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

Chapter

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.

References

  1. 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
  2. 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
  3. Blomqvist, P. (2004). The choice revolution: Privatization of Swedish welfare services in the 1990s. Social Policy and Administration, 38(2), 139–155.CrossRefGoogle Scholar
  4. Blyth, M. (2001). The transformation of the Swedish model: Economic ideas, distributional conflict, and institutional change. World Politics, 54(1), 1–26.CrossRefGoogle Scholar
  5. 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
  6. 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
  7. Eliasson-Lappalainen, R., & Motevasel, I. (1997). Ethics of care and social policy. Scandinavian Journal of Social Welfare, 6(3), 189–196.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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
  10. Government Bill 1990/91:100 Förslag till statsbudget för budgetåret 1991/92 [Draft state budget for 1991/92].Google Scholar
  11. Government Bill 1992/93:43 Ökad konkurrens i kommunal verksamhet. [Increased competition in municipal services].Google Scholar
  12. Government Bill 2000/01:149 Avgifter inom äldre- och handikappomsorg. [User fees in eldercare and in disability services].Google Scholar
  13. Government Bill 2006/07:94 Skattelättnader för hushållstjänster, m.m. [Tax deductions on household services etc.].Google Scholar
  14. Government Bill 2008/09:29 Lag om valfrihetssystem [Act on Free Choice Systems].Google Scholar
  15. 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
  16. Government Report. (1987). Långtidsutredningen 1987 [The Long Term Survey 1987]. SOU 1987:3. Stockholm: Allmänna förlaget.Google Scholar
  17. Government Report. (1991). Konkurrensen inom den kommunala sektorn [Competition in the municipal sector]. SOU 1991:104. Stockholm: Allmänna förlaget.Google Scholar
  18. Government Report. (2004). Sammanhållen hemvård [Integrated Homecare] SOU 2004:68. Stockholm: Fritzes.Google Scholar
  19. 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
  20. 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
  21. 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.CrossRefGoogle Scholar
  22. 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
  23. 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
  24. Hjalmarson, I. (2003). Valfrihet inom äldreomsorgen—en reform som söker sin form [Choice models in eldercare]. Stockholm: Stockholm Gerontology Research Center.Google Scholar
  25. Hjalmarson, I., & Norman, E. (2004). Att välja hemtjänst [To choose homecare]. Stockholm: Socialstyrelsen.Google Scholar
  26. 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
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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
  30. 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.CrossRefGoogle Scholar
  31. Liljeström, R., & Özgalda, E. (1980). Kommunals kvinnor på livets trappa [Women in the Municipal Workers’ Union]. Stockholm: Svenska Kommunalarbetarförbundet.Google Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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
  34. 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
  35. Montin, S., & Elander, I. (1995). Citizenship, consumerism and local government in Sweden. Scandinavian Political Studies, 18(1), 25–51.CrossRefGoogle Scholar
  36. National Agency for Education. (2011). Kostnader för förskoleverksamhet, skolbarnsomsorg, skola och vuxenutbildning 2009 [Costs for childcare and education 2009]. Stockholm: Skolverket.Google Scholar
  37. 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
  38. 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
  39. National Board of Health, & Welfare [NBHW]. (2007). Äldre—vård och omsorg år 2006 [Care and services to older persons 2006]. Stockholm: Socialstyrelsen.Google Scholar
  40. National Board of Health, & Welfare [NBHW]. (2009). Swedish disability policy—Service and care for people with functional impairments. Stockholm: Socialstyrelsen.Google Scholar
  41. 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
  42. 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
  43. National Board of Health, & Welfare [NBHW]. (2011c). Valfrihetssystem ur ett befolknings- och patientperspektiv. [Choice models from population- and patient perspectives]. Stockholm: Socialstyrelsen.Google Scholar
  44. 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
  45. 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
  46. National Insurance Board. (2002). Ideals and reality in disability policy, social insurance in Sweden 2002. Stockholm: RFV.Google Scholar
  47. 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
  48. 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
  49. Ratzka, A. (1984). The prerequisites for independent living (GLADNET collection: Paper 427). Retrieved from http://digitalcommons.ilr.cornell.edu/gladnetcollect/427.Google Scholar
  50. Ratzka, A. (1986). Independent living and attendant care in Sweden: A consumer perspective. Retrieved from http://www.independentliving.org/docs1/ar1986spr.html.Google Scholar
  51. Ryner, J. M. (2002). Capitalist restructuring, globalization and the third way: Lessons from the Swedish model. London: Routledge.Google Scholar
  52. Sipilä, J. (Ed.). (1997). Social care services: The key to the Scandinavian welfare model. Aldershot: Avebury.Google Scholar
  53. 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.
  54. Stockholm stad. (2010). Äldreombudsmannens årsrapport för 2010 [Report from the Eldercare Ombudsman for 2010]. Stockholm: Stockholm stad.Google Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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
  57. Sundström, G., Johansson, L., & Hassing, L. (2002). The shifting balance of long-term care in Sweden. The Gerontologist, 42(3), 350–355.CrossRefGoogle Scholar
  58. Sundström, G., & Malmberg, B. (1996). The long arm of the welfare state shortened. Scandinavian Journal of Social Welfare, 5(2), 69–75.CrossRefGoogle Scholar
  59. 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
  60. 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
  61. Swedish Competition Authority. (2009). Konkurrensutsättning inom hemtjänsten och primärvården [Competition in home care and primary health care]. Stockholm: Konkurrensverket.Google Scholar
  62. Swedish Social Insurance Agency. (2011). Statistics: Assistance allowance. Retrieved from http://statistik.forsakringskassan.se/portal/page/portal/intstat/funk/assers/assers_offstat4.
  63. 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
  64. 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
  65. 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
  66. 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
  67. 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
  68. 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.CrossRefGoogle Scholar
  69. 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
  70. 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

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Faculty of Education and Social WorkUniversity of SydneySydneyAustralia
  2. 2.Department of Social WorkStockholm UniversityStockholmSweden

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