The Swedish elderly home-help service was case studied in this paper in order to examine the context, factors, and the characteristics of the recent change in and the current shape of Swedish social services. A rich review was sought of how the Swedish elderly care service has developed under which conditions and background until 1990, then the changes since then were examined under three themes: payment systems; service providers; and the quality assurance systems. The Swede have developed their social services as a universal, inclusive and generous public service, which was strongly influenced by various contextual factors including political-economic (the labour society), political (the Social Democratic party), socio-demographic (the early aging society), socio-political (women’s power) and cultural-historical (a strong trust in government) ones. The reform of elderly home-help services in the 1990s and afterward, that can be characterised as localization and marketization, has largely been led by the aim of cost containment as commonly seen elsewhere, but it can also be said that the contextual factors and the institutional legacy have partly been shaping it.