Outside the Nordic region, only a few countries around the world maintain public care services for the elderly. Sweden invests 2.8 percent of its gross domestic product (GDP) in the elderly care sector, according to a 2005 report from the Organisation for Economic Co-operation and Development (OECD). Norway is in second place with 1.8 percent.

Of Sweden’s nine million inhabitants, 17.3 percent have passed the retirement age of 65 and are pensioners. According to Council of Europe statistics from 2003, Sweden is among the countries with the largest proportion of citizens over 65 years of age. It also has the largest proportion of people aged 80 or over among the EU member states, totalling 5.3 percent of the population.

The total cost of elderly care in Sweden in 2005 was SEK 80.3 billion. Most of the care was financed by municipal taxes and government grants. Only 4 percent of the financing came from patients’ charges.

In 1980, just over 400,000 elderly people were either receiving municipal home help or were living in homes for the elderly or nursing homes. In 2005, the figure was 245,000. This means the number of care recipients declined by about 40 percent between 1980 and 2005.

One of the reasons why the number of care recipients has fallen is that more and more older people are in good health. This is particularly noticeable among the oldest citizens, those over 80 years of age, whose care requirements have declined since the 1980s.

Over the same period, 1980–2005, the costs of public elderly care have increased by 60 percent in fixed prices (i.e. 2005 prices). The cost per care recipient has more than doubled in that time.

Responsibility for elderly care

About 90 percent of all elderly care is provided by the municipalities (2005). Some have contracted out their elderly care services. In certain areas, the elderly are allowed to choose whether they want their home help or special housing to be
managed by public or private operators.

The aim of municipal care provision is to ensure that older people and those with disabilities are able to live normal, independent lives. This includes living in their own homes for as long as possible. There, they have access to support of various kinds, whether they live in rented accommodation or in a house of their own.

This support includes meals delivered to the home, help with cleaning and shopping, safety alarms and a transportation service. The elderly are also offered health and social care, provided either by the municipal home-help services or by the home medical care service.

Pensioners more numerous and healthier

The elderly are steadily growing in number in Sweden. At the same time, a shift in values is taking place. Due to the fact that older people in Sweden today are increasingly healthy, many travel, do sports and take an active part in public life. They are more demanding and discerning about the products and services they buy, partly because many pensioners are well off.

In 2006, life expectancy in Sweden was 79 years for men and 83 years for women. Nowadays, many people over 65 continue working. The number of people who combine pensions and paid work is also on the increase. The retirement age, normally 65, has become more flexible.

A growing number of the elderly take regular exercise and are physically active. There has been a pronounced rise in this respect since the 1980s. This has meant very substantial health gains, which in turn means less need of assistance. For most Swedes, this need seldom manifests itself until they are in their eighties.

Older Swedes are increasingly healthy, which is why many of them travel, do sports and take an active part in public life. Photo: Jonas Ekströmer / Scanpix

Over the next 10 years, the number of people aged 80 or more will increase only marginally. A dramatic rise in numbers, however, will begin around the year 2020. Between 2020 and 2030, the number of people in the 80+ category will increase by about 240,000. This trend is due to the large number of people born in the 1940s.

Adapted homes

No less than 94 percent of all Swedes over 65 years of age still live in regular flats or houses. This proportion diminishes with rising age.

When planning housing and housing areas, Swedish municipalities are required to ensure that they are adapted to the needs of older people and persons with disabilities. A further goal is for commercial and public services to be easily accessible so that the elderly can continue living at home and looking after themselves. The accessibility requirement has been given greater prominence in legislation.

In the case of people with impaired mobility, the municipalities offer to adapt their homes to their needs. When older buildings are refurbished, some of the flats are adapted specifically to the needs and preferences of the elderly.

Older people with disabilities can apply to the local municipality for home adaptation grants, the aim being to enable them to continue living there. The municipality pays the entire cost if the grant is approved, regardless of the financial status of the applicant. There is no ceiling to the adaptation grant sum. In 2005, the average cost for adapting a home to the needs of a disabled person was SEK 13,200.

Senior housing popular

A growing number of the elderly in Sweden want to live in senior housing, i.e. ordinary homes for people aged over 55. In such homes, accessibility is a priority. Some are newly built, while others are regular homes that have been made more
accessible in conjunction with conversion or renovation work.

Nowadays, property owners of many different kinds offer senior housing – private landlords, municipal housing utilities, tenant-owner associations and foundations. Senior housing is available in the open housing market. This means that all citizens who have reached a certain age can apply for such a home themselves.

The aim of Swedish municipalities is to enable older people and people with disabilities to live in their own homes for as long as possible. Photo: Mascot

The level of adaptation varies. Occupants can be provided with home-help services and home medical care. To give the elderly a greater sense of security, many such housing areas now have special hosts. Premises where people can gather – such as kitchens for making communal meals – are also popular.

Home-help and transportation services

Older people who continue living at home can obtain various kinds of support to make life easier. Almost all municipalities in Sweden offer ready-cooked meals that are delivered to the homes of the elderly and disabled.

Almost half of the country’s municipalities provide communal meals for the elderly at special day centers. A few organize small groups of the elderly into teams that cook their own meals.

When an older person is no longer able to cope with the demands of everyday life, she or he can apply for assistance from the municipal home-help services. The extent of such care is subject to assessment. Older people with disabilities can obtain assistance round the clock, which means that many are able to remain at home throughout their lives. The severely ill, too, can be provided with health and social care in their own homes.

The municipalities offer daytime activities for elderly and disabled people who need to be stimulated and rehabilitated. These activities primarily target older people with dementia or mental disabilities. Daytime activities help many people to continue living in their regular homes.

The elderly and disabled also qualify for transportation services in taxis or specially adapted vehicles. Such services are available to those who are unable to travel by regular public transport. More than half of applicants granted transportation services are over 80 years of age.

Special housing

Just over 16 percent of the country’s inhabitants over 80 years of age live in special housing where staff are on duty day and night. Such housing is needs-assessed and distributed by the municipalities.

Most of those in need of care and support round the clock suffer from dementia. The municipalities are responsible for basic health and medical care in 24-hour accommodation.

In October 2006, some 15 percent of all those over 65 were living permanently in special housing or receiving home help in regular accommodation. Of this group, less than half were living in special housing.

Health care, home medical care and the health care guarantee

Several new forms of preventive health care for the elderly have been introduced in recent years. Studies show that they have proved effective.

One example is physical activity on prescription, both for preventive purposes and as a form of treatment. Older people are prescribed not just exercise in general but a certain type of physical activity, sometimes in combination with medication. Doctors follow up the results.

Personal injury is one of the main health problems among older people. Considerable efforts are made to reduce injuries from falls. Information is made available to the elderly, and special municipal “fixers” help them with things like curtain-hanging and changing light bulbs in the home.

Care guarantees cover all links in the care chain. All who need care, for instance, must be treated by a doctor within seven days. After referral, specialist care is supposed to be provided within 90 days. The care guarantee has shortened queues for health care in Sweden.

Medical advances have brought a steady improvement in medical care for the elderly. Today, it is increasingly provided in the form of outpatient care, either at a hospital or in the home. Average duration of treatment in inpatient care, meanwhile, has decreased.

It is now easier to obtain advanced medical care in the home. In recent years, the care of severely ill and dying patients has been increasingly transferred from hospitals to special housing and older people’s own homes. Consequently, municipalities are under heavy pressure to have trained medical staff working in their elderly care services.

Costs and financing

Approximately three-quarters of health and medical care costs are financed out of tax revenue. Government grants cover about 20 percent. The health care for elderly and disabled patients provided in ordinary homes or special housing is mainly financed through municipal taxes. Patients’ fees cover just over 3 percent of the total cost of health and medical care provision.

In 2005, elderly care in Sweden cost a total of SEK 80.3 billion. In fixed prices, costs were down 1.7 percent compared with the previous year. Health and social care in special housing accounted for the bulk of elderly care costs in 2005. The cost per care recipient is more than twice as high in special housing as in regular housing.

The future

In the 2020s, care requirements among the elderly in Sweden will increase as the 80+ group grows even larger. In addition, those born in the 1960s will reach retirement age. This means that pension costs will increase while at the same time the proportion of citizens in gainful employment will diminish.

The growing number of elderly represents a major challenge to Swedish society. Many researchers believe that in future the families of the oldest citizens will be increasingly obliged to care for them since the number of people in the 80+ age group will increase dramatically over the next 25 years. Also, the 1940s generation is thought to demand more out of life than previous generations. Furthermore, those who will be helping them will be fewer in number than those born in the 1940s.

Links

National Institute of Public Health,
Statens folkhälsoinstitut,
www.fhi.se
Swedish Rescue Services Agency,
Statens räddningsverk,
www.raddningsverket.se
Statistics Sweden,
Statistiska centralbyrån
www.scb.se
National Board of Health and Welfare,
Socialstyrelsen,
www.socialstyrelsen.se
Swedish Association of Local Authorities
and Regions,
Sveriges Kommuner och Landsting,
www.skl.se
Swedish Research Council,
Vetenskapsrådet,
www.vr.se
Swedish IT projects in elderly and social care
(film)
www.kks.se/it-in-health-care

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