The Dutch sector of nursing homes, homes for the elderly and home care is facing great challenges. In a relatively short period of time, care organizations have to transform from risk free financed public services to market oriented social enterprises. In the latter role, care organizations have to cope with new questions, varying from demand driven care concepts and critical care consumers to uncertain revenue streams and financial risks. To cope with these challenges managers of care organizations use an increasing amount of accounting information. This need for more and better information is prompted by three developments. First of all, the necessity to stay in control and to cope with the growing number of environmental uncertainties urges management of care organisations to a more detailed monitoring of financial developments. Secondly, for the purpose of making care services more custom made, all kinds of tasks and responsibilities – including budget related tasks – are delegated.
This decentralization requires both disseminated and uniform management accounting and control systems (MACS). Finally, various stakeholders, like central authorities, banks and health care insurance companies, ask for more detailed information and ditto accountability. These developments impel care organizations to adopt MACS, a concept well known in for profit sectors, and translate these systems to fit the specific requirements of their sector. But so far we do not know how these translations at micro level look like. Nor do we know which tensions emerge with the extension of MACS and how actants solve, mitigate or try to avoid these tensions.
