PARLIAMENT
RESEARCH UNIT
Swedish Older Persons Welfare System
10 October 2007
1. Background
Sweden faces a future characterised by a shift in its population age structure.
In the years ahead Sweden will face an increase of people who are advanced in
age. In 2003, Sweden had a greying population of 8.9 million inhabitants, in
which 17.2 per cent were aged 65 years or older and 5.2 per cent had reached
the age of 80 years or older. It is estimated that the number of elderly people
in Sweden will rise sharply in the decades ahead, particularly of the old
persons aged 65-79. This is the population born between
1944-1948 during the post war baby boom. In 2010, the estimated proportion
of over 65 will be 18.6 per cent and in 2030, it is likely to be as high as
22.6 per cent. The population increase in Sweden in the twentieth century can
largely be attributed to a reduction in mortality at all ages, which raised
average life expectancy. In 2004, average life expectancy for women was 82,7 years and for men 78,4 years. This can be compared with
the figures of 55 and 53 respectively in 1900.
Due to the fact that greater numbers of elderly people live to an advanced age,
many suffer illness, disability and become dependent on help from other people
for their daily existence. Increased life expectancy indicates the need for
policy not only to provide provisions for old age but also to link it with
disability as well as other health needs. As people advance in age their
ability to function on their own becomes limited as they gradually suffer from
hearing and sight impairment. Furthermore, elderly people become more
vulnerable to safety threats such as crime, robbery, rape, assault, and self
sustained injuries. Also, they face a number of health problems, such mental
health problems, which often results in depression and anxiety, cardio-vascular
diseases, Alzheimer's disease, and osteoporosis.
They also need constant supervision and assistance in their daily activities.
All of these factors have important implication for the housing structures and
policies for the elderly. Housing structures should be accessible, located in
safe and central areas and they should be safe in terms of personal accidents.
The Swedish policy for the elderly makes provision for the above-mentioned
factors. It provides for the establishment of accessible housing, transport
services for the elderly, pensions and allowances care for the elderly, home
help service and home nursing, daytime activities and short-term care, and
special housing accommodation.
2. National objectives on policy for the elderly
The policy for the elderly aims at enabling older
persons to live independently with a high quality of life. Older persons in
need of care and social services are entitled to help of high quality. Elderly
care is provided in accordance with democratic principles and is mainly
financed out of taxation revenue. The Swedish Parliament (Riksdagen) has
defined the following objectives for national policy for the elderly:
Older persons shall
·
Be able to lead active lives and have influence in
society and in issues affecting their daily lives,
·
Be able to age with security and with their
independence preserved,
·
Be met with respect and
·
Have access to good health and social care services
One of the most important principles of Swedish policy for the elderly
is that society's initiatives are to be framed in such a way that older persons
can continue living in their own homes for as long as possible, even when in
need of extensive care and social services. An accessible society, good
housing, transport services and home help services are examples of important
measures to realise that principle.
3. Swedish welfare system for the elderly
3.1 Housing and accessibility
A great majority of the elderly in Sweden (about 93
per cent) lives in ordinary homes. The housing conditions of older persons do
not differ significantly from those of the population generally. Most elderly
persons live in modern, centrally heated homes with well-equipped kitchens, hot
and cold running water and an indoor toilet. The great majority of older
persons live by themselves or with their spouses. Very few live with their
children.
Grants for housing adaptation make it possible for persons with functional
impairment to undertake the individual adaptations to their homes and immediate
vicinity that they need to stay on in their own homes. Common adaptations
include removing thresholds and rebuilding bathrooms. In addition, the
Parliament (Riksdagen) in May 2000 passed the Government Bill, "From
Patient to Citizen, a national action plan for disability policy". The
Bill outlines a number of measures to improve access in the society for persons
with disabilities. Among other things, it proposes straighter stipulations in
the Planning and Building Act on the subject of accessibility and also that
public transport is to be made accessible to persons with disabilities by 2010.
3.2 Special housing accommodation
The Swedish Government also makes special housing provisions for elderly
persons who require special care. This provision is done at the municipality
level. This responsibility was transferred from the county council to
municipalities in early 1990s. Municipalities have control of community care,
which includes care of the elderly. The emphasis is on home nursing care, with
24 hour provision of home assistance, such as shopping, hygiene and nursing
intervention. In 2001, around 7% of these services were provided by the private
sector, but paid for mostly by the municipality, with some resident/patient
co-payments.
3.3 Transport services
The municipalities offer special transport services to
persons that are unable to use public transport because of functional
impairment. This service enables persons with functional impairment to travel
by taxi or in specially adapted vehicles at prices on the same level as public
transport fares.
3.4 Pensions and allowances
In January 1999 a new pension system was launched. The
pension system is designed to guarantee elderly a basic measure of economic
security. The reformed pension scheme has a number of different components,
namely, an income-related pension, a pre-funded pension and a guaranteed
pension. A person's income-related pension is based on a person's full lifetime
earnings. The pre-funded, or premium pension is the
portion of a pension that a person may invest in a fund of his or her own
choosing. Persons who have had little or had no earned income are guaranteed
basic protection through the guaranteed pension. The guaranteed pension is also
payable as a supplement to the income-related pension. The new pension scheme
is designed to be viable in the face of demographic change. Pensioners with low
incomes can also obtain a state housing supplement for pensioners and special
housing supplement. This is a means-tested allowance, which guarantees a
reasonable economic standard of living, with provision made for housing costs.
The rules for eligibility are determined by the State.
In January 2003, the Maintenance Support for the Elderly Act came into effect,
Maintenance Support for the elderly is intended for persons who are 65 years
and older, whose basic maintenance needs are not fully covered by other benefits
in the national pension system. Most of those entitled to this support are
elderly persons who have not lived in Sweden for 40 years and they qualify for
a full guarantee pension. This support is an income-tested benefit.
3.5 Pensioners' organisation
Sweden has five nationwide pensioners' organisations and these have local
branches in nearly every municipality. The pensioners' organisations are
interest organisations for the elderly that, among other things, arrange
recreational and educational activities for their members and others. Nearly 50
per cent of the elderly in Sweden belong to these organisations. Also, there
are pensioners' councils at national level and in the majority of
municipalities and county councils. The councils act as advisory bodies to the
Government and the pensioners' organisations are represented in them.
3.6 Home help service and home nursing
Home help service is service and personal care in the home provided by the
municipality under the Social Services Act. Service tasks include cleaning and laundry, help with shopping, post office and bank errands
and preparation of meals. Personal care also includes assistance with eating
and drinking, getting dressed, personal hygiene and moving around. For those in
need, municipal security alarms are available, which are usually linked to the
nearest special housing, where personnel respond and attend to alarms they
receive. In 2004, 9 per cent of persons aged 65 and older were entitled to home
help services in ordinary housing. The corresponding figure for those 80 years
and older was 20 per cent.
During the 1990s home nursing was provided for persons in need of extensive
care and attention. Home nursing means qualified care and highly specialized
medical care as well as terminal care for 24 hours. About one third of the
persons that receive home help services also receive home nursing care. About
half of Sweden's municipalities have taken over responsibility for home nursing
from the county councils.
3.7 Daytime activities and short-term care
Daytime activities and short-term care are provided as stipulated by the Social
Services Act and/or the Health and Medical Services Act. The support of daytime
activities is given in the form of treatment and rehabilitation during daytime
for persons suffering from senile dementia, persons with mental functional
impairment and persons in need of treatment and rehabilitation. In 2004
approximately 1 per cent of persons aged 65 and older were provided with
daytime activities. Short-term care is given in the form of temporary housing,
treatment, rehabilitation and care, for purposes of relief and alternate care.
In 2004 approximately 1 per cent of persons aged 65 or older received
short-term care.
4. The care of the elderly
Responsibility for the care
In Sweden, responsibility for the care of the elderly rests with three
authorities acting at different levels, Parliament (Riksdagen) and Government
at national level. The two authorities formulate policy goals through
legislation and financial control measures. At regional level, the 21 county
councils are responsible for the provision of health and medical care. At local
level, Sweden's 290 municipalities have a statutory duty to meet the social
service and housing needs of the elderly.
Sweden's municipalities and county councils have a high level of autonomy.
Activities in caring services are controlled by politicians appointed to
policy-making assemblies in municipalities and county councils through general
elections. The decentralisation of responsibility for elderly care makes it
possible for local and regional conditions to be taken into account when
policies for the elderly are formulated. Sweden has national authorities, the
National Board of Health and Welfare (focusing on health care issues) and the
21 county administrative boards (focusing on social services issues), which are
responsible for supervision, follow-up and evaluation of municipal and county
council caring services.
The Elderly Reform (Adelreformen), which came into effect on 1 January 1992,
made the municipalities comprehensively responsible for long-term service and
care for the elderly and people with disabilities. Among other things, it
became the duty of municipalities to provide health care in special forms of
housing accommodation and in daytime activities. One of the reform's important
components was the transfer of financial responsibility for patients in county
council hospitals and geriatric departments, whose medical treatment had been
completed, from the county councils to the municipalities. This had the effect
of greatly reducing the number of the elderly in county council institutions,
simultaneously with an expansion of municipal housing capacity for the elderly
in need of care and social services.
Swedish society also has responsibility to ensure that the elderly in need of
care or social services receive help of high quality. Society or family members
assist towards care for the elderly by make voluntary contributions. These
contributions are regarded as an adjunct to public initiatives. Families,
relatives, friends and neighbours, provide a considerable proportion of help
and support for older persons who have difficulty in managing on their own.
5. Parliamentary committee on elderly policy. SENIOR 2005
The Swedish Parliamentary role over the care of the
elderly is carried through the parliamentary committee on elderly policy,
SENIOR 2005. This committee is tasked with the responsibility to lay the
groundwork for the long-term development of policies for the elderly in Sweden.
The committee has 17 members who represent political composition of the
Parliament (Riksdag). To carry out its task in an effective and practical
manner the committee works in collaboration with experts from different
Government authorities, such as the National Board of Health and Welfare and 21
county administrative boards, and organisations, which provide advise to the
parliamentary committee on elderly persons issues.
6. Challenges
6.1 Population increase
Despite these provisions, Sweden faces a challenge, as
indicated earlier, of an increasing aging population. This indicates that
during the years ahead Sweden will face a high rate of retirement, coupled with
a diminishing numbers of younger personnel in the elderly care. This change in
Swedish age structure will in the long run have an impact in the family
structure, social relations in general, labour market and economic activity,
pensions, caring and other services. For instance, the two main forms of public
care - home care and institutional care not keeping pace with the increasing
number of very old persons.
6.2 Geographic inequalities
Decentralisation of welfare services for the elderly to municipalities resulted
in local variations in the provisions of these services in terms of coverage,
costs and accessibility both in the home based and in institutions based care.
The kind of services provided to the elderly varies according to where in
Sweden the elderly person lives influenced largely by financial well being of
local authorities.
6.3 Privatisation
Welfare services for elderly in Sweden have been provided through different
forms of privatization. The former public provision of services have been
handed over to private companies as a result costs and responsibility of care
have become a private business. This has caused these services not accessible
to poor elderly people. This has in turn resulted in the increase of informal
care from families, friends and voluntary organisations.
7. Lessons to be learnt by South Africa
Parliament of South Africa is considering the Older
Persons Bill. The above mentioned policy provisions made in Sweden to cater for
older persons practical needs can provide useful
learning lessons for South Africa. Below are the recommended strategies that
South Africa can use to improve its policies for elderly people:
·
Special housing accommodation: South Africa should
provide housing structures that are specifically designed to specially meet the
needs of elderly people who require special care. This includes catering for
elderly persons physical needs, that is, ensuring that housing structures are
accessible and located in safe environment. The latter particularly refers to
availability of 24 hour safety security.
·
24 hour home assistance and nursing intervention: This
is a very important provision that South Africa needs to make to improve the
care for elderly persons. These should also include provision of assistance for
daytime activities of the elderly, such as shopping, taking medication,
rehabilitation, ensuring personal hygiene, moving around and other activities.
·
Pension scheme: There has been ongoing complaint that
pension package for the elderly does not cover all their basic needs. Swedish
pension system can provide a useful guide for the South African pension system.
Swedish pension as indicated earlier caters for different financial needs of
the elderly people.
·
Management: The management and administration of the
service delivery for the elderly should be carried at the local government
level through municipalities. Municipalities are in a better position to carry
out this responsibility because they operate close to the communities.
Furthermore, this ensures that the delivery of services is decentralized thus
ensuring that regional or provincial specifications for the elderly people are
accordingly planned for.
8. Conclusion
The Swedish policy for the elderly provides for a
comprehensive care system for the elderly. This system ensures for quality care
and that the daily activities of the elderly are taken care of. The Swedish
policy for the elderly provides important lessons for South Africa, as it is
currently in the final stages of the drafting the Older Person's Bill.