Elderly care

Mona Olin (SD)

Mr. Speaker! We are now debating SoU20 Äldreomsorg. In Sweden, the proportion of elderly people in the population is increasing. Unfortunately, many elderly Swedes live under difficult conditions with meager monthly incomes and lack of access to care and services. Violence, abuse, and neglect are also commonly occurring.

It is necessary to reassess the view on elderly care to ensure high-quality care and a welfare society. It is important that elderly care is characterized by empathy and security and that all elderly people get access to good care. The language requirement within the Tidö Agreement is expected to contribute to an improved elderly care with a focus on both the patients' safety and the staff's working environment. This is an issue that the Sverigedemokraterna in particular have been very proactive in and which other parties have also later understood the importance of. We are pleased about it, even if one, like with much else, woke up late. To improve the situation, measures are also required to attract and retain staff within healthcare through improvements of working conditions and the working environment.

Now I wanted to speak a little about the law on choice systems. For most people, the possibility of choice is important and obvious, regardless of age or situation. Elderly care is no exception. Through choice in elderly care, the influence of the elderly and their relatives over the care and support is increased.

In December 2023, Vårdföretagarna conducted a survey among people over 85 years old. The results showed that the majority supported the option of choice within elderly care. It is 85-93 percent who want the opportunity to choose providers within home care, to choose elderly housing, and to choose between public and private elderly care.

Freedom of choice and private forms of care are a positive development. It is important that all healthcare providers maintain a high quality standard. In procurement within the framework of LOV, the municipality specifies the requirements that the providers must meet. The Sweden Democrats believe that quality should always be prioritized over price in procurement. The elderly's self-determination increases, and they become more satisfied when they themselves get to choose who should step through the door and help them with care and service.

The Sweden Democrats consider that LOV should be mandatory for elderly care in all municipalities in the country. Being able to choose one's own housing when old age comes is as self-evident for us as choosing one's own grocery store, one's own pharmacy, and one's own health center.

Malnutrition is a widespread problem in Sweden, especially among the elderly. According to information from the Food Academy, a large proportion of the elderly are in the risk zone for malnutrition, or are actually malnourished. A full 30 percent of those over 80 years old who do not have home care are estimated to be malnourished.

This is a situation that is unacceptable. Those affected experience a diminished quality of life due to, among other things, generally poor health status, weakness, increased risk of fall accidents, comorbidities, and frequent hospital visits.

From a socio-economic perspective, malnourished patients have significantly longer treatment times than other patients. They are affected by fall accidents and treatment complications three times more often, and it requires a longer rehabilitation period.

The advantages if the preventive work is improved are significant both for the individual and for society as a whole. Here I see that a national zero vision could make a real difference. Through relatively simple measures, much can be achieved, for example, that the issue is always raised already at the first contact with the individual.

Loneliness can be self-chosen, but when it is unwanted, it can lead to negative feelings and affect health. Involuntary loneliness can make one feel unwanted and lack close relationships, which can cause mental and physical ill health.

Identifying elderly people who suffer from involuntary loneliness early and offering support is important, and both social services and health and medical care have a central role in this.

There are significant differences in mental health between different groups, and the elderly are a group that rarely receive specialized psychiatric care. However, it is the group that takes the most antidepressants.

Despite the fact that mental ill-health among the elderly is common, it is not sufficiently noticed, which leads to many not receiving the right help in time. Therefore, it is important to work preventatively and detect symptoms early.

Social community, physical activity, healthy diet and meaningful activities are all important for healthy aging and can contribute to preventing mental ill-health. Increased knowledge among healthcare staff and the elderly can help identify risk factors and strengthen protective factors among the elderly.

I look forward to receiving the Public Health Agency's final report on involuntary loneliness and its consequences, and the proposal for a national strategy to develop and intensify the work to prevent and counteract involuntary loneliness. This is to be presented in February 2025.

I conclude by saying that welfare should extend throughout the entire life. Therefore, the Sweden Democrats consider that the description of the elderly's standard of living should naturally be "good living conditions".

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Christofer Bergenblock (C)

Mr. Speaker! Thank you, Member Mona Olin, for the speech!

There is much in the member's speech that I share. This concerns the view on freedom of choice within elderly care, how we should work to counteract loneliness, and that we overall need elderly care of good quality in Sweden.

The Chairman also concludes by saying that welfare shall extend throughout life and that we shall offer "good living conditions". Good living conditions is the new wording we have in the proposal for a new Social Services Act, as opposed to reasonable standard of living.

There is a certain increase in ambition there. But the increase in ambition is not at all in line with the increase in ambition that the Sverigedemokraterna presented before the election. There, it was pointed out very clearly that they wanted to see a unified elderly care law which would also be an entitlements law in the same way as LSS and with the same rights to a good standard as is the starting point in LSS.

Now, last autumn we found out that the government has thrown the proposal for a new elderly care act into the wastebasket with the Sweden Democrats' good memory. The Sweden Democrats were very clear when answering surveys before the election. Not least was it a survey from SPF Seniorerna where it was said: We welcome an elderly care act. It is important for us that it becomes precisely a rights act which means that the elderly have a right to certain interventions.

We can observe that there is much to be done in Swedish elderly care and that an elderly care act would have filled a very important function, not least to bridge the gap between the Social Services Act and the Health and Medical Services Act.

My question is: Why have the Sweden Democrats changed their minds about the need for an elderly care act?

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Mona Olin (SD)

Mr. Speaker! Thank you for the question, Member Christofer Bergenblock!

It is true that we see things similarly on many issues concerning elderly care. I actually believe that all parties can stand behind the idea that the elderly should live a good life, be treated with respect, and receive good care. This should, of course, happen throughout life.

We had an elderly care act in our proposal. But when looking at updating the Social Services Act, it was chosen to include parts there that could have been included in the elderly care act. It is perhaps not so successful to handle the same issue in two different acts. We see that the issues that the elderly care act would have covered are being addressed in the Social Services Act.

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Christofer Bergenblock (C)

Mr. Speaker! The work on the new Social Services Act was in full swing when we were in the election campaign. It could have been stated already then that it would, in that case, be possible to incorporate the proposals from the Elderly Care Act into the new Social Services Act.

It might be perceived as more dishonest in the surveys that one still maintained that one wanted an elderly care law for the reason that the pensioners' organizations have requested it. It is clear that it is easier to answer yes even if one had a different underlying motive. It sounds a bit strange that one changed one's mind so quickly. When the election was over, one also abandoned the idea of an elderly care law.

The very point of an elderly care act was precisely to gather the issues regarding elderly care, where we have seen that there are major deficiencies today. That was what the Corona Commission concluded both in its partial report and in its final report. That was what the Swedish National Audit Office showed in its report from January last year.

There are major deficiencies in Swedish elderly care, and the connection between elderly care and healthcare does not function as it should today. The idea was that it would be bridged in the new elderly care act. It is difficult to see how it will be done in the same way in the new social services act.

The starting point for the Sweden Democrats was that the new elderly care law should be precisely a rights law.

Therefore, my follow-up question to the member is: How can a new Social Services Act, which will not be a rights-based law, compensate for the absence of a unified elderly care law?

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Mona Olin (SD)

Mr. Speaker and members! As I said, we have stood behind that the issues concerning elderly care will be covered by the Social Services Act. It is being developed, and several areas are being added that have not been included in the law previously.

Furthermore, no one knew during the election campaign how the election would turn out. No party can issue information before the election on how they intend to proceed, who they intend to cooperate with, and what the government cooperation will look like.

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Nadja Awad (V)

Mr. Speaker! In 2020, the leader of the Sweden Democrats, Jimmie Åkesson, participated in a debate with the then Migration Minister Morgan Johansson regarding quota refugees. Åkesson's argument was that the then government prioritized refugees so that the elderly would receive the welfare they are entitled to. There is a reason why he mentioned the elderly and welfare in the first place.

Now we stand here and debate elderly care. My question to Sverigedemokraterna's Mona Olin is: In what way has elderly care become better with this right-wing government led by Sverigedemokraterna? How have the elderly received a better welfare through the government's policy? How do you think it is going, quite simply?

There were many praises that came from Åkesson about four years ago, before we had a national election. But now cuts are being made in elderly care across the country. One is opening up for profit-driven companies to establish themselves in municipalities that use LOV.

Cuts are being made to healthcare and care staff, and those who remain are forced to run faster between users. There is a stop to substitutes during sick leave. Staff are forced to work split shifts, and the elderly have to wait relatively long to move to elderly care homes in relation to their needs and remaining life expectancy. Fewer activities and outdoor stays are offered at elderly care homes. Users receive a half sandwich instead of a whole one for the snack. All this happens while the SD government distributes tax cuts and subsidies to the rich.

My question is therefore: In what way have the government's priorities led to the elderly care becoming better?

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

Mona Olin (SD)

Mr. Speaker and Member Nadja Awad! The Government has already made several important decisions to improve elderly care.

The Leader of the Opposition claims that we, or the government, are taking austerity measures in elderly care. The Sweden Democrats are not in the government, but we are a cooperation party in the Tidö Agreement. Elderly care is managed by municipalities and regions. Municipalities and regions have a responsibility to manage their own finances.

The government has, however, made major decisions. An agreement has been reached with SKR regarding over 3.4 billion, which implies continued support for the development area of health-promoting, preventive, habilitative, and rehabilitative approaches for the elderly. The government has made investments to prevent and counteract involuntary loneliness. A three-year community initiative was started in 2023, and there is an ongoing grant for stimulus grants for measures within the elderly area. The Public Health Agency's grant increases by 20 million in 2024. Many different decisions have thus been made.

Furthermore, the National Board of Health and Welfare has in its regulatory letter the mandate to pay out 95 million kronor to the country's municipalities so that they may work to counteract involuntary loneliness.

There are, therefore, many examples that show that both the government and the Tidö cooperation parties are working to ensure that the elderly get it better.

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Nadja Awad (V)

Mr. Speaker! I want to remind the members that the government has a financing responsibility towards the municipalities according to law. This means that the government shall allocate to the municipalities and the regions the resources they need to be able to maintain quality and also be able to develop it if necessary.

I want to remind the member of this, because the Sweden Democrats are the largest party in the government support. This means that the party has a great responsibility to ensure that elderly care, which we are talking about in this case, receives the resources needed so that staff do not have to be laid off and so that the elderly can receive the care and support they are entitled to based on their needs.

It will, however, be very difficult for elderly care to maintain quality and develop its operations when Sveriges Kommuner och Regioner requested 28 billion kronor for this year and the government, with Sverigedemokraterna at the forefront, only gave a third of the money.

It is very sad to hear that the government's and the Sweden Democrats' priorities after nearly two years in power are tax cuts and subsidies for the rich. At the same time, the government says, just as Member Mona Olin says here: The municipalities must take their responsibility.

Does the Prime Minister mean that the municipalities should raise the municipal tax? There are probably several of the Sweden Democrats' voters listening now. Will the municipalities need to raise the tax for them and others so that elderly care can survive?

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Mona Olin (SD)

Mr. Speaker! I completely agree with Nadja Awad that the elderly must receive the care and support they need and deserve. There is no doubt about that.

In the autumn, a forecast came from SKR that money was needed for the municipalities. A forecast is not facts at all, but a forecast is a hint at what one believes municipalities and regions will need.

It must be positive that profit-making companies are started in the municipalities to provide elderly care! If there is a lack of places for the elderly and companies want to start operations, it implies a relief for the municipalities and a positive development and an improvement for the elderly. It does not become more expensive for the elderly, and it does not become more expensive for anyone.

In the actual operation, the private companies shall receive compensation in the same amount that the municipality calculates an elderly care place costs per day, and that is what they shall receive. It is only that at the end of the year, the social services' budget might go into the red because the municipality's elderly care has cost more. In that case, the committee receives money for that, because it simply cannot go into the red, and so it is corrected in the year-end accounts. These funds do not go to those who operate private care facilities.

In practice, many municipalities pay more for the elderly care they provide themselves than for the private one. And one can always wonder: Is a relatively expensive elderly care ambitious or is it inefficient?

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Anna Vikström (S)

Mr. Speaker! In the Sverigedemokraternas member's contribution, we hear some positive things about the mental health of the elderly and the need for psychiatric and psychological treatment and care. We can probably agree that the very sickest and those within elderly care do not receive enough.

I would, however, like to talk about something else. Ahead of the 2022 election, the Sweden Democrats said very clearly that the party welcomed an elderly care law that marked the distribution of responsibility and how the care of the elderly would become better. You also raised the problem that elderly care varies greatly in quality across the country. That was also the very clear answer that the Sweden Democrats gave to the pension organizations, which we heard earlier in the debate.

Now, however, the Sweden Democrats have completely changed their opinion and do not believe that an elderly care law is needed. What proposals do the Sweden Democrats actually want to implement so that the quality of elderly care becomes more even across the country without new legislation? It does not appear in the very brief text about elderly care that exists in the Tidö Agreement how it is to be done.

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Mona Olin (SD)

Mr. Speaker! Thank you for the question, Anna Vikström!

I see that we have similar thoughts on many issues - including mental health, which you bring up. It is a very important topic to discuss. I believe that everyone here also agrees that one must implement early and preventive measures to help the elderly feel well during their old age.

Regarding the elderly care act, I have already debated this with Member Bergenblock. I can only state once again that before the election, we invested in what was right at that time. I am not saying that there is anything wrong with an elderly care act, but when one is in a cooperation with government parties, it is about give and take. Sometimes you win, sometimes you win a little, and sometimes you do not win.

We are still working very actively to ensure that the elderly are well off, not least with all the initiatives that I have already told you about, such as good and close care and person-centered and patient-safe health and medical care. We have proposals for national rules on what quality level should apply in elderly care homes and on whether all municipalities should offer LOV to the elderly.

I think that the Sweden Democrats can truly feel strong in the issues that are being driven within elderly care.

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Anna Vikström (S)

Mr. Speaker! Thank you for the answer, member!

Some of the points the member is now listing belong to what was to be handled within the elderly care act, which the Sweden Democrats said before the election that they were positive about but have now changed their minds on. I think that is very unfortunate. The proposal is clear. It has been referred, it is sitting there, and it could be moved forward directly by both the Sweden Democrats and the government. I think this is inconsistent with what the Sweden Democrats propagated before the election.

The other day, SPF Seniorerna and Riksförbundet Hjärtlung wrote an editorial about the need to strengthen health and medical care in elderly care, which belongs to what the elderly care act should address. Legislation is needed that takes a very broad approach to the issue in order to strengthen the content and position of municipal health and medical care.

I have heard from members of the majority – I cannot swear that it was from the Sverigedemokraterna – and actually even from the Minister for Seniors that it is the new Social Services Act that is somehow supposed to regulate the municipal health and medical care. I question that very much. How is the Social Services Act supposed to regulate health and medical care, which nevertheless has its own legislation? Can the member explain how that is intended?

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Mona Olin (SD)

Mr. Speaker! Thank you for the question, Member Anna Vikström!

The Speaker says that there is a finished proposal that SD and the government can simply move forward with. Yes, they can, but now we have a government that does not want to do so. We in SD do not decide for the government. We are the largest party within the Tidö group, but we still do not decide for the government. And even if we did, we would have to reach an agreement within the group.

It is important that the municipalities receive a more secure position within healthcare regarding its content, what they should do, and what position they should take. At the same time, everyone has a right to healthcare, and it is better to manage everyone under the same law than to break out a group and set up separate laws for it.

We have a health and medical care act. We have invested money so that healthcare shall develop its competence in several different areas such as mental health, preventive measures against malnutrition, and fall accidents. The National Board of Health and Welfare has been tasked with producing working material for this, where they have also included malnutrition.

I am confident that the concerns of the elderly will be addressed within the healthcare system.

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Anna Vikström (S)

Mr. Speaker! Today we are debating motions on elderly care from the general motion period. I move for approval of reservation 1, even though we stand behind all our reservations.

I want to say first that I am fundamentally very impressed by how elderly care in special housing has developed into what it is today, with home-like environments and activities based on ability and will, as well as how the staff, who are often assistant nurses, have built up the operations with great professionalism and competence. It is an important journey that has been made from the housing and nursing homes of former times. I saw some of those during my training a long time ago, and believe me: That is not where we want to go back to.

But elderly care needs better conditions today. I often hear now that there is a concern that the needs of elderly care have fallen into the shadows of other problems in society. I also receive questions about what is being done from the government's side to improve elderly care.

According to the Health and Social Care Inspectorate, there are deficiencies regarding competence supply and staff continuity within elderly care. There are elderly care homes that offer coherent, high-quality care and nursing. However, the quality is unacceptably uneven, and there are structural deficiencies within municipal health and medical care.

It is usually elderly people with multiple illnesses and complex care needs who live in special housing. Unfortunately, they are affected by the fact that the medical care and treatment still show extensive deficiencies. Among other things, the medication management is deficient. In 81 percent of the municipalities, the staff responsible for administering medication do not have sufficient conditions to perform this in a patient-safe manner.

Care at the end of life is also not functioning satisfactorily. In almost all municipalities, the staff lack sufficient knowledge within medical care and nursing to observe and interpret signals regarding, among other things, deterioration in health status and to assess whether a nurse needs to be contacted. And in just over half of all municipalities, there are too few nurses for them to have the conditions to assess the patient's health status on-site. In addition, the total doctor time is often insufficient to meet the residents' needs.

It also appears that municipal health and medical care has become increasingly advanced in recent years. The municipalities are expected today to be able to provide more and more of the medical care that was previously the regions' responsibility.

It is also a question of how much rehabilitation these multi-morbid residents receive. The number of physiotherapists and occupational therapists has practically not increased since 2017, and very few rehabilitation plans are made in special housing, according to the Health and Social Care Inspectorate.

Dental care is also an important health issue. Now there are signs that the accessibility to dental care for elderly people has decreased, when they instead need more.

Against this background, Mr. Speaker, a new journey needs to be undertaken to improve the municipal health and medical care provided within elderly care. The S-led government took the initiative for an investigation of a new elderly care act. The investigation is now complete and presents several proposals for legislation aimed at strengthening health and medical care for persons in elderly care. This includes, among other things, permanent doctor contact, permanent care contact, round-the-clock access to doctors and nurses, and strengthening the responsibility for rehabilitation, as well as the management and coordination of municipal health and medical care.

But SD and the government have chosen to stop the introduction of an elderly care law and are shelving the investigation, which I deeply regret. The Social Democrats believe that Swedish elderly care needs new elderly care legislation. We want the government to take the investigation's proposals and the submitted referral comments further and work out a proposal for new legislation during the mandate period.

Mr. Speaker! The supply of competence in elderly care is a major challenge. On the one hand, employers compete for labor in certain regions, and on the other hand, the employees' work environment and working conditions in elderly care are not sufficiently good. This makes it difficult to recruit and retain nursing assistants and healthcare assistants.

The previous S-led government began the great work of lifting up, securing, and modernizing Swedish elderly care. We took the initiative for a protected professional title for nursing assistants and for an investigation into sustainable competence supply within elderly care. That one also seems to be sitting on the shelf with the government. We took the initiative for the Elderly Care Lift, which is a state grant for competence supply of the staff, and for a sector grant, which is a state grant that goes directly to elderly care. We also developed a central support for language assessment, introduced a fixed care contact in home care, and more.

We Social Democrats propose, against the background of the growing staff shortage within health and social care, that the government should take a completely new initiative for something we call a commission for the welfare sector's staffing supply. Models for similar commissions and cooperation structures exist, for example, in the defense and security sector. We believe that it is required in this situation, as the supply of competence in the welfare sector is one of the coming decade's greatest challenges for municipalities and regions.

Mr. Speaker! It is high time for more reforms within elderly care. But we see that the government prioritizes other things, for example, tax cuts, over the quality of elderly care. There is reason for the concern, which several have expressed, that the needs of elderly care have been sidelined.

We Social Democrats want elderly care to maintain high quality across the entire country, be based on the elderly person's needs and right of self-determination, and be staffed by properly trained personnel who have a good working environment and secure working conditions.

Older people in need of interventions from both health and social services shall be met by a professional team that the elderly person knows. Such elderly care gives people the opportunity to age in security.

(Applause)

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

Malin Höglund (M)

Mr. Speaker! Today we are debating the report SoU20 Elderly Care. The report contains approximately 70 motions from the general motion period.

I vote in favor of the committee's proposal.

Mr. Speaker! Elderly care engages people. We see this, not least here today. We all have our own picture of how we want our elderly care to be. Should it be under municipal management, should it be in a cooperative, or should it be operated in private management? In surveys with the elderly, it has emerged that nine out of ten want to choose the provider of home care and housing themselves.

Why should we only choose when we are younger? Parents choose preschool for the children, if there is anything to choose between in the municipality where they live. We also choose school for the children. But when we get older, we are not expected to choose ourselves. Why should my municipality choose housing for my mother, who is 80 years old? Why should she not get to choose it herself?

Mr. Speaker! There are goals for the care of the elderly. The elderly shall be able to live an active life and have influence in society but also over their everyday lives. One shall be able to age in security and with maintained independence. One shall be met with respect, have access to good care and nursing, and be offered equal care and nursing.

Mr. Speaker! Today we are living longer and generally getting more healthy years. The proportion that is 80 years and older is expected to increase from 5.5 percent in 2020 to 9.1 percent in 2050, that is to say, almost double. Even though the health of the elderly has improved, the elderly's need for care and nursing will therefore increase sharply in the coming years.

At the same time, the challenges with skills supply within elderly care are increasing, and as we all know, the staff within elderly care is the most important thing. The need for skills supply can primarily be met by increasing attractiveness and finding new ways of working. The work environment needs to be improved, and the status needs to be raised.

A protected professional title for nursing assistants is precisely such an initiative. The protected professional title is an important tool to secure competence and increase the minimum standard. But it is also important to raise the profession's status and increase its attractiveness and thereby contribute to strengthening the supply of competence.

As I mentioned earlier, the staff is elderly care's absolute most important resource. Therefore, the government is investing in Äldreomsorgslyftet and extending it to 2026 with 1.7 billion kronor.

Mr. Speaker! Good knowledge of the Swedish language is a prerequisite for the work within elderly care to be able to be performed in a safe manner. The elderly must be able to understand the staff and be able to make themselves understood. The Moderate-led government has therefore appointed an inquiry that investigates language requirements for staff within elderly care. There are already today municipalities that make use of language tests.

Since July 1, 2022, there have been new provisions in the Social Services Act with requirements that those who have home care shall be offered a fixed care contact. The exception is if the municipality assesses that it is obvious that it is not needed. From July 1, it is a requirement that the person appointed as a fixed care contact shall have the professional title of assistant nurse. It is a requirement that has not existed before, which is actually a bit surprising.

Language requirements and that the person appointed as a permanent care contact shall have the professional title of nursing assistant are important steps to increase safety for our elderly and raise competence.

Mr. Speaker! Welfare technology is already used today in many municipalities. It makes the elderly more independent and is also a support for the staff. A government bill on welfare technology was adopted in December last year. It now provides support for the municipalities' work with introducing welfare technology and strengthening the knowledge base. 20 million kronor go to SKR and Kompetenscenter välfärdsteknik.

Mr. Speaker! The care and support provided in the homes of the elderly has become more advanced. The medical competence must be strengthened in all of the country's 290 municipalities. The investigation on strengthened medical competence in the municipalities shall strengthen the municipalities' access to doctors, provide proposals on how the municipalities can employ their own doctors, and also provide proposals on how the supply of competence can be strengthened.

Mr. Speaker! Dementia is one of the major diseases of the people in Sweden. Hundreds of thousands of Swedes live with some form of dementia, and tens of thousands of Swedes receive a diagnosis every year. Relatives of those living with a dementia disease perform an important but heavy task.

We cannot cure a dementia disease yet, but it can be countered. Some of the world's leading researchers in the field work in Sweden. We need an updated dementia strategy that takes into account new research within both care and pharmaceuticals and that concerns both municipalities and regions.

Mr. Speaker! The investigation into an elderly care act, which was previously discussed here, was handed over to the previous government in June 2022. The previous government chose not to proceed with the proposal for such an act. The conditions for a holistic view regarding the individual's needs risk being worsened if elderly care is separated from other social services. Elderly care will continue to be regulated in the Social Services Act, which will also be finalized before this summer. All people have the right to a dignified old age.

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Christofer Bergenblock (C)

Mr. Speaker! Thank you, Malin Höglund, for the speech! I was particularly pleased that the member highlighted the issue of freedom of choice in elderly care. It is a question that is important for many elderly people.

During a seminar organized by SPF Seniorerna together with Vårdförbundet, a survey was presented showing that older people want freedom of choice. Just as one wants freedom of choice throughout life, one wants it in old age. One chooses a preschool for one's small children. One chooses a school for one's older children. One chooses a health center when one is an adult. Naturally, one also expects to be able to choose home care companies and elderly housing when one is old.

Unfortunately, it is the case that very many elderly people - in fact the majority - do not have the opportunity to make these choices because Sweden's municipalities have not introduced the law on freedom of choice. Consequently, people are deprived of the freedom of choice that they should have a right to and which today is a given when it comes to, for example, choosing a health center.

The Minister for Seniors, the Moderate Anna Tenje, was present at the seminar. Despite her saying that she was a strong advocate for freedom of choice, just as we heard the member say just now, she could not present a single measure she had taken and not a single investigation she had commissioned as minister to increase seniors' freedom of choice. It sounds like this is just lip service from the Moderates' side and no practical policy.

My question to the member is how it is that the Moderaterna are no longer actively working to strengthen the elderly's right to choice.

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Malin Höglund (M)

Mr. Speaker! As Christofer Bergenblock knows, elderly care is carried out in the municipalities. It is the municipalities that decide. It is the municipalities' politicians who decide what it should look like, what different types of housing should be available, and whether they should only exist under municipal management or if one is open to housing in private management, as for example in Mora where I come from. We also have a cooperative. That was why I wanted to mention it. There are actually different variants. The municipality's politicians decide how it should look in the municipality, quite simply.

I am a strong advocate for freedom of choice. As I mentioned, one chooses preschool and school for their children, but as soon as one gets older, the municipality is expected to solve that – even though one as an older person also wants to choose! Nine out of ten want to choose for themselves how they shall live. The municipality should be able to meet those wishes and ensure that there are housing options, perhaps both municipal, cooperative, and private. They should ensure that there is a variation, but we have not quite gotten there yet, and it looks very different in the country's 290 municipalities.

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Christofer Bergenblock (C)

Mr. Speaker! It is true that elderly care is carried out in the municipalities. Education in the primary schools is also carried out in the municipalities, but it is not the municipalities that decide whether there should be independent alternatives to it. It is the state – that is, the Riksdag – that has decided that there should be an opportunity for alternative providers to establish themselves. This is also done all around Sweden. Health centers are run by the regions. There, it is also the case that others have the opportunity to establish a health center and conduct operations.

What the Moderaterna say about being for freedom of choice is not really consistent when it comes to elderly care. One is not prepared to take the step required for us to actually have freedom of choice within Swedish elderly care. One notes that nine out of ten elderly people want freedom of choice but is not prepared to take the consequences of it and legislate. We have had the freedom of choice law in Sweden since 2007. It is obvious when even the possibility of choosing home care companies is not offered in half of Sweden's municipalities that the law has not been implemented in the way we desired at that time. Then one needs to go one step further.

My follow-up question is whether the Moderaterna will support the Centerpartiet's proposal to legislate on LOV at least within home care. We just heard that it is also a requirement from your coalition partner Sverigedemokraterna, who obviously are also pushing for this. Will you stand up for the elderly's right to choice, or is it just lip service? That is what I wonder.

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

Malin Höglund (M)

Mr. Speaker! I must say again that it is the municipalities themselves that decide how they want things to be. It is very different how the municipalities are governed across Sweden. Not all are governed in the same way. There are many different coalitions. As long as no party has 51 percent, one perhaps cannot push through all of one's issues. This also applies in my municipality. There, we in the Moderaterna cooperate with Centerpartiet and Kristdemokraterna. We do not have 51 percent and therefore cannot decide either.

But this is a municipal issue - that is what I absolutely think. I think that one should encourage the municipalities to ensure that there are several different types of housing. There should be municipal housing for those who want to live that way, but one should also encourage other actors to ensure that there are private dwellings and that there are cooperatives for those who want to live in that way, for example, slightly smaller.

LOV in home care is something that even my municipality has made a decision on, but we have no provider. We have made a decision on it, but we get no provider. I don't think we are alone in that. We are a fairly small municipality. Most of Sweden's municipalities are not huge but perhaps have around 16,000 inhabitants. In that case, it can be difficult to get providers to come there.

This is not a very simple matter, but we can agree that we think quite similarly. We want there to be freedom of choice for the elderly so that they can continue to choose.

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Anna Vikström (S)

Mr. Speaker! Yes, I agree with some of what Malin Höglund says and has argued previously regarding the needs in elderly care when it comes to quality. Those needs exist. I also agree with what I thought I heard regarding the need to strengthen the health and medical care in the country.

But when we talk about health and medical care in residential care, I must say that it will not work to include it in the Social Services Act. Health and medical care is a separate legislation, so it simply cannot be done. One might perhaps include other administrative parts or cooperation parts in the new Social Services Act, but when it comes to health and medical care, we mean that a specific elderly care act is needed to do this.

I would also like to say that in various reviews of elderly care, it appears that the staff do not have the right conditions to perform their work in a good way. They have insecure employment, and continuity is lacking. It affects the residents - one does not have sufficient knowledge of the residents' needs and wishes. A good deal of staff also do not receive the right education or competence development.

Now the municipalities also face major economic problems. A majority need to make cuts in welfare.

My question to the member is how the conditions for the staff to perform high-quality work in elderly care shall be strengthened in this situation, now and in the future, and what measures the government will take to strengthen the long-term competence supply in elderly care.

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

Malin Höglund (M)

Mr. Speaker! First and foremost, I believe that the staff must start speaking well of their own work.

I was in Älvdalen on Friday and visited an assistant nurse and her husband. To their horror, they wanted to show how many had applied to the health and social care program in three municipalities - Mora, Orsa and Älvdalen. It was 19 who had applied and 12 who had been admitted. That does not even cover the need in Älvdalen municipality.

Several of the municipalities across Sweden also do not accept interns from the health and social care program in upper secondary school, as they consider themselves to have no time.

I believe that the employees must do some of the work themselves, speak well of their profession and not disparage it, because they do a fantastic job. It is an incredibly important work they do.

The municipalities must also be prepared to receive interns.

Very many people are employed in municipalities and regions for things that I think perhaps are not needed. Over the last six years, I believe it is, 100,000 people have been employed within municipalities and regions for things that do not really belong to welfare professions. It could be communicators or others. I am not saying that they were not needed. They were also needed. But more people must be employed who work in the core of the welfare sector. That is what I believe much more in.

The elderly care boost is a way to strengthen competence, and it is now being extended to 2026 with 1.7 billion kronor.

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

Anna Vikström (S)

Mr. Speaker! I did not hear what measures the government is taking in this situation with large cuts and reductions even within municipal care - we are not to debate the school today - to strengthen and make the professions within elderly care more attractive.

We cannot believe that an industry becomes attractive if the burden only increases. On the contrary, reforms need to be made that strengthen the supply of skills. This applies to working conditions and on-site skills development, and it applies to leadership.

Our proposal is to take a holistic approach to a preparation for the entire welfare sector's skills supply. I am naturally curious about what the member thinks and what the government is prepared to do in terms of investments in this situation to facilitate the skills supply and increase the quality.

I noted that Malin Höglund in the previous debate mentioned an investigation that we had commissioned and which was completed in 2021. It is called Vilja välja vård och omsorg and concerns exactly elderly care. I mean that it could be used, but as far as I know, it is also sitting on the shelf at the government along with the elderly care act. We think that is very unfortunate.

What is the government prepared to do?

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

Malin Höglund (M)

Mr. Speaker! Again: The elderly care boost is what strengthens so that the staff can get more clothes on, so to speak, and manage their assignment better.

Having trained nursing assistants is like having trained staff in preschool. We wouldn't talk about the school, but it is the same thing there. There must be trained staff. Either you are a nursing assistant, or you are a healthcare assistant. There must be a difference between those, because we must raise the status of the job.

Leadership is incredibly important. I heard that as well in Älvdalen on Friday. It is incredibly important that leadership recognizes its employees, because they actually do a fantastic job. It is A and O. Leadership is A and O, not just within this area.

The municipalities must also make their own efficiencies. What is it that is important to have? What is it that we can remove? These 100,000 people who have arrived as extra over the last six years within municipalities and regions, were they needed? Can we remove them or train them to be nursing assistants or some other job within welfare instead? The municipalities also have a job to do in this, absolutely.

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Nadja Awad (V)

Mr. Speaker! The Left Party has for a long time pointed out the risks of the dismantling of the Swedish welfare state.

Privatizations, profit-seeking, and demands for economic efficiency within elderly care have resulted in many substitute workers, lower staffing levels, high staff turnover, and lower wages. The elderly are not seen as individuals with their own needs but as units in an already underfunded welfare system that is supposed to generate a financial surplus for the shareholders in private companies.

Because the government does not provide sufficient state grants to the municipalities, cuts are occurring across the country's elderly care, which means that elderly care is currently in a crisis.

The situation within elderly care has also reminded us of the inequality and imbalance that prevails.

Given that the number of people over 80 years of age will increase significantly, it is of importance to take measures now to have preparedness for future needs of both medical competence and a sufficient number of employees.

Without an expanded elderly care, it falls on the relatives to take an increased responsibility, and it is a fact that women are overrepresented both among staff and among those who take a large responsibility for elderly family members. An expanded and well-functioning elderly care is therefore a prerequisite for an equal society.

Still, hardly any of the observations or any of the points and proposals in the Corona Commission's over 300 pages long report on elderly care during the pandemic have led to measures from the government and the Sverigedemokraterna. This means that elderly care is in a state at least as vulnerable as before the pandemic and is therefore equally exposed to new crises.

That is why the Left Party has called the Minister for Older People, Anna Tenje, to the Committee on Health and Welfare due to the government's deprioritization of elderly care. To achieve good elderly care for our elderly and a good workplace for our employees who provide care and support, a political leadership is required which, according to the Left Party, the government and the Sweden Democrats do not demonstrate in this issue.

To achieve an equitable elderly care, the municipalities need to be provided with sufficient resources. Quality of life for users and well-being for employees must cost something. Vänsterpartiet has therefore consistently budgeted for state grants that Sveriges Kommuner och Regioner, SKR, have requested and more beyond that to develop the operations further.

The basic staffing must be sufficient to be able to provide care of good quality, while at the same time employees shall have time for competence and professional development during working hours. This benefits both users and staff. There shall be sufficient staffing in special housing and in home care services, not least regarding the care and treatment of those with dementia.

That employees have the opportunity for continuous competence and professional development is part of creating attractive jobs, which is needed to ensure a long-term sustainable supply of skills. Today, binding national staffing guidelines are lacking.

Kommunal has listed proposals for national staffing guidelines which include requirements for 1) a minimum number of full-time employees per elderly person, 2) that 90 percent of the staff shall be permanently employed, 3) that full-time work shall be the norm, and 4) that 100 percent of the staff shall be professionally trained in health and social care or undergoing training. Vänsterpartiet argues that such national staffing guidelines are necessary to strengthen the quality of elderly care and increase equality between all of Sweden's municipalities.

Vänsterpartiet also wants a sustainable labor market, where people can manage to work until retirement age without being worn out prematurely. Shorter working hours - a general reduction in working hours - with maintained wages would be a decisive step in such a progressive and freedom-expanding development, together with the possibility to influence one's own work environment and the limitation of split shifts.

Vänsterpartiet also considers that the Swedish elderly care needs to return to being governed based on the health and medical services act's portal paragraph on care and nursing according to need - because the paragraph is not complied with today. The elderly have to wait a long time to move to elderly care homes in relation to their needs and remaining life expectancy. This means that many have a long wait before they can receive the care and nursing they need.

Another example is activities at elderly care homes, which also play a role in the elderly's well-being and where a connection exists regarding fear, worry, and anxiety. At elderly care homes with regular activities, users experience fewer problems with fear, worry, or anxiety compared to elderly care homes that rarely or never offer activities. Also, the possibility of outdoor stay affects the elderly's well-being.

Good meals and meal solutions can, in addition to preventing malnutrition among the elderly, also be a tool for creating social contexts and breaking loneliness.

It must be possible to trust elderly care, both for those who need support, care and nursing and for their relatives but also for the staff, who need good working conditions. Vänsterpartiet considers that the government should return to the Riksdag with a communication on how elderly care has developed after the pandemic and account for the identified needs. I therefore move for approval of reservation 3.

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

Dan Hovskär (KD)

Mr. Speaker! I would like to begin by expressing my approval of the committee's proposal in the report.

Sweden's elderly deserve world-class elderly care. Therefore, we Christian Democrats propose a powerful reform to create a secure and dignified elderly care. This requires that the staff in elderly care have good conditions, that the elderly are 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 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 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. That is not good.

Freedom of choice for the elderly is important, as we have discussed earlier in the debate. That was also why we once introduced the law on freedom of choice systems, LOV, to strengthen the elderly's right to self-determination and to choose for themselves.

I am not surprised that nine out of ten people over 85 years old want to be able to choose care themselves. There is no reason to believe that the elderly differ from the rest of the population. It is clear that one wants to be able to choose housing or who will come to one's home to help with cleaning or cooking. As a rule, we want to be able to decide over our everyday lives and influence our situation, and this naturally does not change just because one gets older.

The National Board of Health and Welfare has pointed out major competence and recruitment deficiencies within the fields 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 80 years of age is expected to increase. Action is required to improve the conditions for staff within elderly care and strengthen the possibility to recruit more staff. It is also urgent to reduce the occurrence of shared shifts and relieve the managers within elderly care. Additionally, more training opportunities are needed.

Other deficiencies are language barriers, which can impair safety and well-being. Therefore, the Tidö parties have presented proposals on language requirements for staff - so that the elderly can be understood and make themselves understood. This is important for medical safety and for the work environment.

More medical competence is needed within elderly care, we in the Christian Democrats argue. Municipalities provide increasingly complex care and services. Medical competence must be ensured. Therefore, it will be interesting to see what the investigation into strengthening medical competence, which is ongoing until November 1, concludes.

Something that is immensely important is the great effort that many relatives make to take care of, for example, a partner. We have many informal caregivers - every fifth Swede is actually an informal caregiver - and they make a fantastic effort. An investigation is now underway on strengthening the support for them, for example with a contact person.

The government's goal in accordance with the budget is that 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 and with maintained independence. The elderly should be met with respect and have access to good care and support. The elderly should be offered equal and equitable care and support.

An area of development that the government intends to continue with and invest more in is how we can strengthen staffing and competence. The introduction of a protected professional title for nursing assistants is a good step that can contribute to this. There are ongoing challenges across the country regarding ensuring that the elderly are offered more equal care.

Dementia is one of the major diseases of the people. Hundreds of thousands of Swedes live with some form of dementia, and tens of thousands receive a dementia diagnosis every year. Many relatives do a very important and sometimes heavy work. They are indispensable.

Mr. Speaker! The Government is now investing in dementia care with increased support to Svenskt Demenscentrum, support for dementia registries, as well as support to Nationellt kompetenscentrum anhöriga. The project shall provide support to municipalities and regions in the work to achieve seamless care and nursing throughout the entire course of the disease. It is important to simultaneously update the dementia strategy.

The government continues to invest in countering involuntary loneliness among the elderly. The money shall, among other things, be used for projects that facilitate for the elderly to participate in social and health-promoting activities, which is a very important and good investment that makes a difference.

Community to promote the health of the elderly through elderly calls in all municipalities as well as digital aids to break isolation are also important measures, we in the Christian Democrats believe.

The Government also strengthens the preventive work against fall accidents for the elderly through an information strategy towards municipalities and regions.

Much is in motion, and as I said in the introduction, we Christian Democrats want to build a society where people can age in security and dignity and have access to good care and services.

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Christofer Bergenblock (C)

Mr. Speaker! I thank Member Dan Hovskär for the speech.

One of the issues that the member raised at the end was that the Christian Democrats and the government base want to counteract involuntary loneliness. It is, of course, a very good ambition. But it clashes very poorly with the draconian cuts that the government is simultaneously making to study associations in Sweden, because if there are any who work to counteract involuntary loneliness among the elderly, it is our study associations and our civil society with associations and churches. But it is precisely these organizations that the government chooses to cut heavily in.

I say draconian cuts, because they truly are. The Christian Democrats and the rest of the government are making a cut of 500 million kronor over three years for student unions. It is a third of the state grants.

The most important groups for the study associations and their activities are those living in rural areas, people with disabilities, and retirees, and the absolute largest target group is precisely retirees. They are offered today various forms of study circles that provide companionship, well-being, and meaningfulness, and which counteract loneliness, as the member just requested.

My question is whether the Christian Democrats consider it unimportant that civil society makes efforts to organize study circles and activities for the elderly, given the cuts that the government is now making to the study associations.

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Dan Hovskär (KD)

Mr. Speaker! I thank Christofer Bergenblock for the questions.

Civil society has a very important task. Study associations are also a part of that. But what we are now investing in is money for regions and municipalities to work with issues of loneliness. They receive substantial supplements in these areas.

When it comes to civil society, we allocate funds to different parts, for example sports clubs that are to work with various contacts to reduce loneliness, then perhaps not primarily within elderly care. But there is also an opportunity for associations to make investments for the elderly.

Studieförbunden are not actually an issue for this debate. That the government is reducing the grants to studieförbunden has been caused by the fact that there is cheating occurring there and that very many tax dollars are going to the wrong things. But we are investing in the association life and civil society through very many more parts than just through studieförbunden. The loneliness initiative alone receives funding in different ways and through very many channels in society.

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Christofer Bergenblock (C)

Mr. Speaker! Fraud is not countered by reducing resources. Fraud is countered by increasing control. These are two completely different things. It is rather the case that the Tidö parties have taken the examples of fraud that have occurred as arguments to cut down, dismantle, and slaughter the activities of the study associations, because parts of the Tidö base have a contempt for folk education.

Mr. Speaker! We may be drifting slightly away from the subject of elderly care. But I will bring us back there, because just as I said earlier, the largest group for the study associations is elderly people. Courses are offered on health for the elderly, on digital environments for those who have not learned to use a computer, on mobile phones and their apps for those who are unfamiliar with using these, cooking courses for men who throughout their lives have been provided with food by a former partner but who have been left alone, and on how to avoid being cheated online. This is done within civil society organizations in general and in study associations in particular.

Now I hear from the member that he wants to replace the activities of the study associations with municipal activities. It feels to me as a conservative and liberal politician incredibly strange that the Christian Democrats, who are also usually a conservative party, believe that society should solve these tasks better than civil society does today. They want to move the responsibility from the study associations to municipal officials.

My final question then is: Do the Christian Democrats mean that civil society organizations should be replaced with municipal staff? In what way will that be better?

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Dan Hovskär (KD)

Mr. Speaker! I believe that Member Bergenblock needs to read up significantly more on the loneliness initiative. It is a major initiative with great breadth that the government is undertaking now.

We have no contempt for popular education at all. But there will be certain cuts, which means that one will have to review one's costs.

What we are doing now with the new initiative is that we are providing money to civil society and the municipalities. Different associations, sports clubs, churches, community organizations and so on have the opportunity to apply for money. It is not about cutting any money to the association life. Here, there are new opportunities to work with community building in different ways. The regular resources can be used for different parts where one can think a bit differently.

We Christian Democrats are working very hard to strengthen civil society in this way. I look forward with confidence to the investment that is now being made.

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Anna Vikström (S)

Mr. Speaker! I thank Member Hovskär for the contribution.

The Chairman of the Committee speaks about the loneliness of the elderly. I want to speak about how the Health and Social Care Inspectorate in its report in December 2023 wrote that there are deficiencies in end-of-life care within elderly care. Some elderly people are forced to die alone. There is a lack of information to the staff closest to the patient on how the care should proceed, that is to say, that there is often a lack of transition conversations. And it occurs that the elderly do not receive adequate medication. There are, therefore, deficiencies across the entire line.

In a majority of Sweden's municipalities, cuts are now expected in 2024. The activities where it is feared that the most will be saved are elderly care and school.

How does the member view how competence reinforcements can be made to get more nursing assistants, nurses, and doctors into elderly care when a majority of the municipalities need to make cuts?

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Dan Hovskär (KD)

Mr. Speaker! Thank you, Anna Vikström, for the questions! Let me start with what you raised first. The loneliness initiatives are part of trying to lift such things that have been seen as deficiencies. Now, it does not completely align with Ivo's report, but it is important to see where we have problems in society. Loneliness is a major societal problem. We must address it in different ways.

This issue of care at the end of life is a very serious matter. We must see how people can best receive a dignified end. It is about establishing systems so that no one has to die in solitude. I do not believe there are any actual political dividing lines here, but rather it is about finding systems.

We Christian Democrats have spoken about a dignity guarantee. It is about working with values that are important in the final stage of life. We have also tried to highlight those issues.

When it comes to the economy, I want to say that we have gone through a tough economic crisis in Sweden. We have not had the opportunity to pump out money, because inflation has been high and we must bring it down. Now we are beginning to see results. But we have, from the government's side, injected money.

Since then, it has been a municipal matter to prioritize different parts. Different municipalities prioritize differently. The Government has provided a large sum to municipalities and regions.

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Anna Vikström (S)

Madam Speaker! Thank you, Member, for the answer! I believe I know that this is an issue that is close to the hearts of the Christian Democrats, namely such as care at the end of life and loneliness, both in general and towards the end of life.

It is, however, difficult today to see how the priorities that the government makes rhyme with the member's previous statements about strengthening health and medical care and elderly care and about increasing competence in elderly care. It does not look that way.

It is not an option for more money for elderly care from the Sweden Democrats, the Christian Democrats, and the government. The government is actually making other priorities that do not benefit the oldest and sickest in society. They do not benefit care and municipal health and medical care.

The Tidö Agreement is formulated very sparingly and concisely when it comes to elderly care. It is obviously not prioritized. I can also mention that the Minister for Elderly Care has not had reason to come to the Committee on Social Affairs a single time since she took office, even though she is now to come soon, next month.

What does the member say - will the government change its mind and prioritize elderly care and provide the resources required?

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Dan Hovskär (KD)

Madam Speaker! The member is raising important issues. Now, the Minister for Pensions will come to the Social Affairs Committee next month, as I understand it.

We are making major investments. As I pointed out, several large parts are underway. Not least, it is about developing the dementia strategy and about strengthening dementia care - to work with more training, diagnostics, and treatments. The dementia strategy aims at medical support and treatment. It is about dignity for people who are extremely vulnerable and perhaps cannot speak for themselves.

We continue to provide funds through the Äldreomsorgslyftet, 1.7 billion. Then it is about the language requirement - one must be able to make oneself understood. It is different parts that are being lifted to strengthen elderly care.

Since then, it is important to work on issues of freedom of choice, just as I emphasized in my speech. One should be able to feel that one is involved and has an influence even as an older person. I believe that we have even more to do in that regard moving forward.

Many different initiatives are underway. Much has been started up. I feel confident about the future. Many initiatives are being launched now or in the near future.

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Christofer Bergenblock (C)

Madam Speaker! How pleasant to be able to use that title and not just Mr. and Madam Speaker!

I would like to begin by moving for approval of reservation 17 regarding the elderly healthcare program.

Madam President of the Ageing Committee! There is much to say about Swedish elderly care. Every day, magnificent efforts are made by staff, civil society, and relatives to provide people with the care and support they need when, after a long life, their strength begins to wane. But at the same time, there are also things that are problematic in Swedish elderly care. These are things that do not work or lead to people not receiving the support and help they need.

After the pandemic, we could observe that the deficiencies within Swedish elderly care are tangible, not least regarding the connection between elderly care and health and medical care. This was something that the Corona Commission established.

A year ago, a report from the Swedish National Audit Office was presented, which showed that the handling of lex Sarah and lex Maria cases is deficient and that there is a lack of clear quality criteria for Swedish elderly care, which makes it difficult even for Ivo to follow up on the care in an adequate manner.

The government has now been in power for nearly two years. In this area, there has until now been a complete lack of initiative. The most concrete thing that we in the Riksdag have found out is that the idea of creating an elderly care law has been scrapped, which otherwise has been requested for a long time both from the political parties and from the pension organizations.

From the Center Party's side, we would have wanted to see a new elderly care act in order to strengthen the rights of the elderly when it comes to care and treatment, and we will continue to push forward on that issue.

Madam Speaker! Already last year, the Center Party highlighted the proposal to establish an elderly healthcare program in the same way as there are healthcare programs for children and young people. Now, the Social Democrats and the Green Party have also joined that idea, and I look forward to further parties joining before the same debate next year. Perhaps we will have a majority for the proposal before the parliamentary term is over.

What then is an elderly healthcare program? What we in the Center Party envision consists primarily of three different parts. For the first, it is about creating a vaccination program for the elderly. Exactly what should be included in such a vaccination program will, of course, be up to the authority to decide, but a reasonable assumption is that vaccination against seasonal influenza should be included and perhaps also vaccination against shingles.

Secondly, it is about applying screening earlier in life, for example regarding mammography. But it can also apply to a number of other diagnoses.

Thirdly, it is about offering structured health consultations even to seniors. It is about talking about lifestyle habits. This can concern food, drink, smoking, and physical activity. Through a conversation, one can identify risk behaviors and help the individual make active choices that contribute to a healthier lifestyle, which in turn contributes to preventing diseases.

Another thing that is important to note in these contexts is involuntary loneliness. We know that many elderly people suffer from loneliness, not least if they have been left alone after a partner has passed away. An important part of counteracting loneliness is to support civil society, which provides many of the activities aimed at the elderly. Therefore, the Tidö parties' slaughter of the support for study associations represents a very hard blow for many elderly people who are deprived of opportunities for community and activities that they would otherwise have had.

Madam Speaker! The Centre Party also wants to strengthen the freedom of choice within Swedish elderly care. I am the third speaker today to say exactly that. I was recently at a seminar, organized by Vårdföretagarna and SPF Seniorerna, together with several people here in the chamber. At the seminar, a report was presented which showed that nine out of ten seniors themselves want to be able to choose both home care companies and elderly housing. Just as one wants to be able to choose preschool, school, and health center during life, one wants to be able to control one's choices even when one becomes older. Extra interesting was that the survey was actually conducted among those it concerns. The respondents were namely 85 years and upwards. The oldest participant was 109 years old.

That people want freedom of choice throughout their lives is not the least surprising. More surprising is that the majority of the country's municipalities cannot offer this today. I myself sat in the social welfare committee in Varberg when the Act on Freedom of Choice, LOV, was introduced. We even preceded it and introduced freedom of choice within home care before the law was in place. It was very appreciated and it still is. The person who needs home care wants to be able to choose for themselves who should perform the services – the municipality or one of the private companies.

From the Center Party's side, we want to provide as many as possible with the opportunity for freedom of choice within home care. We see a need to legislate LOV within this area.

I said that I was the third, but I am actually the fourth to have highlighted the need for freedom of choice. In the debate, the Sweden Democrats, the Moderates, and the Christian Democrats have now highlighted how important freedom of choice is even for the elderly. Then it is up to be proven. It is a matter of daring to legislate when it is actually needed, because the municipalities today do not live up to this.

In conclusion, Madam President of the Ageing Committee, the Centre Party believes that one should be able to feel confident about growing old and secure during one's old age. Naturally, one should have the opportunity to live a healthy life as far into the years as possible. When one needs help from society, one should naturally receive it – in one's own home, in a sheltered housing unit, or in a special housing unit.

Through an elderly care act, we could take a much-needed holistic approach to strengthen issues regarding the care and treatment of the elderly. Through an elderly healthcare program, we could contribute to more seniors being healthy further into their years. Through increased freedom of choice, we show that as an elderly person, one has a right to the self-determination that the rest of the population sees as a given.

More needs to be done to strengthen Swedish elderly care - more than this government is capable of.

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Malin Danielsson (L)

Madam President! Some time ago, I met some people who truly inspired me. They represented a large group of researchers. Together with their colleagues at the university where they work, they conduct high-quality research, both nationally and internationally. They also share their experience and their international networks with young researchers at the same university.

Common to all these researchers is that they are elderly. They have passed the retirement age, as we now call it in Sweden. But they choose to continue to contribute through their research. Despite the fact that it is they themselves who draw the research grants for their research, they must fight to continue researching, as from the university's side – lo and behold – they are strictly prohibited from this group of elderly researchers.

For a long time, prejudices regarding the elderly have characterized our society. But research actually shows that 70 is the new 50. The person who is elderly today lives a completely different life than the person who reached retirement age 50 or 60 years ago. But our image of the elderly remains, in many ways, in a bygone era.

Fortunately, we see clear signs that this is about to change. More people work long after they have passed 70, because they want to. It has become increasingly common with companies offering services performed by seniors. And last year, SVT launched a popular dating program aimed at the elderly: Hotell Romantik, which I can really recommend.

Madam President! Our view on elderly care is reflected by our view on the years. During the first part of the 1900s, the focus was on poor relief when it came to elderly care. When the focus shifted from care to care in the homes in the 60s, the home service was carried by housewives who worked for a symbolic sum.

Today, thank goodness, elderly care is neither poor relief nor dependent on social goodwill. Today, the focus is on that one should be able to live life throughout life, on how we can make the healthy years more, and on how we make self-determination greater the day we need help.

The question is whether anyone has done more when it comes to changing the view on age than Barbro Westerholm has. Her actions spanned many areas, but the fight for the freedom and rights of the elderly was always central. She was keen on using the word "årsrik" (rich in years) as a synonym for old or elderly. She wrote in a motion to the Riksdag: It denotes that it is about people who are rich in number of lived years, knowledge, and life experience. To increase the self-determination and choices of "årsrika" people is a central task in the Liberals' policy.

Madam President! One area where elderly people have to a large extent been treated as a collective is what we are debating today: elderly care. The same solutions are offered to everyone, often with a foregone pat on the head.

Therefore, it is important that elderly people who need help in their daily lives themselves get to decide who it is that shall step over the threshold to perform the home care, that they get to decide which elderly care home they want to live in when there are alternatives to choose between, and that they have the opportunity to choose RUT instead of home care when it concerns cleaning and food that they want help with, which in many municipalities is also cheaper than turning to home care.

Another issue that Barbro Westerholm was deeply engaged in was the rights of hbtqi persons – from the right to enter into marriage to being able to live openly as an hbtqi person when one is elderly. Therefore, it is very distressing to read Socialstyrelsen's situation report 2024.

The mapping shows that only every fifth municipality over the last three years has provided staff with knowledge on specifically LGBTQI issues and the elderly. Many in the group of elderly LGBTQI persons are concerned that the elderly care staff will not respect their sexual orientation or gender identity.

It is time for the issue to be raised on the political agenda. It is therefore very good that Socialstyrelsen has been tasked to produce and disseminate knowledge-enhancing material on hbtqi issues within elderly care.

Madam President! Even though the healthy years are increasing, the need for care for many increases with advancing age. Not least for the elderly, it is therefore important with the primary care reform that the Liberals have long championed. It provides security and continuity for the patient and ensures medical involvement in municipal healthcare and care in the municipality.

The municipalities' possibility to employ doctors is another important issue to ensure a well-functioning elderly care. Today, the responsibility for medical interventions lies with the regions and may not be transferred to the municipalities. There are therefore obstacles for the municipalities to employ doctors in elderly care.

More than a quarter of Swedish healthcare is, however, conducted in municipal activities, without one being allowed to employ medically trained specialists. Geriatricians and general practitioners should be able to be employed by elderly care homes or the municipality. This is being investigated right now, and we hope that it will become a reality soon.

In the Liberals' Sweden, the fight for a better, safer and more adapted elderly care is not over. More people need to be given better opportunities to live life throughout their lives, and a good deal of the fight against age discrimination that we lead in our country, we have taken forward following Barbro Westerholm's fantastic work over very many years.

With this, I move for the approval of the committee's proposal in the report.

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

Christofer Bergenblock (C)

Madam President! One of the major challenges we have in Swedish elderly care is the supply of competence. From the Center Party, we see as a goal that all care work should be performed by practical nurses in the future. We are far from that today, but in the future, it should be that way. We need to strengthen with more nurses within elderly care and, as mentioned in the report, with geriatric competence.

At the moment, however, it is the case that we must employ people who work as care assistants and who do not have a nursing assistant education. That is how it looks in many parts of the country and in many of our elderly care homes, even though it is not the target goal.

In the community of Harads in Norrbotten, there are the two elderly care homes Edestrand and Älvstrand, where one had – a part of them one still has – eleven employees who do not have nursing assistant training and who come from third countries. When the government in the autumn decided to raise the wage floor for labor migration to 27,400 kronor per month, the unit manager for these two elderly care homes announced that she would be forced to dismiss these eleven employees. There were no others to recruit, as it was not the case that a lot of unemployed people were standing and waiting to get work in this location. In TV, she said that she would probably be forced to close one department to compensate for the loss.

Madam President! My question is why the Liberals want to prevent people from third countries from working within Swedish elderly care.

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Malin Danielsson (L)

Madam President! Thank you, Christofer Bergenblock, for the question!

We have a challenge when it comes to the supply of skills within elderly care; I clearly share that view. I am very pleased that the government continues the investment in Äldreomsorgslyftet which the Social Democratic government started. One part where Äldreomsorgslyftet has now been broadened is to make it possible to a greater extent to study the Swedish language within the initiative and thereby be able to study further to become an assistant nurse. I believe this is a very important reform, precisely because it gives people from third countries a greater opportunity to be able to work within elderly care.

I also believe that we have much else to do. We need to make it more attractive to seek out this profession, and we need to reassess the view of the profession today. I believe that we, to an all too great extent, reflect on minutes and seconds instead of reflecting on the care of people. I believe that many within the care professions would gladly like to work more in a way where one can be close to those who are in elderly care and, with the care competence that one possesses, also be able to provide these persons with that care.

There are many municipalities that have tested new variants and, for example, removed the digital technology which means that one must register in minutes and seconds how long one is with a person to whom one is providing care and support. Instead, they have done it in the traditional way and simply switched from screen to binder and divided the tasks in the morning to then go out to the users.

What will be the consequence? Well, more people experience a better working environment, and many who receive care experience that it becomes better.

I believe there is a great deal to be done to increase the attractiveness of the profession. It is also about making it possible for people who come to Sweden to be part of our workforce by giving them better knowledge of the Swedish language so that they can further their education and obtain the career opportunities that we both see ahead of us, for example as a nursing assistant.

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

Christofer Bergenblock (C)

Madam President! I fully share the member's view that we must strengthen the attractiveness of working within Swedish elderly care. I do, however, become a little concerned when reference is made to digital technology, because the support that can be obtained via technology is precisely a support for existing staff so that they can spend their time on care and personal interaction. It is not about being able to remove staff from the care.

I also do not think that the unit manager in Harads will be particularly happy to hear that the eleven people she is getting rid of at her workplace are to be replaced with digital technology, for that will, of course, not be allowed to happen.

Madam Speaker! I am somewhat surprised when the member refers to the fact that Äldreomsorgslyftet would give persons from third countries the opportunity to study to become a nursing assistant and thereby reach this wage floor. The wage floor in autumn was 27,400 kronor per month, and that was possibly reachable as a nursing assistant but not as a care assistant. Now, however, the government has announced a new increase to 34,200 kronor, and the average wage for a nursing assistant lies somewhere around 30,000 kronor per month. They will therefore not be able to obtain a residence permit in Sweden even if they have studied to become a nursing assistant.

The Liberal Party's party leader Johan Pehrson answered the TV4 news anchor and said that if one can move from Azerbaijan, then one can move from Alingsås or Askersund to jobs that become vacant. It is a very strange policy that one should force Swedish elderly care to lay off staff in order to instead replace them with people in other parts of the country who are not prepared to move – as far as is known, no one has offered to move north to take these jobs.

What do the Liberals have to say to the unit manager in Harads and others who are losing their staff?

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

Malin Danielsson (L)

Madam Speaker! Thank you, Christofer Bergenblock, for the question!

I believe that Christofer Bergenblock misunderstood me slightly; I did not say that we were to replace staff with digital technology, but perhaps rather to place a little less focus on administration via digital technology and a little more focus on actually working with what one has chosen the profession for, namely to provide good care to individuals.

A municipality that was hit by a computer crash a number of years ago experienced this. The home care service had to switch from screen to folder and distribute the tasks in the morning before heading out to provide the care. After the systems started up again, they chose to continue in that way, and one reason for this was that they no longer needed the four administrators who sat and administered the system and decided who would go where and when. The staff could actually do it themselves.

More local self-determination and a better working environment, but also better care for the individual, is what I meant when I spoke about the need to re-evaluate this profession a bit and actually go back to what it was from the beginning: good care for the individual without having to go in and report in an app all the time.

It is incredibly important to be able to contribute to society by working. There is a fantastically high level of unemployment today with many individuals who do not get into the labor market, and children do not get to see their parents go to work every morning. There is an incredibly important thing to address here. I believe that elderly care is a good place to start working for many.

Through Äldreomsorgslyftet, the Swedish language can also be highlighted, and then more opportunities are gained. This applies to both those who come from third countries and those who are in Sweden today.

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

Jan Riise (MP)

Madam Speaker! I thank the members for the review of a long series of different issues concerning a large group in society that is often lumped together under the designation elderly or seniors. It has been pointed out that we are underrepresented in the Riksdag because only 4 percent of the members are 65 years old or older, while the voting group constitutes approximately 28 percent. I say "we" because I happen to be one of them. I have a great interest in the issue because I intend to spend the rest of my life in that group. It is naturally important that I follow along.

We in Miljöpartiet have been in contact with our own organization, Gröna Seniorer, and have had interesting meetings. Everyone emphasized what is perhaps the most important elderly policy issue, namely the one about combating what is often referred to as ageism. For it is ultimately ageism that makes it possible to treat the elderly without respect, without consideration for individual wishes and needs, without truly making it possible for everyone to continue living their lives as they wish. We must work for a society where everyone can share their experience and knowledge, and society must have ways to take advantage of these experiences. Those who want to continue working should be able to do so, and those who do not want to should have the opportunity to live well on their pension. Interpersonal meetings and relationships shall have space, and support measures and well-thought-out structures shall exist and be offered to those who need them before acute needs arise.

Preventive work can prevent ill health, postpone extensive care needs, and pave the way for healthy aging and a rich life with as many healthy years as possible as we all want. One of the Green Party's proposals that we believe will make this a reality for more is to introduce a public health law, and others have also touched upon this. It should be a law that clarifies how the responsibility for public health work should look at local, regional, and national levels. Since the health of the elderly is clearly linked to lifelong conditions for health and the preventive measures that are taken, the public health perspective is extremely important. The health of the elderly is not an issue that only concerns healthcare or that elderly care can take responsibility for, but it is the broader public health perspective in society and the measures that occur there that make a real difference.

The knowledge base is extensive regarding which measures promote the health of the elderly, but the results are limited by the fact that we lack national coordination. The Government should task the appropriate authorities with developing a national elderly healthcare program, in the same way as a health program for children and young people up to 20 years of age was recently commissioned.

In such an elderly healthcare program, a vaccination program could be part of it, as well as the question of offering preventive health consultations and offering free or subsidized exercise and rehabilitation.

There is a need for physiotherapists, occupational therapists and also dietitians in sufficient numbers so that all elderly people can live their best lives. This also includes the question of physical activity on prescription at home. Miljöpartiet believes that this should be included in the high-cost protection. We also believe that it is important that the right to a coordinated individual plan, a so-called SIP, truly becomes a right that everyone with a need, including the elderly, also has access to in practice.

Madam Speaker! In addition to a public health act, the Green Party wants an elderly care act. In December 2020, when the Green Party joined the government, an investigator was commissioned to propose an elderly care act. The intention was that problems that had emerged during the covid period should be addressed, and the preventive focus should be strong.

The investigation submitted its proposals to the government in June 2022. But in December last year, we unfortunately received the news that the government chose not to proceed with the proposal and that elderly care will continue to be regulated in the Social Services Act. We regret this. So does the association SKPF, which in a debate article from February this year writes, among other things, that the extensive deficiencies and the inequality that were the origin of the bill remain. Where people live determines what care they receive, and a decisive cause of the problems is that the regulation of elderly care in the Social Services Act is vague. The lack of clarity leaves room for chronic underfunding.

In the proposal for an elderly care act, there are sharp, clear requirements, for example regarding sufficient staffing. It is highly uncertain whether it will be enough to introduce this in the Social Services Act, which the government has signaled. In that case, it requires that the proposal for a new Social Services Act be reworked. Miljöpartiet argues that it is time to establish that undignified care, enormous differences, and constant understaffing are illegal. An elderly care act is needed.

Madam President! Finally, I would like to say something about housing. How we live has great importance for our well-being. Miljöpartiet considers, among other things, that access to a green outdoor environment is important in all forms of housing. Therefore, access to a green outdoor environment should be an issue included in procurements and choice systems within elderly care and in the planning of elderly housing. There is stable research that supports this view, and it is also part of the Agenda 2030 goals – albeit in the lower part of the hierarchy of sub-goals.

Those who want and need to move, for example from a villa to adapted housing, may feel that the task is overwhelming. Therefore, I argue that there must be an opportunity to move to intermediate housing in all municipalities. A right to moving assistance should also be introduced in the Social Services Act. Finally, the possibility of self-admission to short-term housing should be investigated. The Government should take appropriate measures in these matters.

I naturally stand behind all of the Green Party's reservations, but I move for approval of reservation 4 regarding knowledge-based care and nursing.

The deliberation was hereby concluded.

(A decision was to be taken on 17 April.)

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