Response to interpellation 2024/25:160 on deficiencies in elderly care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns deficiencies in elderly care and how these should be addressed. M believes that the government is working systematically with structural reforms to increase quality, strengthen competence, and increase the attractiveness of the profession 1 2 3. M emphasizes the importance of freedom of choice and competition 1, as well as that it should be profitable to work and enable further education 3. M is driving reforms for medical competence, language requirements, and improved dementia care 4. V believes that the government prioritizes tax cuts for the wealthy over resources for elderly care 5 6. V wants national staffing guidelines, a ban on profits in welfare, and that state grants be indexed 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Madam Speaker! [The member] has asked me what measures I intend to take to meet the staff shortage and improve working conditions within elderly care. Nadja Awad has also asked me what measures I and the government intend to take to ensure the supply of competence within elderly care, particularly in rural areas. Nadja Awad has additionally asked me if I intend to take the measures recommended in "Profit is somewhere else" (Vinst är någon annanstans). Nadja Awad has finally asked me if I intend to take measures in light of the study that profit-driven organizations within elderly care deliver poorer elderly care.
Madam Speaker! The supply of competence in welfare is complex and requires efforts within several different policy areas. It is about, for example, being an attractive employer, offering career paths, and finding solutions for a sustainable working life. In Sweden, we have a system of municipal self-government, and elderly care falls within the municipal area of responsibility.
The Swedish labor market model further implies that employers and employee organizations sign collective agreements on wages, working hours, and other employment conditions, as well as cooperate on the working environment. The municipalities have both the opportunity and the responsibility to take measures to ensure the supply of staff and competence. The state can simultaneously strengthen the conditions for the municipal sector to plan and execute the welfare mandate.
Elderly care is a priority issue for the government, which has taken several measures to strengthen the quality of care. The government does this, among other things, through the so-called sector grant for elderly care, which the municipalities can utilize based on their own conditions and needs. The government has also extended and developed the special initiative Äldreomsorgslyftet. The government has also completed the reform on the protected professional title for nursing assistants, partly to ensure competence within care and to increase the profession's attractiveness and status. In the budget bill for 2025, several proposals are submitted to strengthen Swedish elderly care.
The government has also during 2023 and 2024 supported the municipalities with increased general government grants, while a successful fight against inflation now provides the municipalities with better economic conditions for 2025 and onwards.
These are measures that link to what the Institute for Human Rights proposes in the report Home is Somewhere Else regarding providing municipalities with sufficient resources. Regarding the report, I also want to emphasize that human rights, which are universal and apply to everyone, are a basis for the social services' work, so even with a new Social Services Act.
Madam Speaker! I share Nadja Awad's opinion that freedom of choice should apply to the elderly. For me and the government, it is self-evident that people, regardless of age, should have influence over their own lives, and we definitely want to promote increased freedom of choice and participation for the elderly.
Surveys show that a broad majority of elderly people themselves want to be able to choose who provides their care. From the Socialstyrelsen survey, which the interpellator also refers to, it appears that elderly people living in special housing operated in private ownership are more satisfied in several respects than elderly people living in special housing in public ownership. A functioning competition in the care market can create better conditions for both municipal and private operations to continue working to improve quality and increase competence in the operation. Freedom of choice can also be beneficial for staff within elderly care as there are more employers to choose from.
With that said, the municipalities are responsible for following up on the individual actors who perform social services on the municipality's behalf. Furthermore, the Health and Social Services Inspectorate, Ivo, is responsible for supervision of all activities within care, regardless of who operates them. Deficiencies in execution, as have occurred in the examples raised by the interpellor, cannot be accepted within either municipal or private operations.
The government has recently tasked Ivo with strengthening its work against unserious actors within the care sector. I will definitely follow this issue very closely going forward.
Nadja Awad (V)
Madam Speaker! Thank you, Minister for Pensions Anna Tenje, for the answer!
Madam Speaker! I believe this government is avoiding a very big question. In what way is it okay for Prime Minister Ulf Kristersson to give himself a tax cut of 3,900 kronor every month? Why should Minister for Older People Anna Tenje and all other ministers in the right-wing government give themselves tax cuts of at least 3,000 kronor every month? Why should you give your Moderate friends who earn over 60,000 kronor every month a tax cut?
I think that one should answer these questions. It is this prioritization the government makes instead of spending money on the municipalities' elderly care and instead of lowering the tax for the care staff. The nursing assistant gets a tax reduction of only 150 kronor every month. Why is she obviously significantly less worthy than the ministers and their Moderate friends according to the government?
I consider it disrespectful of the government to prioritize in this way, Madam Speaker.
It is not only I who think that the government is prioritizing incorrectly. One finds no report, no factual basis, and no figures regarding elderly care where it is not mentioned that savings and cuts are being made within elderly care because the government provides too few resources.
Out of a total of 60 billion kronor in the government's budget, almost half, 27 billion, goes to tax cuts that benefit wealthy men in Sweden. The female-dominated welfare sector – healthcare, schools, and elderly care – does not even receive a third of that amount. Why should the richest in society be allowed to spend with the new tax cuts while elderly care is forced into savings and cuts that affect both the staff and the elderly, Madam Speaker?
Kommunal warns of a mass exodus from elderly care. The staff experience that the work is too physically and mentally demanding, even though they love their tasks and are passionate about making a difference for our elderly. It is chronic understaffing, low wages, poor working conditions, and a poor work environment. More and more people are therefore choosing to leave the profession. They even want to retire early because of the poor work environment.
If the government truly means that the work for equality in Sweden should be taken seriously and not suffer a massive blow, then one should invest in our welfare workers so that every woman and every worker in Sweden receives a good salary, a good working environment, good working conditions, and a good pension—not invest in making rich men richer, Madam Speaker.
When older people adapt their expectations and wishes to the staff's work situation, which is almost universally described as time-pressured and heavy, the elderly end up in a situation of dependency in relation to the staff. They make concessions on their rights, because they see that the staff is in too much of a hurry or that there is a staff shortage, Madam Speaker. We cannot have it this way in Sweden.
Is this how the government and Minister for Seniors Anna Tenje want elderly care to look - in Sweden, in the 2000s? Take your responsibility as a government and stop blaming everything on the municipalities' responsibility!
Statsrådet Anna Tenje (M)
Madam Speaker! The Member of Parliament posed a number of questions in his interpellation which I attempted to answer initially during the rather limited time available to me. I would like to take this opportunity to take a step back and look at the overall picture when it comes to Swedish elderly care.
Let us first remember what the situation looked like when the government took office. After eight years with a Social Democratic government, which the Left Party supported, we had several different societal problems. Elderly care was definitely not an exception. But we also saw a stalled growth and skyrocketing inflation of 10 percent, which put a high pressure on the municipalities' finances.
Deficiencies in the quality of care were well-known from before. The municipalities had worked with it for a longer period, but it was highlighted, not least during the pandemic and in the Corona Commission's report. It was about staff who do not speak Swedish, insufficient medical competence, and deficiencies in continuity and coordination regarding the elderly. These were deficiencies that became well-known but which the then left-wing government was unable to address.
Since I took office as Minister for the Elderly, the government has conducted systematic work to address these deficiencies, improve the quality of care, and ensure that Swedes can age in security. We supported the municipalities with state grants while simultaneously fighting inflation. And we won that fight. The year 2025 now looks significantly brighter for Sweden's municipalities.
At the same time, we are carrying out a number of different structural reforms to strengthen precisely the quality of elderly care. I appointed three inquiries shortly after I took office. One concerns language requirements. I will receive that inquiry next week. The others concern strengthened medical competence and strengthened support for relatives. I have already received those, and the proposals are now being fully prepared in the Government Offices.
At the same time, we are working on developing a new Social Services Act, and we are allocating funds in the budget to introduce fixed care contacts also in the elderly care homes.
We support where it is needed, and we strengthen where we can. Step by step, we are creating a safer elderly care.
Nadja Awad (V)
Madam Speaker! According to the Socialstyrelsen's annual survey on the quality of elderly care, the quality has fallen over the last ten years. Elderly care is now, according to the annual survey, at its worst in ten years. And it is something that the elderly report; it is they who have answered the survey.
If Minister for Older Care Anna Tenje and the government think that elderly care is a priority issue, why has elderly care not become significantly better over the last two years than it was in the years before? One cannot blame everyone else. I do not think it is an honest way to debate.
If elderly care is a priority issue, let us talk about elderly care and how it can become better.
I think we need to address that the number of employees in elderly care needs to increase by more than 30 percent, 58,500 people, until 2031 due to demographic developments. Approximately the same number are expected to retire. This means that a total of 111,000 people need to be employed, according to Sveriges Kommuner och Regioner, SKR. The demographic development in rural areas will also lead to the staffing of welfare in rural areas being put under pressure.
The main factor is to ensure that staff stay within elderly care and that more people come to elderly care. How is the government going to do that, when there are cuts in all municipalities' elderly care, across the entire country? It is quite bold of the government to choose to prioritize tax cuts for billions and billions again to the very richest instead of ensuring that the municipalities have sufficient resources.
Therefore, I wish to have a number of things answered by the Minister for Seniors. How does the Minister for Seniors view an indexing of the state grants, so that they can follow both population and price developments? Sufficient, stable, and long-term state grants are important for the continuity of elderly care. That was the first matter.
The second matter concerns the fact that Vänsterpartiet wants to see national staffing guidelines within elderly care. Full-time employment should be the norm, and general fixed-term employment should be abolished. By improving working conditions, more people can be lured back to the profession and stay in elderly care. In this way, the staffing density can increase. What does the Minister for Health and Social Affairs think about that?
The third matter, which was actually mentioned earlier, concerns the new study from the University of Gothenburg which shows that non-profit organizations are overall best at elderly care in Sweden. Those organizations do not engage in profit distribution but instead reinvest their financial surplus into the operations.
The Left Party believes that profits in welfare should be prohibited and that companies' right of free establishment should be abolished. Freedom of choice shall apply to the elderly, not to profit-driven actors, Madam Speaker.
It is very good that the government has tasked the Health and Social Services Inspectorate, Ivo, with strengthening its work against unserious actors within care, even though Vänsterpartiet believes that the resources for Ivo need to increase. But privatization has resulted in many substitute workers, lower staffing, high staff turnover, and lower wages. In addition, the alarming reports of neglect continue to come in when it concerns profit-driven actors.
Does Minister for Health and Social Affairs Anna Tenje believe that profit extraction at the expense of the elderly and the staff's working conditions should be allowed to continue?
Statsrådet Anna Tenje (M)
Madam Speaker! The interpellor sometimes has a somewhat high tone, but a great commitment to elderly care nonetheless, and that I share.
I definitely do not blame anyone else. That was exactly the point. We are making major structural reforms to improve the quality of elderly care. That is what I have prioritized. In Sweden, one should be able to age in security, with respect for the individual's participation and freedom of choice. And every day should count.
Then elderly care must be strengthened, the deficiencies addressed, and the quality raised. I believe that the interpellor and I are in complete agreement there, Madam Speaker. But we differ when it comes to which tools we should use. Vänsterpartiet's solution is the same as it always usually is: Raise taxes significantly, borrow even more, make it less profitable to work, and believe that it will solve the structural problems.
The truth is that it is not the solution at all. Nor is it what will solve the challenges of elderly care, rather the opposite. We saw what low growth and low profitability for work led to.
The government's alternative is clear. We make a real difference. It is structural reforms that matter. We identify the deficiencies, and we act on them. It could be about strengthened support for relatives. It could be about the language requirement, so that the elderly can understand and make themselves understood, or about strengthened dementia care, for those who are met by the great crisis in their lives and the great public health challenge.
We are also strengthening the work line. We are making it more profitable to work, not least for all the 400,000 people across Sweden who can work today but for various reasons do not and are unemployed. We also want to make it possible for them to further their education, and preferably into one of the many important care professions.
We believe in the individual, whether it is an employee or the elderly. We believe that the individual, regardless of age, wants to choose for themselves. One wants to choose housing and also an employer. Therefore, we hunt down the unserious actors and convict them for welfare crime. We do that to protect the freedom of choice.
What the interpellator is actually proposing is that the elderly should be able to choose but have no choices to make at all. In order for more people to be able to choose where they want to live and who should perform the home care, one must also have alternatives to choose from. Then the unserious actors should be removed from the welfare sector, while we would gladly see those who behave and conduct work with quality remain.
In these areas and many more, we are now implementing large and small reforms - many small streams - to together strengthen and increase safety for the elderly. Together, it becomes a whole that makes a real difference for employees in care, for municipalities, but also for relatives and, above all, for the individual.
It is only with such systematic work that one can create a safe, individually tailored and qualitative care.
Nadja Awad (V)
Madam Speaker! I would have liked to get answers to my questions. I had concrete questions about how elderly care can be improved for the staff and for the elderly, but I have not received answers to my questions.
It is very unfortunate that Minister for the Elderly Anna Tenje does not want to talk about the indexing of the state grants, because this is exactly what I have heard about since I took office as the Left Party's spokesperson for elderly care issues, and I hear about it from managers and employees in municipalities and from trade unions. Everyone talks about the indexing of the state grants in order to be able to plan for the future in their operations. And that is done regardless of which government we have and what governance one has in the municipalities. I actually want to get an answer to this question.
The same applies to the national staffing guidelines. We hear about this all the time. What does Minister for Older Persons Anna Tenje think about these?
We completely agree that unserious actors need to disappear from elderly care. But it is no coincidence that very many of the unserious actors are engaged in profit-seeking. I also did not receive an answer to the question of what Minister for Health and Social Affairs Anna Tenje thinks about profit-seeking within elderly care?
I am also thinking of the report from the Institute for Human Rights which addresses the eight demands they direct to the government, for example regarding equality data, regarding the removal of the discriminatory age limit for personal assistance, and regarding ensuring that policy documents, general advice, and legislation align with Sweden's international commitments on human rights. This has also not been raised in the debate despite my request to the Minister for Seniors.
Could I get answers to these questions, or do I need to call the Minister for Senior Citizens to yet another debate?
Statsrådet Anna Tenje (M)
Madam Speaker! We can gladly have a debate on elderly care once again, because I truly think it is an important issue to debate. I am very happy that the debate finally took place. Now it was the third time that the interpellor submitted their interpellation. I have long looked forward to this debate and am glad it took place and gladly accept more.
I and the interpellator do not agree on much in particular, but I appreciate her commitment to elderly care and think it is beneficial that it is brought forward. This was, after all, only my second debate on the area of elderly care since I took office two years ago. I am passionate about the issues and do not shrink back from a good debate.
Sweden's elderly deserve a secure and safe elderly care. The difference between us is who carries it out. It is easy for the opposition to think various things about what should happen and what should be implemented, especially if one is a Left Party member and has a bit of difficulty implementing their politics.
The government is now pushing through large and small reforms that truly strengthen Swedish elderly care. Competence supply, reinforced medical competence, language requirements, improved dementia care, and not least stronger support for relatives as caregivers are reforms that make a real difference. We are not coming here with empty words at all.
We are now working systematically to address the deficiencies that have emerged, not least in the Corona Commission's reports, in order to strengthen the quality and improve life for both the elderly and all employees within elderly care. Step by step, we are strengthening Swedish elderly care.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.