Skip to main content
SpringerLink
Log in

Long-Term Care in Sweden: Trends, Actors, and Consequences

  • Chapter
  • First Online:
Book cover Reforms in Long-Term Care Policies in Europe

Abstract

Sweden constitutes a traditionally well-developed system of long-term care, based on tax-funded, mainly publicly provided services. This system has changed significantly in recent decades. There has been some retrenchment in eldercare evident in falling coverage and stronger targeting of people with higher levels of need. This development has led to the informalization of care for some groups of older people. In disability care, there has been a considerable expansion of services, perhaps most notably in the introduction of a personal assistance scheme for people with severe disabilities. These divergent trends in services for older people and people with disabilities have coincided with a convergent development across both care fields: the marketization of services and the emergence of large, corporate, for-profit providers. This chapter explains how and why these changes have happened, and their consequences for service users and for the possible future of social care in Sweden. In addition to the dynamic interaction of state-steering and municipal response that are typically important in explaining change in patterns of social service in countries with multilevel government, “invasive displacement” and “layering” are identified as processes transforming the institutions that directly and indirectly organize care service provision.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Three groups are specified in the Disability Act: (1) persons with an intellectual disability, autism, or a condition resembling autism; (2) persons with a significant and permanent intellectual impairment after brain damage in adulthood; and (3) persons with other lasting physical or mental disabilities (not due to normal ageing) if these disabilities cause significant difficulties in daily life requiring extensive support.

  2. 2.

    Childcare is another area where increased government ambitions have reduced the municipal resources available for eldercare: with the implementation of the School Act 1995, municipalities became obliged to offer childcare to all children 1–12 years of age. As a result, between 2000 and 2009, the public resources for childcare increased by 67 % (National Agency for Education 2011).

  3. 3.

    Also, after the actual tax-freeze several government initiatives have imposed restrictions on the municipalities’ decision latitude in raising tax rates. For instance, between 1997 and 1999, municipalities that raised their tax forfeited government grants equivalent to half of the increase in revenue (Palme et al. 2003).

  4. 4.

    In Sweden, a parliamentary commission usually is appointed to investigate an issue before a Government Bill is put to the Parliament. The commission presents one or more Government Reports, which are discussed widely during a consultation process designed to provide feedback to the Government. Bills are drafted after the consultation process has concluded (Ministry of Justice 2007).

  5. 5.

    People who begin to access services before they turned 65 are allowed to keep the (typically much higher) level of provision under the Disability Act, rather than be moved into the eldercare system. However, if they have personal assistance, they are not permitted any increase in the service offering, even if their needs change.

  6. 6.

    The study also found that LSS spending also crowded out spending on education, but did not crowd out spending on other municipal social responsibilities, including childcare, social assistance, and culture and leisure activities (Birkelöf 2009).

  7. 7.

    Younger disabled people with smaller care needs who are not eligible under the Disability Act rely, similar to older people, on services under the SSA, or on informal or market care, and they have been similarly affected.

  8. 8.

    Particularly important was the 1987 Long-Term Survey, which suggested both limits on taxation and the introduction of market mechanisms such as a division between purchaser and providers and that private companies should be able to compete with public providers. The argument was that “the consumers’ free choice will show under which organizational forms an activity is best provided according to the consumer’s wishes” (Government Report 1987, p. 178).

  9. 9.

    The same Minister was responsible for both issues, the Minister of Civil Affairs, Bengt K.Å. Johansson, former Assistant Minister of Finance.

  10. 10.

    In contrast to the “real” market, the price is set in advance; thus the providers are expected to compete only with quality.

  11. 11.

    As the deduction is offered to all purchasers of domestic and care services, without needs assessment, it is not possible to determine whether these purchases are a direct substitute for publicly subsidized services offered via the formal care system.

  12. 12.

    As measured by a higher proportion of residents with university education and a higher tax base, both of which correlate to higher average household incomes.

References

  • Antman, P. (1994). Vägen till systemskiftet—den offentliga sektorn i politiken 1970–1992 [The road to the system shift—The public sector in politics 1970–1992]. In R. Å. Gustafsson (Ed.), Köp och sälj, var god svälj? Vårdens nya ekonomistyrningssystem i ett arbetsmiljöperspektiv [Buy and sell. Work environment perspectives on NPM in Swedish health care services] (pp. 19–66). Stockholm: Arbetsmiljöfonden.

    Google Scholar 

  • Birkelöf, L. (2009). Do local public expenditures for functionally impaired crowd out other local public expenditures? [Umeå Economic Studies No. 797]. Umeå: Umeå University.

    Google Scholar 

  • Blomqvist, P. (2004). The choice revolution: Privatization of Swedish welfare services in the 1990s. Social Policy and Administration, 38(2), 139–155.

    Article  Google Scholar 

  • Blyth, M. (2001). The transformation of the Swedish model: Economic ideas, distributional conflict, and institutional change. World Politics, 54(1), 1–26.

    Article  Google Scholar 

  • Dir. (1988). Samhällets stöd till människor med funktionshinder [Social support for people with disabilities]. Instructions for the disability commission of 1989. Stockholm: Ministry of Health and Social Affairs.

    Google Scholar 

  • Edebalk, P. G., & Svensson, M. (2005). Kundval för äldre och funktionshindrade i Norden. Konsumentperspektivet. [Customer choice for elderly and disabled persons in Scandinavia: The consumer perspective] (Tema Nord No. 507). Copenhagen: Nordic Council of Ministers.

    Google Scholar 

  • Eliasson-Lappalainen, R., & Motevasel, I. (1997). Ethics of care and social policy. Scandinavian Journal of Social Welfare, 6(3), 189–196.

    Article  Google Scholar 

  • Feltenius, D. (2007). Relations between central and local government in Sweden during the 1990s: Mixed patterns of centralization and decentralization. Regional and Federal Studies, 17(4), 457–474.

    Article  Google Scholar 

  • Fried, R. (2007). Hemtjänsten i Stockholm—en enkät till brukarna hösten 2006 [Home-care services in Stockholm: A survey of users 2006]. Stockholm: Stockholms stads utrednings- och statistikskontor AB.

    Google Scholar 

  • Government Bill 1990/91:100 Förslag till statsbudget för budgetåret 1991/92 [Draft state budget for 1991/92].

    Google Scholar 

  • Government Bill 1992/93:43 Ökad konkurrens i kommunal verksamhet. [Increased competition in municipal services].

    Google Scholar 

  • Government Bill 2000/01:149 Avgifter inom äldre- och handikappomsorg. [User fees in eldercare and in disability services].

    Google Scholar 

  • Government Bill 2006/07:94 Skattelättnader för hushållstjänster, m.m. [Tax deductions on household services etc.].

    Google Scholar 

  • Government Bill 2008/09:29 Lag om valfrihetssystem [Act on Free Choice Systems].

    Google Scholar 

  • Government Bill 2010/11:1 Förslag till statsbudget för 2011. Hälsovård, sjukvård och social omsorg [Draft state budget for 2011: Health and social care].

    Google Scholar 

  • Government Report. (1987). Långtidsutredningen 1987 [The Long Term Survey 1987]. SOU 1987:3. Stockholm: Allmänna förlaget.

    Google Scholar 

  • Government Report. (1991). Konkurrensen inom den kommunala sektorn [Competition in the municipal sector]. SOU 1991:104. Stockholm: Allmänna förlaget.

    Google Scholar 

  • Government Report. (2004). Sammanhållen hemvård [Integrated Homecare] SOU 2004:68. Stockholm: Fritzes.

    Google Scholar 

  • Government Report. (2007). Vård med omsorg—möjligheter och hinder [Careful care: Possibilities and obstacles]. (Betänkande från Delegationen för mångfald inom vård och omsorg [Report from the Delegation for diversity in care]). SOU 2007:13. Stockholm: Fritzes.

    Google Scholar 

  • Government Report. (2008). LOV att välja—Lag om valfrihetssystem. (LOV—[Legislation on choice] Betänkande av Frittvalutredningen [Report from the Choice Commission]). SOU 2008:15. Stockholm: Fritzes.

    Google Scholar 

  • Green-Pedersen, C. (2002). New public management reforms of the Danish and Swedish welfare states: The role of different social democratic responses. Governance: An International Journal of Policy, Administration, and Institutions, 15(2), 271–294.

    Article  Google Scholar 

  • Grunewald, K. (1974). The guiding environment: The dynamic of residential living. In D. Boswell & J. M. Wingrove (Eds.) The handicapped person in the community: A reader and sourcebook. (pp. 10–18). London: Taylor and Francis.

    Google Scholar 

  • Gustafsson, R., & Szebehely, M. (2009). Outsourcing of eldercare services in Sweden: Effects on work environment and political legitimacy. In D. King, & G. Meagher (Eds.), Paid care in Australia: Politics, profits, practices. (pp. 81–112). Sydney: Sydney University Press.

    Google Scholar 

  • Hjalmarson, I. (2003). Valfrihet inom äldreomsorgen—en reform som söker sin form [Choice models in eldercare]. Stockholm: Stockholm Gerontology Research Center.

    Google Scholar 

  • Hjalmarson, I., & Norman, E. (2004). Att välja hemtjänst [To choose homecare]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • Huber, M., Rodrigues, R., Hoffmann, F., Gasior, K., & Marin, B. (2009). Facts and figures on long-term care: Europe and North America. Vienna: European Centre for Social Welfare Policy and Research.

    Google Scholar 

  • Johansson, L., Sundström, G., & Hassing, L. (2003). State provision down, offspring’s up: The reverse substitution of old-age care in Sweden. Ageing and Society, 23(3), 269–280.

    Article  Google Scholar 

  • Korpi, W. (1996). Eurosclerosis and the sclerosis of objectivity: On the role of values among economic policy experts. The Economic Journal, 106(439), 1727–1746.

    Article  Google Scholar 

  • Lakomaa, E. (2009). The “Ädel Reform”: An economic-psychological analysis of the transfer of government activities from counties to municipalities. In E. Lakomaa (Ed.), The economic psychology of the welfare state. Stockholm: Economic Research Institute, Stockholm School of Economics.

    Google Scholar 

  • Larsson, K. (2006). Care needs and home-help services for older people in Sweden: Does improved functioning account for the reduction in public care? Ageing and Society, 26(3), 413–429.

    Article  Google Scholar 

  • Liljeström, R., & Özgalda, E. (1980). Kommunals kvinnor på livets trappa [Women in the Municipal Workers’ Union]. Stockholm: Svenska Kommunalarbetarförbundet.

    Google Scholar 

  • Loughlin, J., Lidstrom, A., & Hudson, C. (2005). The politics of local income tax in Sweden: Reform and continuity. Local Government Studies, 31(3), 351–366.

    Article  Google Scholar 

  • Meagher, G., & Szebehely, M. (2010). Private financing of eldercare in Sweden: Arguments for and against (Working Paper 1/2010). Stockholm: Institute for Futures Studies.

    Google Scholar 

  • Ministry of Justice. (2007). The Swedish law-making process. Factsheet Ju 07.06e. Retrieved from http://www.sweden.gov.se/sb/d/8589/a/84861.

    Google Scholar 

  • Montin, S., & Elander, I. (1995). Citizenship, consumerism and local government in Sweden. Scandinavian Political Studies, 18(1), 25–51.

    Article  Google Scholar 

  • National Agency for Education. (2011). Kostnader för förskoleverksamhet, skolbarnsomsorg, skola och vuxenutbildning 2009 [Costs for childcare and education 2009]. Stockholm: Skolverket.

    Google Scholar 

  • National Association for Persons with Intellectual Disabilities [FUB]. (2007). Historik: Från idiot till medborgare—en sammanfattning av FUB:s historia [History: From idiot to citizen—A summary of FUB’s history]. Retrieved from http://www.fub.se/fub/historik/.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2003). Konkurrensutsättning och entreprenader inom äldreomsorgen. Utvecklingsläget 2003 [Competition and out-sourcing in eldercare. Status report 2003]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2007). Äldre—vård och omsorg år 2006 [Care and services to older persons 2006]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2009). Swedish disability policy—Service and care for people with functional impairments. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2011a). Lägesrapport 2011. Hälso- och sjukvård och socialtjänst. [Status report 2011. Health care and social services]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2011b). Äldre och personer med funktionsnedsättning—regiform m.m. för vissa insatser år 2010 [Management forms in services for older persons and for persons with impairments in 2010]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2011c). Valfrihetssystem ur ett befolknings- och patientperspektiv. [Choice models from population- and patient perspectives]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health, & Welfare [NBHW]. (2012a). Äldre—vård och omsorg den 1 april 2011 [Care and services to older persons April 1, 2011]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Board of Health and Welfare [NBHW]. (2012b). Tillståndet och utvecklingen inom hälso- och sjukvård och socialtjänst Lägesrapport 2012. [Trends in health care and social services. Status report 2012]. Stockholm: Socialstyrelsen.

    Google Scholar 

  • National Insurance Board. (2002). Ideals and reality in disability policy, social insurance in Sweden 2002. Stockholm: RFV.

    Google Scholar 

  • Nirje, B. (1969). The normalization principle and its human management implications. In R. Kugel & W. Wolfensberger (Eds.), Changing patterns in residential services for the mentally retarded. Washington: President’s Committee on Mental Retardation.

    Google Scholar 

  • Palme, J., Bergmark, Å., Bäckman, O., Estrada, F., Fritzell. J., Lundberg, O., Sjöberg, O., & Szebehely, M. (2003). A welfare balance sheet for the 1990s. Scandinavian Journal of Public Health, 31(60 suppl.), 3–143.

    Google Scholar 

  • Ratzka, A. (1984). The prerequisites for independent living (GLADNET collection: Paper 427). Retrieved from http://digitalcommons.ilr.cornell.edu/gladnetcollect/427.

    Google Scholar 

  • Ratzka, A. (1986). Independent living and attendant care in Sweden: A consumer perspective. Retrieved from http://www.independentliving.org/docs1/ar1986spr.html.

    Google Scholar 

  • Ryner, J. M. (2002). Capitalist restructuring, globalization and the third way: Lessons from the Swedish model. London: Routledge.

    Google Scholar 

  • Sipilä, J. (Ed.). (1997). Social care services: The key to the Scandinavian welfare model. Aldershot: Avebury.

    Google Scholar 

  • Statistics Sweden. (2012). Statistical database. Final income and tax statistics 2010. Retrieved from http://www.ssd.scb.se/databaser/makro/produkt.asp?lang=2&produktid=HE0110.

  • Stockholm stad. (2010). Äldreombudsmannens årsrapport för 2010 [Report from the Eldercare Ombudsman for 2010]. Stockholm: Stockholm stad.

    Google Scholar 

  • Stolt, R., & Winblad, U. (2009). Mechanisms behind privatization: A case study of private growth in Swedish elderly care. Social Science and Medicine, 68(5), 903–911.

    Article  Google Scholar 

  • Streeck, W., & Thelen, K. (2005). Introduction: Institutional change in advanced political economies. In W. Streeck & K. Thelen (Eds.), Beyond continuity: Institutional change in advanced political economies. Oxford: Oxford University Press.

    Google Scholar 

  • Sundström, G., Johansson, L., & Hassing, L. (2002). The shifting balance of long-term care in Sweden. The Gerontologist, 42(3), 350–355.

    Article  Google Scholar 

  • Sundström, G., & Malmberg, B. (1996). The long arm of the welfare state shortened. Scandinavian Journal of Social Welfare, 5(2), 69–75.

    Article  Google Scholar 

  • Svallfors, S. (1989). Vem älskar välfärdsstaten? Attityder, organiserade intressen och svensk välfärdspolitik [Who loves the welfare state? Attitudes, organised interests and Swedish welfare politics]. Lund: Arkiv Förlag.

    Google Scholar 

  • Svensson, M., & Edebalk P. G. (2010). Kundval i äldreomsorgen—Stärks brukarens ställning i ett valfrihetssystem? [Customer choice in eldercare—Is the user’s position strengthened in a choice model?]. Stockholm: Swedish Association of Local Authorities and Regions.

    Google Scholar 

  • Swedish Competition Authority. (2009). Konkurrensutsättning inom hemtjänsten och primärvården [Competition in home care and primary health care]. Stockholm: Konkurrensverket.

    Google Scholar 

  • Swedish Social Insurance Agency. (2011). Statistics: Assistance allowance. Retrieved from http://statistik.forsakringskassan.se/portal/page/portal/intstat/funk/assers/assers_offstat4.

  • Szebehely, M. (1995). Vardagens organisering. Om vårdbiträden och gamla i hemtjänsten [The organisation of everyday life—On home helpers and elderly people in Sweden]. Lund: Arkiv förlag.

    Google Scholar 

  • Szebehely, M. (2005). Care as employment and welfare provision—Child care and eldercare in Sweden at the dawn of the 21st century. In H. M. Dahl & T. Rask Eriksen (Eds.), Dilemmas of care in the Nordic welfare state. Aldershot: Ashgate.

    Google Scholar 

  • Szebehely, M. (2011). Insatser för äldre och funktionshindrade i privat regi [Privately provided care services for older and disabled persons]. In L. Hartman (Ed.), Konkurrensens konsekvenser. Vad händer med svensk välfärd? [The consequences of competition. What happens to welfare in Sweden?]. Stockholm: SNS—Center for Business and Policy Studies.

    Google Scholar 

  • Szebehely, M., & Trydegård. G. B. (2007). Omsorgstjänster för äldre och funktionshindrade: skilda villkor, skilda trender? [Services for elderly and for disabled persons: Different trends, different conditions?]. Socialvetenskaplig Tidskrift, 14(2–3), 197–219.

    Google Scholar 

  • Szebehely, M., & Trydegård, G. B. (2012). Home care in Sweden: A universal model in transition. Health and Social Care in the Community, 20(3), 300–309.

    Google Scholar 

  • Thorslund, M. (1991). The increasing number of very old people will change the Swedish model of the welfare state. Social Science and Medicine, 32(4), 455–464.

    Article  Google Scholar 

  • Westerberg, B. (2008). Speech at the conference celebrating 25 years of independent living in Sweden, 28 November. Retrieved from http://www.independentliving.org/25yearswesterberg.

    Google Scholar 

  • Winbladh, U., Andersson, C., & Stefansson, K. (2009). Kundval i hemtjänsten—erfarenheter av information och uppföljning [Customer choice in home care—experiences of information and follow-up]. Stockholm: Sveriges Kommuner och Landsting.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Education and Social Work, University of Sydney, Sydney, NSW, Australia

    Gabrielle Meagher B.Ec(SocSci)Hons. Ph.D.

  2. Department of Social Work, Stockholm University, 106 91, Stockholm, Sweden

    Marta Szebehely B.A. Ph.D.

Authors
  1. Gabrielle Meagher B.Ec(SocSci)Hons. Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marta Szebehely B.A. Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabrielle Meagher B.Ec(SocSci)Hons. Ph.D. .

Editor information

Editors and Affiliations

  1. , Economic Sociology, Milan Polytechnic, VIA BONARDI 3, MILANO, 20133, Italy

    Costanzo Ranci

  2. , Economic Sociology, University of Macerata, Don Minzoni 2, Macerata, 62100, Italy

    Emmanuele Pavolini

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Meagher, G., Szebehely, M. (2013). Long-Term Care in Sweden: Trends, Actors, and Consequences. In: Ranci, C., Pavolini, E. (eds) Reforms in Long-Term Care Policies in Europe. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4502-9_3

Download citation

Publish with us

Policies and ethics

Search

Navigation