt like order. But it said nothing about what the help was actually like. One care worker said she stayed with the person longer than needed, so that the registered time matched the planned time. The system built in waste while everyone believed the opposite.
“But really, we had no idea what the quality of the work actually was.”
Sofi Ludvigsson Ferm (translated from Swedish)
The next step
In version 2.0 the needs assessment decides that there is a need, not exact tasks and times. Care workers plan the help together with the person, and some people call for help themselves instead of having fixed visits. A woman who was woken for three planned toilet visits each night chose to call when she needed to. She slept through the night.