Elderly care

Malin Höglund (M)

Madam Speaker! Today we are debating the Committee on Social Affairs' report 22 Elderly Care. I would like to begin by moving for approval of the committee's proposal in the report.

Madam Speaker! The elderly should be able to live an active life and have influence in society and over their everyday lives. The elderly should be able to age in security with maintained independence. The elderly should be met with respect and have access to good care and nursing, as well as be offered equal and equitable care and nursing. Good health increases the possibilities to live an active life and have influence over everyday life.

Madam Speaker! When one is alert and healthy, one might not think so much about the support and the help that one may need when health deteriorates. It is important to be able to have influence over one's everyday life and to know what is happening and when it happens. One wants to be able to influence when the home care service comes during the day or which days one wants help with, for example, showering or shopping. Today's elderly have been able to steer and direct their lives throughout their entire lives, and they want to be able to continue doing so. It is also important that the elderly feel safe in the home and with the staff who come to their homes.

Madam Speaker! In recent years, we have seen that home care has decreased somewhat among the elderly. One explanation could be the corona pandemic. But a large number of elderly people are also healthier at higher ages.

Physical activity is more important the older we get. Research shows that regular balance and strength training reduces the risk of falls and fall-related injuries. Most fall-related injuries occur in the home. The risk of falling and hurting oneself seriously increases with age. In addition to physical activity, it is also important to review how things look in the home. One can remove rugs or place non-slip pads under them. Good eating habits and the right drinks, which provide both energy and nutrition, can reduce the risk of falling.

During my eight years as the chairman of the social welfare committee in Mora, I made continuous visits to residential homes but also within the home care service. The staff plays a large and significant role when they come to the elderly's homes. They ensure that the meal is pleasant. Food with different colors looks nice on the plate and thus also increases the appetite.

Madam Speaker! When one can no longer manage at home, there must be access to special housing for the elderly or assisted living for those who wish. During the pandemic, we saw that applications to the various types of housing decreased slightly. The municipalities now see that it is starting to go up again.

Madam Speaker! Staff have become a hard currency within many industries. At the same time, there are 1.3 million people who cannot support themselves through work. It is not only within health and social care that staff are needed, but they are needed in all industries. It is also a challenge to retain staff within health and social care, as other jobs where one does not need to work on weekends, evenings, and nights can be attractive. The majority of the staff working in elderly care are women, even though it has become more common with men, which is good for achieving an equal workplace. Staff continuity must improve within elderly care.

Madam Speaker! It is important that the staff has the right competence to be able to provide good care and nursing to elderly people. Just as important as it is to have the right competence in preschool and school is to have the right competence in elderly care. The Government has allocated 4 billion kronor to the country's municipalities annually to ensure good care and nursing for elderly people and to increase staff continuity. Staff continuity can contribute to security and independence for the elderly.

Madam Speaker! Today we speak a lot about AI and digitalization, not least within health and care. The technology has given us new opportunities that are for the benefit of everyone. For those who feel insecure or are easily disturbed at night by the home care service, there is the possibility of night cameras, which has been very good.

Sweden shall be a country where we people feel safe. To be independent and be able to continue living at home in one's own home is what most want. Safe elderly people feel better.

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Mikael Dahlqvist (S)

Madam Speaker! I thank the member for her speech. I heard her mention that the supply of skills is a challenge.

In SKR's personnel forecast, it can be seen that an enormous number of more employees are needed for municipalities and regions during the coming ten years. In total, one needs to employ approximately 410,000 people until 2031. If one looks at the demographics at the same time, one sees that the number of people over 80 years of age increases by almost 50 percent during this period. According to SKR's own figures, this will mean that one needs to employ more than 30 percent more staff during the same period.

How does the member stand regarding an extension of the Elderly Care Boost (Äldreomsorgslyftet) after 2023?

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Malin Höglund (M)

Madam Speaker! I thank member Mikael Dahlqvist.

The elderly care boost did not become as good an initiative as it was intended to be. I was very positive at the beginning when it was introduced. But then we saw that many people dropped out. Because people were away from the workplace for studies and substitutes were hired, it did not turn out quite as well as intended. Initially, many started, but then very many stopped.

Now an evaluation of Äldreomsorgslyftet is coming, and one must take that into account and see what is written there. I believe that something else is needed, some other combination, because we need to have staff, as member Mikael Dahlqvist also mentioned. There will be almost a gap in elderly care. The member mentioned that 410,000 people are needed by 2031, and at the same time, many are elderly. New technology and other things can perhaps remove part of the need for new staff, but not all of it.

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Mikael Dahlqvist (S)

Madam Speaker! I thank you for your answer, Member Höglund. The elderly care boost is a success, I claim. If one listens to the trade unions, SKR, that is, the Swedish Association of Local Authorities and Regions, pension organizations and several others, one hears that it is a success. In 2021, 6,000 people began training to become nursing assistants or care assistants. Of these, 2,000 have finished. We must hope that most start within elderly care.

Madam Speaker! We have had a pandemic, and it can be understood that there have been some problems due to the focus on other issues. But as said, Member Malin Höglund, I have received a completely different description of Äldreomsorgslyftet. I am a bit surprised that the Member does not think it has been a success. My question, Madam Speaker, to the Member: Can you state which references and sources you have when you say that Äldreomsorgslyftet has problems?

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Malin Höglund (M)

Madam Speaker! I myself served as the chairman of the social welfare committee for eight years. I was out in the field very much. I also had contact with other municipalities around in Dalarna and in other counties. Initially, many started attending training, but then unfortunately many dropped out. What that is due to, perhaps we can read in the evaluation that will come at the end of March.

It is important that we train staff. We need staff within elderly care. We need nursing assistants, and nursing assistants and nurses. But we must wait and see what happens and what the evaluation says.

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Christofer Bergenblock (C)

Madam Speaker! I thank you very much for a good speech, Malin Höglund. I can agree with almost everything you took up from the rostrum regarding how Swedish elderly care should look moving forward. You gave a very good description of many different parts. It was about the competence supply, the content of the care, and the preventive work.

What I, however, missed in your speech were the concrete proposals, just as much as the proposals regarding the money to build up the competence supply moving forward. It is not the money that is the big problem, but the access to personnel. There, the concrete proposals were missing.

Now, you represent one of the government parties, and the government currently has both a Minister for Health and a Minister for Older Persons. One might have expected a few more concrete proposals and clear starting points regarding what you intend to do during the mandate period. Until now, it has been very quiet in the area of elderly care.

One of the points you raised was, as mentioned, the preventive work. We know that through good preventive work we can ensure that the elderly stay healthy longer into their years, avoid diseases and do not need to move into elderly care as early. It can be about having health talks. It can be about having a clear national vaccination program even for the elderly. But I heard nothing about that.

My question to Malin Höglund is: What concrete proposals does the government intend to pursue regarding the preventive work within elderly care?

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Malin Höglund (M)

Madam Speaker! I thank Christofer Bergenblock for the question. There is an investigation called "Vilja välja vård och omsorg - En hållbar kompetensförsörjning inom vård och omsorg om äldre" which is currently being prepared within the Government Offices. It also concerns staying active as an elderly person. Our pension organizations, which exist all around Sweden, play a very large role in ensuring that our elderly feel like they are part of a community. Various excursions and other activities are offered. It also ensures that one stays healthier and more alert. My own mother is a member of one of them. Physical activity is very important to stay fit and healthy.

The competence supply is, just as I said, a challenge for all industries. It is just as difficult to recruit preschool teachers and teachers as it is to recruit nursing assistants and healthcare assistants. We have today 1.3 million people who cannot support themselves and who could enter workplaces.

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Christofer Bergenblock (C)

Madam Speaker! You landed on the competence supply again, Malin Höglund. It is a challenge that we are happy to discuss. What I would have liked to hear a bit more about were precisely the concrete proposals regarding the preventive work, which is so important and which in itself ensures that we can save personnel resources and money in the end, but above all ensure that our elderly feel better and have a long and good life.

The pension organizations fulfill a very important function. There is no doubt about that. They receive support primarily from the municipalities for the work they carry out. Encouraging physical activity is a very important part of this work.

From the Center Party, we have a proposal to develop an elderly healthcare program in the same way as we have child healthcare programs, that is, to ensure that there is an overall responsibility and an overall vision at the national level on how we should promote the health of the elderly. Such a healthcare program could include health talks, which are to promote health and prevent things that can result in diseases. Discussions can then be held about eating habits, lifestyle, social contacts, and so on. We also see that there is a need for a vaccination program within the elderly healthcare program, so that the vaccination of the elderly is addressed in the same way as it is done with children and offering free vaccination to those over 70 years of age.

These are questions that we have been quite in agreement on between our parties previously, even if we perhaps have not used the exact expression elderly healthcare program. My concluding questions to Malin Höglund are: How do you, the Moderaterna, and the government stand regarding that form of proposal? Do you have other concrete proposals for working at a national level to prevent ill health among the elderly?

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Malin Höglund (M)

Madam Speaker! The preventive work is taking place today in the municipalities. I have myself been involved in making decisions in our municipality to reach out early and have these conversations with the elderly – if I remember correctly, it was at the age of 70. Those conversations are very good, because then one can also ask questions about loneliness and such. Senior centers are something that has been discussed, even in my county, but at the government level, as far as I can remember, we have not had that question up.

The preventive work is incredibly important. It can be done in different ways, but I think a very large amount lies with the municipalities.

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TREDJE VICE TALMANNEN

For the sake of the debate, I would like to remind everyone of the Swedish parliamentary custom which implies that speakers should use first and last names when mentioning other speakers. This means that direct addresses between speakers, for example saying you or you (plural) to one another, should not occur.

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Mikael Dahlqvist (S)

Madam Speaker! Today's report concerns elderly care issues in general. Approximately 40 motions from the general motion period are to be debated and later decided upon.

It is pleasing that we are becoming more active and older in our country. Average life expectancy has increased steadily in Sweden during the recent decades. According to forecasts, the number of people over 80 years of age will increase by almost 50 percent by 2031. More and more are able to lead an active life and work longer. It is a success for our welfare society. At the same time, it will place great demands on our country's elderly care.

More elderly people with greater needs will require more resources and more staff, and this is in a situation where even today, the operations are already seeing great difficulties in recruiting. Staff supply is and will become an even greater challenge in the years to come. A new perspective within elderly care is required where staff are valued and competence is rewarded. For far too long, elderly care policy has been about streamlining by pressing staff harder with ever less appreciation. That time must be over now.

Madam Speaker! The previous S-led government initiated initiatives to lift, secure, and modernize Swedish elderly care. It was about new legislation and about resources. The Social Democratic government introduced, through the 2021 budget bill, a sector grant in the area of elderly care which amounted to approximately 4 billion SEK per year and which was to be distributed specifically in the area of elderly care and go towards interventions that raise the quality.

The Social Democrats also introduced an elderly care boost of approximately 2 billion SEK per year. We secured the title of nursing assistant and ensured that elderly people with home care received the right to a fixed care contact. We introduced a national relative strategy as well as a national competence center for elderly care at the National Board of Health and Welfare. I dare say that more happened within the national elderly care policy than what has happened in recent decades, but it is not enough. It was only a beginning.

Madam Speaker! I want to highlight some things in our committee motion that we Social Democrats want to introduce.

The previous government appointed an inquiry in 2020 with the mandate to propose a specific elderly care act. Our purpose was to secure long-term conditions for Swedish elderly care as well as to secure access to good medical care. This summer, the inquiry submitted its report Next steps - increased quality and equality in care and nursing for elderly persons with a proposal for an elderly care act with specific provisions on care and nursing for the elderly.

I assume that the government will promptly return to the Riksdag with concrete proposals. It is important. The future of elderly care cannot wait.

Madam Speaker! We Social Democrats also demand that the Äldreomsorgslyftet be extended. It is an initiative that truly delivers! The state initiative was launched in 2020 and aims to increase competence in elderly care, strengthen the position of healthcare staff, and contribute to the municipalities' competence supply. It is a billion-kronor reform that gives new and existing staff opportunities to educate or further educate themselves during paid working hours.

The elderly care boost fills and broadens competence. During 2021, over 6,000 people began the training to become a care assistant or nursing assistant. Over 2,000 of them completed their studies with passing grades, and hopefully, they are now working within elderly care. The staff is our most important resource. But in the government's budget document, it states that the reform ends on December 31 this year.

Madam Speaker! Even before the pandemic, we saw major deficiencies within elderly care, and these were clarified during the pandemic. In my speech so far, I have touched upon the lack of competence and resources. The Corona Commission's report also notes deficiencies in the coordination between regions, municipalities, and the state. Major changes are required in the governance of elderly care, including medical care.

I believe that a forthcoming elderly care law will solve some of the problems, primarily by raising medical competence in residential care and in home care services. But even here, the Corona Commission clearly points to the need for higher staffing levels, increased competence, and reasonable working conditions – simply better conditions within elderly care. This will improve staff continuity, which in turn provides better quality and increased security for the elderly.

Madam Speaker! In summary, elderly care is an important issue for society, and it must be taken seriously. More resources and staff are needed to offer the elderly a dignified and secure care and support in the autumn of their lives. An elderly care must be created that takes into account the individual's needs and wishes - a care that truly meets the elderly's needs. It is important that the government does not slow down the pace of reform. Take over where we Social Democrats left off, and continue the work of strengthening Swedish elderly care!

The Social Democrats support all reservations, but for the sake of time, I only move for approval of reservation 16 under point 8, Extension of the Elderly Care Boost.

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Dan Hovskär (KD)

Madam Speaker! I would like to begin by moving for the approval of the proposals in the committee's report.

Sweden's elderly deserve world-class elderly care. Therefore, we Christian Democrats propose powerful reforms to create a secure and dignified elderly care. It requires that the staff within elderly care have good conditions, that the elderly can be guaranteed a place in an elderly home, that the pensioners' finances are improved, and that the elderly's opportunities for community are strengthened. We Christian Democrats want to build a society where people can age in security and with dignity. The elderly should be able to live an active life and have influence over their everyday lives, be met with respect, and have access to good care and support.

Many elderly people want to stay in their own homes for as long as possible. At the same time, there is a large group of elderly people who feel that they need a different form of housing but are denied a place. The assistance assessments have become stricter. The Christian Democrats therefore want to introduce an elderly housing guarantee where every person over 85 years of age has a statutory right to receive a place in an adapted residence when and if they want. We also propose an investment support to produce more elderly housing places and new assisted living facilities.

The National Board of Health and Welfare has pointed out major competence and recruitment deficiencies within the areas of geriatrics and gerontology. It is therefore important that geriatric knowledge increases and that the care of the elderly is strengthened – it must be characterized by the highest quality regardless of where in the country one lives.

There is a labor shortage in elderly care at the same time as the group of elderly over 85 years of age is expected to increase. Action is required for improved conditions for staff within elderly care and to strengthen the possibility of recruiting more staff. It is urgent to reduce the occurrence of split shifts and to arrange relief for managers within elderly care. More educational opportunities are also needed.

More medical competence is needed within elderly care, we, the Christian Democrats, argue. Therefore, we want that, among other things, more nurses are employed within elderly care.

The government's goal in accordance with the budget for 2023 is that the elderly shall be able to live an active life and have influence in society and over their everyday lives. The elderly shall be able to age in security and with maintained independence. The elderly shall be treated with respect. The elderly shall have access to good care and support, and the elderly shall be offered equal and equitable care and support.

For this, the government has allocated just over 4 billion kronor, which is set aside for initiatives to increase quality within elderly care.

Development areas that the government intends to invest more in are continued ways to strengthen staffing and competence. The introduction of a protected professional title for nursing assistants may potentially contribute to this. Continued challenges across the country are how the elderly can be offered equal care.

Madam Speaker! What else has the government done so far in this area? Well, they have strengthened the work with dementia by allocating 8 million kronor in a new initiative. Projects shall provide support to municipalities and regions in the work to achieve seamless care and nursing throughout the entire course of the illness.

The government is also investing 50 million kronor to counteract involuntary loneliness among the elderly. The money will, among other things, be used for projects that will make it easier for the elderly to participate in social and health-promoting activities. It is a very important and good investment that makes a difference, we Kristdemokrater think. Investment is also being made in community to promote the health of the elderly through elderly calls in all municipalities as well as digital aids that can break isolation.

The Government strengthens the preventive work against fall accidents among the elderly through an information initiative towards municipalities and regions.

Madam Speaker! A lot is underway, and as I said in my introduction: We Christian Democrats want to build a society where people can age in security and dignity and have access to good care and nursing.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you, Member Dan Hovskär, for the speech! I noted that the Member spoke a lot about quality and about the need for more staff, especially nurses.

In my speech, I also highlighted the need for resources, above all resources to create opportunities to solve the skills shortage. We Social Democrats have, in our budget motion, proposed twice as much money for welfare.

The other day, we received a presentation in the committee of the Swedish National Audit Office's report on lex Sarah and lex Maria, which describes irregularities within the care of and nursing of the elderly. The care of and nursing of the elderly face great challenges. The individuals who receive interventions within elderly care are sicker today than ten years ago. An overall conclusion in the report, Madam Speaker, is that the state's interventions are insufficient. In that, the state, and above all the government, is ultimately responsible.

My question to Member Dan Hovskär is whether the Member agrees with my description of the problem.

Question number two is whether the member, as a government representative, will ensure that more resources are specifically allocated for elderly care in the upcoming budget.

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Dan Hovskär (KD)

Madam Speaker! We received this report this week. It describes how reality looks in many places.

We Christian Democrats have elderly care as a priority issue. We see the deficiencies that exist across the country, and we have many different proposals to introduce improvements.

I stand behind the government's policy, but we Christian Democrats would like to invest even more in elderly care and are fighting to get more resources for this area. The Member of Parliament can therefore be sure that we Christian Democrats will highlight these issues and try to secure even more investments within the area.

Then we have to look at exactly how we are to approach the parts mentioned in the report we received. We will have to come back to that and analyze it a bit more deeply.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, Member Dan Hovskär, for the answer!

It is pleasing that the member shares the view that more money is needed for elderly care. I do not doubt the member's will and intention either. Then, however, the member must get their own party and, above all, the government on board on this journey.

We find ourselves in an extremely extraordinary situation. First came the pandemic a couple of years ago. We may still be dragged along a bit by the effects of the pandemic, Madam Speaker. Then came the war in Ukraine. Now we have also received inflation, double-digit, and interest rates are on the way up.

This means that above all the municipalities, which are primarily responsible for elderly care in our country, are starting to go to their knees. We will see a significant resource shortage already during the autumn, I believe, and certainly during next year.

The Social Democrats have, in their budget motion for this budget year, stated that they have doubled the appropriation compared to the government's regarding money for the general welfare.

My question to Member of Parliament Dan Hovskär is whether the government will truly prioritize elderly care and provide the resources required. We already see in the cooperation agreement between the parties governing the government, the Tidö Agreement, many other reforms that cost an enormous amount of money. Are there funds left for elderly care?

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Dan Hovskär (KD)

Madam Speaker! Yes, we face great challenges in Sweden. We have an unemployment rate that is increasing. We have great challenges when it comes to inflation and the economy for both municipalities and regions and for the state. We have much to do in many different areas.

Then it is about doing the right things. It is about trying to reduce inflation, which is a very important part for the economy and Sweden as a whole to get back on its feet faster. Therefore, it is an incredibly important issue. It is also about how we use our tax funds in the right way.

We Christian Democrats believe that healthcare and elderly care is an important part to invest heavily in. We invest a lot in healthcare, and we invest a lot in elderly care. Therefore, as I said earlier, one of our intentions is to work to see how we can bring in more funds for elderly care in the future.

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Christofer Bergenblock (C)

Madam Speaker! Thank you, Dan Hovskär, for your speech! I fully agree that in Sweden, one must be able to age in security and dignity.

I also share the member's ambition for powerful reforms in this area. However, I may not agree that we have seen these powerful reforms proposed from the government's side.

I think Dan Hovskär raised many important issues in his speech, including what concerns the supply of competence and the content of elderly care. Not least, the member raised that health consultations are also needed for our elderly. I hope that we can join forces and push that issue forward.

The committee members also raise the need for more medical competence and more nurses in our elderly care homes, and on that issue, I agree. We do not only need more people with medical competence, but we also need better conditions in our elderly care homes to utilize the medical competence that exists. Today, there is a clear dividing line between what may be done in our hospitals and what may be done in home healthcare. More advanced medical care needs to be able to be carried out also in homes, either in special housing or in people's own homes.

My question to Dan Hovskär is: Why has the government, which has both a Minister for Health and Care and a Minister for Older Persons, still not taken the initiative to strengthen the possibility of advanced healthcare at home?

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Dan Hovskär (KD)

Madam Speaker and Member Christofer Bergenblock! It is very large processes that are underway. The current government has now sat for almost six months, and we have many processes underway. Many of the different parts are being investigated. One needs to look over large structures from the beginning.

Within healthcare, person-centered care is specifically mentioned. We must also look at that – the same perspective could also be applied within elderly care. The Christian Democrats think it could be an exciting part. It means that one can be involved in shaping one's life throughout life. It is not just elderly care that is needed, but it can also be about other parts, such as community development issues, the pension system, civil society's various contributions, and so on. It is therefore appropriate to look at many different parts and broaden the view on these different issues.

So, we are looking at and investigating many different parts ahead. Quite a few investigations have now been started, so we will have to return to these issues.

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Christofer Bergenblock (C)

Madam Speaker! Thank you for the answer, Dan Hovskär! I have not perceived that an investigation is underway regarding home healthcare and the possibilities there, but I hope that is correct.

Already in the Corona Commission's final report, the problem with the lack of access to advanced healthcare in our elderly care homes was raised, primarily; the same problem also exists at home for people who have access to home healthcare today. Instead, very many are forced out onto our roads to be transported by ambulance for miles from their specific residence to a hospital, to undergo healthcare there that is not always so advanced. It can involve blood transfusions, fluid-boosting drips, intravenous antibiotics and similar things that one needs but which could just as well be given at the elderly care home or directly in the home, with the technology and the staff we have today.

From the Center Party's side, we see a great need to equate home healthcare with other healthcare in order to have the opportunity to provide more advanced medical care even in the home, just as the investigation has shown and the Corona Commission also concluded.

My question to Member of Parliament Hovskär is therefore finally: What initiatives does the government intend to take to drive forward the issue of more advanced healthcare at home?

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Dan Hovskär (KD)

Madam Speaker and Member Christofer Bergenblock! We Christian Democrats have for a longer period talked about how we could handle the availability of doctors also at the municipal level. The availability of doctors within municipal health and medical care needs, we believe, to be looked at and strengthened so that the elderly and relatives can feel secure and so that correct medical assessments of healthcare needs can be made, as you were touching upon. We believe that this could best be done if the time allocated for primary care's medical interventions within elderly care were extended so that there was sufficient time to make the medical assessments required to follow up the work together with the entire care team.

One can, therefore, look at this from a few different perspectives. But these are issues that the Christian Democrats consider important and will continue to raise.

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Carita Boulwén (SD)

Madam Speaker! Today we are debating SoU22 on elderly care issues. That Sweden's elderly receive a secure and dignified old age is for us in the Sverigedemokraterna one of the highest priority issues. The elderly should have the opportunity to live a rich life characterized by independence and autonomy, under secure conditions and with respect for self-determination and privacy. They should feel participation and community and be treated with respect.

We in the Sweden Democrats have for many years championed, among other things, the issue of an elderly minister in Sweden's Riksdag precisely because we consider these issues to be extremely important and should be high on the agenda. The current right-wing government has now, which is pleasing for Sweden and the Swedish people, received such a minister.

Madam Speaker! Those who, through a long life, have contributed to building up Sweden's welfare shall also receive the very best possible care and support when needs arise - a world-class elderly care, regardless of where in the country one lives, with the possibility to choose for oneself who shall perform it. We therefore consider that LOV should be made mandatory in all the country's municipalities in order to increase freedom of choice and also strengthen the quality.

Care and nursing shall be characterized by safety, continuity, and accessibility and be based on the elderly person's needs. We thus see a great need to ensure that special housing is staffed around the clock and that a coordinated individual plan is established from day one to ensure that the right interventions are made from the beginning. We do not want the care recipient to meet an unreasonably large number of different employees. There shall be continuity, and one should feel safe with the staff who arrive. We also consider that geriatric knowledge needs to be ensured.

I am proud and happy that the Sweden Democrats, together with the other Tidö parties, have reached an agreement on important reforms that will increase patient safety and raise the basic requirements within elderly care. The elderly, as they say, deserve world-class care in a welfare country like Sweden. The care of the most fragile and sick elderly must never be neglected.

Language requirements for staff within elderly care is a very pressing issue for us, and proposals on how this can be implemented and integrated into Swedish law shall now be investigated. The importance of language cannot be overemphasized. Language barriers can have very serious consequences: omitted or incorrect care, increased risk of injuries, and risk of serious conditions. Staff must be able to communicate, read, understand, and document themselves in Swedish. This is fundamental for a safe and secure elderly care and a prerequisite for a functioning work environment – both from a care and nursing perspective and from an employee perspective.

Most of the other parliamentary parties have now woken up enough to see that what the Sverigedemokraterna have long advocated for regarding language requirements is important and a pressing issue, which is very pleasing.

Madam Speaker! We have incredibly many fantastic employees all over the country, who daily toil to do their very best within healthcare and elderly care. Unfortunately, reports of serious deficiencies within elderly care have succeeded one another through the years. That structural problems have existed for a long time is probably what most agree on; this was made clear, not least during the pandemic. The staff must be given sufficient and correct resources and tools - there, it has at least failed.

Both Ivo's and Socialstyrelsen's reviews have repeatedly shown serious deficiencies in elderly care in almost all of Sweden's municipalities, including regarding end-of-life care, medication management, competence, and the staff's knowledge of the Swedish language, which naturally constitutes a patient safety risk. At the same time, criticism is directed at Ivo as a supervisory authority because evaluations and follow-ups are not carried out to the extent required to achieve improvements where there are deficiencies.

The Swedish National Audit Office's recently produced report also unfortunately points out that healthcare injuries and substandard conditions are very likely heavily underreported. The national governance of quality in elderly care needs to be strengthened. It cannot continue like this!

We in the Sweden Democrats believe that elderly people in need of care and support should be given a stronger position. We believe that the concept of "reasonable standard of living" is not good enough and should be phased out and replaced with "good living conditions". We also want to clearly strengthen the rights of the elderly in law.

Furthermore, we believe that the government should consider the possibility of introducing a requirement that there should be an elder ombudsman in every municipality who monitors and takes care of the interests and needs of the elderly.

Madam Speaker! Let me be clear: The Government and the Sweden Democrats have hit the ground running with the work to strengthen measures for the elderly during the few months that have passed with the new government. We are making, among other things, extra investments to counteract involuntary loneliness among the elderly. This involves, for example, that the municipalities can start, improve, or expand the work with health consultations.

Madam Speaker! I am pleased that the Sweden Democrats, together with the other coalition parties in the Tidö Agreement, have agreed to develop and implement a number of political reforms to address deficiencies within Swedish health and medical care and to improve the working environment and the supply of skills for the country's health and medical care personnel.

The staff is the healthcare system's most important resource. I really want to extend a big thank you to all employees across the country. Without them, we have no welfare. But a thank you is of course not enough, so one of the government's and the Sweden Democrats' priority issues is to solve the staffing problems that the healthcare system has. The work to secure the supply of competence is long-term, and to meet the needs in the whole country, the government believes that the national commitment regarding the supply of competence needs to be strengthened.

We see a great shortage of staff in all regions, and we must truly improve the working conditions within all healthcare and in particular within elderly care. The Tidö parties are actively working to strengthen the supply of competence in the country so that the healthcare profession is an attractive career that people actively choose to seek out.

Madam Speaker! In the report we are now debating, we in the Sverigedemokraterna want to strengthen the work even further. I want to say, therefore, that we stand behind all our reservations, but I want to specifically move for the approval of reservation 39 regarding health-preventive work. We need to ensure that more preventive measures are invested in to increase the proportion of elderly people with maintained health and minimize the risks for both physical and mental ill health and also reduce the burden on healthcare.

I could stand here for a long time and talk about all the initiatives that we in the Sverigedemokraterna want to make within elderly care - it concerns dementia villages, nutrition and meals, among other things - but unfortunately, time is running out. I have already significantly exceeded my speaking time, so I will stop here.

(Applause)

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Mikael Dahlqvist (S)

Madam Speaker! When I listen to Carita Boulwén's speech, I think she sounds exactly like all the representatives of the government parties here in the chamber today: we are to have a world-class elderly care, the staff is our most important resource, we need to strengthen the quality and so on. I share that view. I agree in large part with most of what has been said from the rostrum so far during this debate.

But we always come to the question that I miss: How is one to finance everything one desires? The government, together with SD, chose in its budget to lower the tax for the highest earners in this country. These funds - billions - could have gone to, for example, elderly care.

We know that elderly care and the municipalities are starting to go to their knees. We know that there is a huge competence shortage. If one is to get more staff, one must improve the work environment and the working conditions. One must increase the staffing and invest in education. All of this costs money.

Madam Speaker! My simple question to Member Carita Boulwén is: How are you going to finance all your pipe dreams?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Madam Speaker! Thank you, Mikael Dahlqvist, for your question!

Daydreams are being spoken of here. I would rather assert that it is the Social Democrats who are now doubling their expenditures in certain areas. One could ask what you have done during the years you have sat in government. You have not invested these sums, in any case. It feels as if the Social Democrats really perform best in opposition.

I think we have clearly shown that we are ready to take responsibility. We intend to ensure that we get the healthcare in order, which has been devastated during the time the Social Democrats have been in power.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you, Member Carita Boulwén, for your answer! I actually received no answer to the question I asked. My question was very simple: How do you add more resources to elderly care?

Then perhaps Carita Boulwén has missed the previous government's investments. These are historical investments that were made in welfare. We are talking about billions of kronor. Thanks to these investments, there is a certain surplus in regions and municipalities, which is now being eaten up. But already at the end of this year and during next year, the municipalities will be forced into either substantial tax increases or cuts.

Carita Boulwén claims that the Social Democrats have not invested in welfare. I would like to ask her to consider where she has obtained that information from.

My question remains: How does the government, together with the coalition partner SD, intend to ensure that resources are increased? More is needed. The number of elderly people is increasing, and the competition for staff is increasing. Can the member give any proposal to remedy this in the next budget?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Madam Speaker! If I am not mistaken, we are debating elderly care today. We do not have a budget debate. We will have to return to that later.

In our proposal for the budget, the member sees that we are making an incredible amount of investments. Previous speakers have also highlighted this. That is my answer to the member's question.

The Social Democrats' reasoning, that one should always put in more money when one sees that something is not working, is not always the solution. Other solutions must be found. That is where we are innovative. We will find ways to improve healthcare and improve it for the staff and for those who need it.

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Christofer Bergenblock (C)

Madam Speaker! Thank you, Carita Boulwén, for the speech! I agree with much of what the member took up in the rostrum and agree on the importance of elderly care.

The chairman of the committee exceeded the time limit by one minute. It must be considered fully acceptable when it is such an important issue that we are debating.

The member states that it is one of the absolutely most important issues for the Sweden Democrats. The member also referred to the Tidö Agreement. I have had reason to read it a number of times since it was presented. It is 62 pages long, and of the 62 pages, three pages are devoted to health and medical care. On those three pages, one paragraph is devoted to elderly care. That paragraph is not about the content of elderly care but about setting requirements for language skills among the staff in elderly care. Thus, only a single paragraph of text is devoted to what was supposed to be one of the absolutely most important issues!

It could be that the Sweden Democrats are simply bad negotiators, but given other parts of the Tidö Agreement, one is not really tempted to believe that. Other so-called heart issues for the Sweden Democrats have indeed been given a lot of space.

I ask myself a question, and I also ask it to the member: Why is elderly care the least prioritized area at all in the Tidö Agreement?

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Carita Boulwén (SD)

Madam Speaker! Thank you, Member Christofer Bergenblock, for the question! Yes, we can certainly discuss the Tidö Agreement, what is in it and how much influence we have had. We hear quite often in this chamber that it is the Sweden Democrats who are the winners in this agreement. As the Member notes, however, it does not say particularly much about what we have agreed regarding elderly care. It is language requirements, and then there is the possibility of employing municipal doctors out in the municipalities.

The Sweden Democrats have even more initiatives on exactly the elderly, as I mentioned in my speech. We are therefore not without proposals even if we have not had them passed in this round, in our agreement with the other Tidö parties.

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Christofer Bergenblock (C)

Madam Speaker! I thank you for the answer, even though I did not quite understand it. The member emphasizes that the Sweden Democrats are perceived as winners in discussions regarding the Tidö Agreement. Either one has actually managed to get through exactly what they wanted regarding elderly care - a single requirement concerning language skills - and thus perhaps elderly care is not the most important issue for the Sweden Democrats, or the other three Tidö parties have been so mean to the Sweden Democrats that they have overridden them in everything related to elderly care and said: We will not include that in our Tidö Agreement.

I find it a bit difficult to believe this. I find it a bit difficult to believe that this is actually the most prioritized issue for the Sverigedemokraterna or that it is very important when it has been given so incredibly little space.

But the point that is nevertheless raised concerns imposing language requirements on staff within elderly care. The member highlighted in their speech that it was important because language barriers can have very serious consequences.

I think I recognize the debate about how language barriers within healthcare can have serious consequences from another context. Yes, exactly, every single person working within Swedish healthcare today has reacted extremely strongly and negatively to the proposal that the Tidö parties have put forward to make it more difficult to access an interpreter within Swedish healthcare by imposing economic requirements and charging a fee for an interpreter for those who do not master the Swedish language. There, it has been highlighted that precisely language barriers can have very serious consequences.

My question to Carita Boulwén is: Does what was just said regarding the problem with language barriers mean that the Sverigedemokraterna and the Tidö parties have abandoned their demand regarding interpretation within Swedish healthcare?

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Carita Boulwén (SD)

Madam Speaker! No, we have absolutely not done that. We have not abandoned it. Just as important as being able to speak the language when working as an assistant nurse and a nurse is being able to speak the language when working as a doctor. Therefore, we want to set requirements that one can speak the Swedish language. We want to clarify this so that it really becomes so that the individual takes on this responsibility. When one comes to Sweden and is going to work and be employable here, one must learn and be able to speak the language. This is connected to what we are talking about now regarding the language requirements within elderly care.

(cont. § 8)

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