(cont. from § 5) Elderly care (cont. SoU22)
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
L believes that age discrimination has characterized elderly care 1 and advocates for a primary care reform for security 1. L emphasizes support for relatives providing care 1 as well as language training for staff 2 3 and utilizing staff's competence in other languages 2 3. C argues that language requirements are the only point in the Tidö Agreement regarding elderly care 4 and wants to avoid language barriers 4 by having municipalities offer instruction 5 as well as meet the need for other languages 5. V believes that privatization has led to deficiencies 6 and wants to increase staffing density 6 as well as resources to municipalities 6. V advocates for specialist training 6 and criticizes interventions in the home that limit freedom of choice 6. V wants to carry out a national mapping 6 and change guidelines for special housing 6. C wants to strengthen municipal health and medical care 7. M wants an elderly care act 8 and that aids are included in the high-cost protection 8.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Malin Danielsson (L)
Mr. Speaker! According to the World Health Organization, age discrimination is the most difficult ground of discrimination to address. It is found in all sectors of society, not least within health care and elderly care.
It became extra clear during the corona pandemic, when both the ageist view of elderly people and the lack of quality in elderly care became apparent. People who were 70-plus were regarded as a collective. They were to isolate themselves, not become infected, not infect others, and not take up places in healthcare.
At the same time, serious deficiencies in elderly care, which have existed for many years but have not been prioritized because other needs in society have been considered more pressing, were exposed. We see it as pure and simple age discrimination. Even if it is often unconscious, it is a spinal reflex that the elderly are valued less.
Mr. Speaker! Two major investigations have been presented recently concerning elderly care: the Corona Commission's report and the investigation Next Steps, increased quality and equality in care and services for elderly persons. There is much to take hold of in these investigations, but I choose to focus on two of the proposals.
The first thing concerns a clearer regulation of permanent primary care contact. The Liberals have long proposed a primary care reform that will provide security and continuity for the patient and ensure physician involvement in municipal healthcare and care in the municipality.
An audit from Ivo shows that 44 percent of the residents in special housing lack a municipal care plan and that 50 percent lack a medication review. If the mandate for the fixed doctor contact is clarified, in addition to the individual being able to feel a sense of security in meeting the same doctor continuously, it will likely also lead to these types of deficiencies being avoided.
The second proposal concerns the municipalities' possibility to employ doctors. Today, the responsibility for medical interventions lies with the regions and may not be transferred to the municipalities. There is thus a barrier for the municipalities to employ doctors in elderly care. According to the Corona Commission, there is no corresponding division of responsibility between different primary owners in our neighboring countries, and it is noted that this type of categorical division between municipality and region regarding medical responsibility is not appropriate. Therefore, the commission considers, in line with what the Liberals have advocated, that it should be possible for municipalities to employ doctors.
These are two of many important measures to tackle the deficiencies that exist within elderly care today.
Mr. Speaker! It is not only in elderly care that measures are needed. A significant proportion of all elderly care is performed by relatives. Anhörigas Riksförbund estimates that 1.3 million people in Sweden today provide care and support to relatives. Often it is given voluntarily and with joy, but it can also be heavy sometimes. It is important that relative care is always voluntary and not a must for a relative.
It is also important that there is support for the relatives. Much has been written about how support can be provided, but all too often it is only words that end up on paper. The support for relatives needs to be developed, and the differences between the country's municipalities must be addressed.
Mr. Speaker! In the Swedish synonym dictionary, there are 28 synonyms for the word "old". 25 of them are negative, such as "musty", "feeble", and "outdated", and only 3 are neutral. Barbro Westerholm, who unfortunately is no longer among us, enriched our language with a new positive word: "årsrik" – rich in years and rich in experience, something that Barbro herself so well symbolized. She fought for everyone's right to live life throughout their whole life and to be seen based on what need one has and not based on what birth year is written in one's passport. We human beings are not so simple that we can be simplified down to a number.
The elderly deserve for us to take their issues seriously and provide the conditions to truly solve the challenges that have been exposed. When one as an elderly person is in need of support from society, it should be there with warmth and love. In the Liberals' Sweden, the fight for better, safer, and more adapted care for the elderly is not over. It is part of the fight against age discrimination in our country – a fight that we Liberals will continue to wage with the same strength and passion as Barbro Westerholm has so successfully done for many years.
With that, I move for approval of the committee's proposal in the report.
Christofer Bergenblock (C)
Mr. Speaker! Thank you for the speech, Malin Danielsson!
I previously raised a question with the Sweden Democrat member regarding the language requirement in elderly care, which is the only point in the Tidö Agreement that is addressed when it comes to elderly care. A lot has been talked about elderly care today, but this is actually the only point that has been raised there.
Language requirements in elderly care is an issue that functioned as a circular motion from the Sweden Democrats during the entire previous parliamentary term. The Centre Party and the Liberals then, municipality by municipality, voted down this motion. Among other things, in my home municipality Varberg, we noted that the underlying reason for the language requirement was not about protecting either the elderly or the staff, but about keeping immigrants away from elderly care.
Now, it is perhaps expressed with a bit more nuance in the Tidö Agreement. We also heard Carita Boulwén from Sverigedemokraterna speak earlier about it being a matter of avoiding language confusion. I fully share that view. It is very important not to have language confusion within healthcare and elderly care.
Now, the language proficiency issue has two sides. One side, naturally, is about the fact that staff need to be able to speak Swedish. As far as I know, this has also constantly been a requirement for staff in all municipalities, completely without the need for national language tests. But another problem regarding language proficiency is that we have very many elderly people with an immigrant background who, in the autumn of their lives, perhaps forget their spoken Swedish and revert to only being able to speak their original mother tongue.
The question is, given that the language requirement is the only issue raised in the Tidö Agreement, how you from the Tidö parties intend to meet the problem of language barriers when it is the elderly who do not manage the Swedish language.
Malin Danielsson (L)
Mr. Speaker! Thank you very much for the question, Christofer Bergenblock!
Language is important. Being able to speak languages gives freedom. Being able to speak for oneself and make oneself understood is an important part both in care and in many other parts of society.
The Liberals were early in talking about language requirements in general. We see that if one has the language, one can also be integrated into society. One can get a job, one can make oneself understood, one can understand what is happening around one's children during development talks and so on.
Just as Christofer Bergenblock is pointing out, it is essentially a requirement already today that you must be able to speak the language to get a job. At the same time, we see deficiencies within elderly care where older people experience that they cannot communicate at a sufficiently good level with the staff. Either it is due to, just as Christofer Bergenblock points out, that one has lost the language because one has become older, or it is due to that persons who work within elderly care do not have the knowledge in Swedish that is needed.
This is something we obviously need to address. The government is therefore also investing in language training for staff within healthcare and elderly care, which I believe is very important so that more people can enter employment within healthcare and elderly care.
But I also believe that we, just as Christofer Bergenblock is pointing out, must take advantage of the competence in other languages that exists within elderly care. There are many good examples out in our municipalities where one can offer other languages within the special residential homes and where the elderly person who may have been affected by dementia and fallen back to their mother tongue can still receive very good care thanks to that.
Christofer Bergenblock (C)
Mr. Speaker! Thank you very much for the answer, Malin Danielsson!
Language deficiency is a problem. What I see is that the government and the Tidö parties have taken initiative precisely regarding increasing the pressure on the staff and on the municipalities, while at the same time I do not perceive that it has been a major problem. To go back to my own home municipality, Varberg, they offer those in the staff who have problems with the language instruction in Swedish to improve it. It is a much better way to get staff to seek out care and stay in care that the municipality offers that help.
We have now established that there are two sides to the coin. One side is the staff's language skills regarding Swedish, and the other is precisely the need for other languages among the staff to meet the needs created by more immigrant groups at our nursing homes. Have the government and the Tidö parties intended to take a corresponding initiative regarding just that question, which I believe is at least as important as the first, that is, to meet the needs that exist when the elderly and perhaps especially those with dementia can no longer manage to speak Swedish?
Malin Danielsson (L)
Mr. Speaker! These are important issues that we need to discuss. One needs to be able to make oneself understood even in the autumn of life in order to be able to live life all the way through, just as I touched upon in my speech.
I see many good examples out in our municipalities where the language skills among the employees are being utilized. We have the national minority languages, and we see many elderly care homes with those orientations. But we also see that the language skills that exist are being utilized.
If there is a need for a more nationally targeted mission in this area, I will leave that unsaid. But I still note that we from the government are investing money in language training for care staff. I believe this is very important, both to ensure patient safety and security and to strengthen our staff out in the care sector so that they can feel they can do a good job.
Maj Karlsson (V)
Mr. Speaker! Today I am replacing Karin Rågsjö in the debate on our elderly. I do not intend to try to fill her shoes - that is quite impossible - but instead try to convey her message.
Vänsterpartiet has for a long time pointed out the risk of dismantling and fragmentation of the Swedish welfare system. Unfortunately, we have been able to observe, through the consequences of the corona pandemic, that this has clearly led to major deficiencies, particularly within elderly care. Savings and privatizations have contributed to a severely under-dimensioned healthcare and care system, and based on the consequences of the high spread of infection, we can only regret the development.
The situation in elderly care has also reminded us of the inequality and imbalance that prevails. Vänsterpartiet has highlighted both the inequality and the dismantling, privatization, and other already identified deficiencies regarding elderly care. We have also on several occasions highlighted the need for increased staffing and competence.
The number of people over 80 years old will, according to SCB, increase by approximately 50 percent by 2028. Then we must have preparedness for increased medical competence and a sufficiently large number of employees. Without expanded elderly care, relatives will have to take on increased responsibility. It is a fact that women are overrepresented among both the staff and those who have to carry the heavy burden of caring for elderly family members.
Elderly care must be reliable, for both those who need support, care and nursing and their relatives. This also applies to the staff, who need to have good working conditions. Vänsterpartiet wants to invest in increased staffing levels and more further education within elderly care to get staff to stay in the profession. With permanently employed and educated staff, we can create a stable and equal elderly care throughout Sweden. The elderly receive the care they are entitled to, and the staff receive the working environment they deserve to have.
But for us to achieve an equitable elderly care, the municipalities need to receive sufficient resources from the state. And the working conditions for elderly care staff must be improved. Our elderly must be seen as individuals with their own needs, not as units that are to generate a financial surplus for shareholders in private companies. Quality of life costs and takes time. More staff are needed, along with increased opportunities for competence development and career paths. At the same time, staffing must be planned based on the large numbers of upcoming retirements.
The medical competence must be high within elderly care. The development towards more and more people becoming older and that the care needs among the elderly are thus also increasing has not led to development and access to adequate medical competence. The Government must therefore take measures to strengthen the medical competence through requirements for specialist training in geriatrics for the doctors who work within elderly care.
There will also be extensive care needs among elderly people who receive municipal care and services. In that case, it should be a matter of course that the competence of nursing assistants is regulated and ensured at a national level. We therefore believe that the government should take the initiative to develop all specialist educations for nursing assistants at the university of applied sciences level and that these shall be nationally coherent.
Mr. Speaker! Since the beginning of the 2000s, a redistribution has occurred from assisted living to interventions in the home. That more people should stay at home longer can become a way for the municipalities to keep down cost increases. Is that good? Is it good for the individuals? Vänsterpartiet considers the development to be negative if it comes at the expense of the elderly's needs and limits their opportunities for influence and freedom of choice. The elderly should be able to live at home as long as they want themselves, but when the need for support increases and they want to move, there must be an opportunity for that.
In an article in Aftonbladet from January 2022, it appears that thousands of elderly Swedes are being rejected when they apply for a place in an elderly care home. The elderly and their relatives describe how they experience the struggle to reach safety after having had their applications rejected by both the municipality and the administrative court. The justification is that their needs can be met with interventions in their own home that can provide a so-called reasonable standard of living, despite the fact that the elderly and their relatives claim the opposite. Several elderly people also describe the insecurity it entails to have help at home from many different people.
This often concerns people who are between 80 and 90 years old and sometimes also have dementia. Several relatives testify to an eternal struggle against the authorities. It does not get better by the fact that guidelines and processing regarding special housing vary greatly across the country.
We in Vänsterpartiet believe that the government should carry out a mapping at the national level of the number of special housing units in the municipalities. The mapping also needs to examine how many decisions are made to grant or reject applications for special housing for the elderly.
Furthermore, the government should take measures to implement the legislative changes required to better meet the elderly's right to special housing. The government should take the initiative to change national guidelines so that fear and loneliness shall constitute a basis for assessing the right to special housing.
We also believe that the government should take the initiative to change the guidelines so that everyone over 85 years of age shall be offered the intervention of assisted living.
Christofer Bergenblock (C)
Mr. Speaker! Initially, I would like to move for approval of reservation 23 under point 12, Health and medical care within elderly care.
On Tuesday, the National Audit Office presented a report on the state's work against healthcare injuries and conditions of neglect within elderly care. It is not a cheerful read. The overall conclusion is that the state's interventions are not effective. The recommendation to the government is clear: to strengthen the national governance of quality within elderly care in order to reduce the amount of neglect and the number of healthcare injuries. Furthermore, it is stated that the National Board of Health and Welfare should be tasked with calculating the costs of the neglect and healthcare injuries that exist within elderly care, as a justifiable overall picture is lacking today.
Does any of this feel familiar? Yes, the conclusions from the National Audit Office are not entirely different from the conclusions from the Corona Commission, which delivered its partial report on elderly care in December 2020 and its final report in February 2022. There has, therefore, been time for both the previous government and the current government to act, but far too little has been done.
Mr. Speaker! The Centre Party wants to see tightenings in a number of areas within elderly care. But today I will focus on that which concerns healthcare and health work.
Firstly, the Center Party argues that municipal health and medical care needs to be strengthened in order to provide better care for the elderly both in their homes and in special housing. It should not be the case that someone who becomes acutely ill in special housing or at home is forced to travel several miles to reach an emergency department unless it is absolutely necessary. But today, this is more standard than the exception in Swedish elderly care. It is simply not the elderly who are protected, but the system.
We mean that home healthcare needs to be equated with other healthcare. It is not reasonable that the building itself should be decisive for which legislation applies. A telling example is the issue of requisitioned medicines. The interpretation of the current regulatory framework is that the medicines procured and financed via healthcare may only be used within the physical walls of the hospitals. The physical location thus becomes decisive instead of what kind of care is provided or what need the patient has. Centerpartiet wants it to be the opposite. The patient's needs and the care of the patient must always come first.
Furthermore, we argue that there must be access to adequate medical equipment in our elderly care homes. The lack thereof was one of the problems highlighted by the Corona Commission. We also see a need to legislate on cooperation between region and municipality to ensure that persons receiving home care shall have access to medical care and the correct medical treatment.
The development is moving towards more and more advanced healthcare being able to and having to be performed outside of hospital premises. The Government must take greater responsibility to ensure that legislation and national governance facilitate such a development.
Secondly, the Center Party wants to see a national elderly healthcare program in order to promote the health of the elderly. Both the individual and society have everything to gain from the final years of life being as healthy as possible. In the same way as it is currently a given that we have child healthcare programs to give our children a good start in life and prevent health problems, it should be a given that the elderly receive the same support in the form of an elderly healthcare program.
Coordination is needed to prevent health problems and to detect risks or diseases in a timely manner. An important part of such a program is to offer everyone over 70 years of age a health consultation that can result in an individual health plan. It would be a conversation to identify needs for support and help, but it also concerns lifestyle, such as eating habits, physical activity, social contacts, and so on.
We also want to see expanded screening for those who are older, for example in the form of mammography significantly further up in years than today and free vaccination programs for those over 65 years of age.
Mr. Speaker! Challenges are not lacking within Swedish elderly care. The criticism has been harsh, primarily from the Corona Commission but also in the just-released report from the National Audit Office. Despite this, the ambition from the gathered Tidö parties seems to be anything but well-considered. Healthcare is covered on three pages in the 62-page Tidö Agreement, and elderly care is mentioned in only a single sentence—and that sentence is not about the content of the care. More than that should be expected from the government.
Centerpartiet argues that the care of the elderly is one of the most important issues we have to handle ahead in this country. It faces many challenges, but two of the most important are to work preventatively with the help of a national elderly healthcare program as well as to equate home healthcare with hospital care in order to put the individual, not the building, at the center.
Sweden shall be a society where everyone can feel security regarding their old age.
Ulrika Westerlund (MP)
Mr. Speaker! It must naturally be mentioned that today, when we have our debate on elderly care and other issues concerning the elderly, it has been only two days since we learned that one of the clearest voices for the rights of the elderly has left us. Barbro Westerholm's contributions in the field can probably not be overestimated. For me, it is also clear that she became such a strong advocate for the rights of the elderly because she saw them precisely as rights issues. She had long experience working with rights issues, not least within one of the areas that is close to me: LGBTQI rights.
The situation of the elderly is strongly linked to rights. The need for elderly care is not static, and to what extent the elderly need elderly care is strongly connected to how much we enable care and nursing needs to be postponed through, for example, various preventive and health-promoting interventions. If and when the care need arises, it is central that the rights perspective is guiding. The elderly should be able to be themselves and live their lives as they wish well into their later years. When someone needs and receives interventions, it should be possible for this to happen with the individual's needs in focus and with regular, recurring staff who have the opportunity to get to know the person receiving the support.
Mr. Speaker! I want to touch upon three areas today. It is a comprehensive report we are discussing. I want to mention the rights of the elderly, the staff's conditions, and health interventions that prevent poor health for the elderly.
Miljöpartiet considers it extremely central that the work against age discrimination is ongoing, in the same way as other work against discrimination. In the government, we contributed to ensuring that the Discrimination Act contains requirements that all employers and educational providers shall ensure that active measures are taken to prevent discrimination regarding all grounds for discrimination. We believe that DO's supervision of the active measures taken to prevent age discrimination should need to increase.
The government we joined also commissioned an inquiry into a specific elderly care act. This inquiry has now submitted its report. The purpose of the inquiry was that clearer requirements should be set regarding what elderly care is and what it should entail. We truly hope that the government prepares the inquiry's proposals and the received referral comments and returns to the Riksdag with a proposal for new legislation during the mandate period.
Our member organization for the elderly, Gröna Seniorer, is positive about elderly care being covered by a specific law. This should strengthen the elderly's opportunities to receive the right support and service. Gröna Seniorer views the law's purpose to clarify the definition, mandate, content, and possibility for national equal quality of elderly care positively. The preventive health-promoting perspective is important, as are rehabilitative interventions as well as supporting the functions and abilities that exist in the elderly.
There is, however, potential for improvement in the proposal that the investigation submitted, Gröna Seniorer also points out. Among other things, it is hoped that the term reasonable standard of living in the law is changed to good, in accordance with the definition in LSS. This is something we hope the government will review.
Mr. Speaker! That the staff have sufficiently good conditions to have a chance to do a good job is fundamental. As I have mentioned in several other previous debates, Miljöpartiet wants to prioritize a major investment in the staff in both health and medical care as well as care and nursing. We want to see a permanent state investment for a strengthened work environment and strengthened working conditions with a focus on more employees and higher wages. A new construction is required where the state takes a permanent and large responsibility to contribute to better conditions for the staff in health and medical care and in municipal care and nursing.
Miljöpartiet was involved in pushing through the recovery bonus, which was aimed at staff groups within healthcare and elderly care. The bonus is intended to provide the opportunity to develop new ways of working for an improved work environment. The purpose is to take advantage of staff groups' own development ideas and give them the opportunity to test these, including testing new working time models. Among other things, the money can be used to reduce the number of involuntary so-called split shifts.
I also want, as previous speakers have done, to emphasize the importance of Äldreomsorgslyftet. It is about increasing competence and ensuring that it should be possible to both undergo initial training and further education during paid working hours. According to Miljöpartiets view, it is an important investment that provides opportunities for staff in elderly care, including first-line managers.
Mr. Speaker! Finally, I want to say something about the preventive work for better health, which is also an important elderly policy issue. Miljöpartiet is pushing for a public health law. It must be made clear how society should work at different levels to promote health and who is responsible for it. We want to see more of different types of preventive work. Investing particularly in health care programs for the elderly, which, according to the expert agencies, include relevant free vaccinations and screenings, is important. Upper age limits for different cancer screenings may also need to be reviewed.
Miljöpartiet also wants us to get a system where assistive devices are included in the high-cost protection. In the current situation, it looks very different across the country. Some types of assistive devices can be lent out, but far from always. With assistive devices, one can, for example, avoid injuries and falls and postpone a more extensive need for support. Miljöpartiet also wants to strengthen the cooperation between elderly care and healthcare with the goal that every elderly resident shall have access to a fixed named doctor.
In conclusion, I also want to say something about the report that the National Audit Office presented this week, where they have audited the state's work against healthcare injuries and malpractice within healthcare and elderly care. The conclusions are clear. Among other things, it is stated that the work to prevent healthcare injuries and malpractice can be improved in healthcare and elderly care operations. Healthcare injuries and malpractice are not always detected. Investigations of healthcare injuries and malpractice have deficiencies, and the operations have difficulty producing the right measures that lead to improvements. The management and follow-up of the work to prevent the injuries and malpractice should be strengthened.
The National Audit Office recommends, among other things, that the government strengthen the national governance of quality in elderly care with the aim of reducing the number of deficiencies, for example through a national action plan or equivalent. The Green Party will follow the issue very closely going forward.
I naturally stand behind all of the Green Party's reservations, but for time-saving reasons, I wish to move for the approval of reservation 1 under point 1 regarding the rights of the elderly.
The deliberation was hereby concluded.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.