Response to interpellation 2024/25:631 on elderly care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
M argues that the municipalities' economic conditions are linked to the tax base and growth 1. M believes that the government has permanently increased the general state grants 1, implemented reforms so that more people move from benefits to work 1 and taken measures to strengthen the quality of care 1 2. M emphasizes the importance of leadership, a protected professional title for nursing assistants 3 as well as introducing a clear language requirement and strengthening medical competence 4. S argues that welfare has not been prioritized and that elderly care is underfunded 5. S believes that the resources are too few 6, which leads to cuts and risks for patient safety 6. S wants to prioritize a strong elderly care 7 where the individual's needs are at the center 8. S emphasizes that the work environment is deficient 7 and advocates for general state grants 9. S argues that M has not allocated more money to elderly care in its budget than the government has 3.
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! Eva Lindh has asked me what measures I intend to take to ensure that Sweden's municipalities have sufficient financial conditions to strengthen elderly care.
One of the cornerstones of Swedish democracy is local self-government. Elderly care falls within the local government's area of responsibility. Through the right of local taxation, the municipalities have both an extensive responsibility for and a great opportunity to influence the financing of their operations. Tax revenues account for the very largest part of the municipalities' total revenue. The municipalities' economic conditions are therefore, as with the rest of the public sector, strongly linked to the development of the tax base and economic growth. In order to strengthen the municipalities' economy and the conditions to finance elderly care in the long term, increased growth and a re-established work line are therefore of great importance.
Elderly care is a priority issue for the government, which has also taken several measures to strengthen the quality of care. The budgets for the last two years, namely for 2023 and 2024, were characterized by a situation where the municipal sector's finances were weakened rapidly, primarily due to high inflation. The government therefore proposed increases of the general state grants by a total of 16 billion kronor for 2023 and 2024. The level increases were permanent – meaning that they remain in 2025 and onwards. The municipal sector's finances are expected as a whole to be strengthened during 2025 compared to the last two years. The government is also implementing reforms so that more people will move from benefits to work, which can also benefit the elderly care's competence supply. The municipalities also receive continued state grants specifically for elderly care, partly the sector grant which the municipalities can use freely to ensure good care and nursing for elderly persons, partly the Elderly Care Boost (Äldreomsorgslyftet), which has been extended to 2026. The government also proposes other investments in the budget bill for 2025 to strengthen elderly care as a whole.
In the budget bill for 2025, several proposals were submitted to strengthen Swedish elderly care, such as a permanent care contact in special housing, strengthened relative support, as well as continued support for knowledge dissemination and quality registers for persons with dementia. For the government, it is important to continue to support the municipalities in their work to strengthen the competence of staff within the elderly care sector. The regulation of the profession of nursing assistant and the Elderly Care Initiative (Äldreomsorgslyftet) can contribute to a more secure and safer elderly care, but also to making it more attractive to work in elderly care.
The Government appointed inquiries early in the term of office to strengthen both the medical competence in municipal health and medical care as well as the knowledge of the Swedish language in elderly care. The reports have been subject to consultation and are being prepared in the usual order in the Government Offices.
Madam Speaker! For the government, it is important to continue to support the municipalities in their work to strengthen welfare. We therefore continue the work with reforms in several areas for a safer elderly care throughout the country.
Eva Lindh (S)
Madam Speaker! The Swedish welfare state is being challenged from several sides. Welfare has not been prioritized by the SD-led government and has not been given sufficient resources. This hits the welfare state hard – against healthcare, against schools, against crime prevention work, and against elderly care.
Sweden faces one of our time's most predictable yet underfunded societal missions: to provide the elderly with the care they deserve after a long working life.
In five years, the number of people over 80 years of age is expected to have increased dramatically compared to today. This cannot come as a surprise to anyone. We have known that for a long time.
This requires a great deal from us. It requires a lot from the municipalities, of course, and from the regions, but also from the state.
Instead of elderly care being strengthened, it has decreased in scope, and it has been eroded in terms of quality. The current government does not seem to be able to stop that development.
Elderly care, of course, looks very different in different places, but in many places, the deficiencies are great. The most important resource in elderly care is its staff. I meet very many who work within elderly care who, with warmth, tell about their work with the elderly but who also, with sadness, tell about the conditions for their job. They love their job but often feel that they are not enough.
Some time ago, I was out in the home care service, for example. There was a young woman who was absolutely fantastic. I told her that I hoped she would continue working in elderly care when I got older and that she could then come to me with her absolutely fantastic approach – she had a very great understanding of the elderly she worked with. But she said that she probably wouldn't be able to do that, because the conditions were so difficult. It was about conditions regarding salary, working hours, and other things.
It is these people that we do not want to lose from elderly care. But the number of nursing assistants within elderly care decreased between 2022 and 2023 by a full 4.5 percent, according to the Socialstyrelsen's latest situation report. It is therefore not more who are working in elderly care now, but fewer.
At the same time, one can look at Kommunals' member survey. According to it, 43 percent, almost half, of those who work in elderly care say that the staffing is rarely or never sufficient and that the staffing in elderly care is so low that it poses a risk to the elderly at least once a week.
What does this have to do with the state? One might wonder after the answer, which I, of course, want to thank the Minister for, from the Minister.
Everything that happens in Sweden is also a state matter, regardless of whether we have good local self-government – I think that is very good. The municipalities can see for themselves what the differences are between municipalities and so on. But the state has a responsibility to give the municipalities – and the regions – the conditions to provide people with good care and good healthcare in their old age.
Zara Leghissa (S)
Madam Speaker! Many thanks to Eva Lindh, who has initiated this interpellation debate!
The social services of society shall, on the basis of democracy and solidarity, promote people's economic and social security, equality in living conditions, and active participation in social life. The social services shall, taking into account the human responsibility for one's own and others' social situation, be directed towards liberating and developing the resources of individuals and groups. The activities shall be based on respect for people's right to self-determination and integrity.
Thus reads the portal paragraph in the Social Services Act, the one that is to be the guarantee that one can live a decent and meaningful life throughout life.
Madam Speaker! How is today's elderly care doing? There are many testimonies pointing out that it is going in the wrong direction. Relatives who feel worried when their loved ones are to receive home care or move to a residential facility feel helpless when the care and support do not function.
The elderly who expect a good quality of life in the autumn of their lives feel betrayed, and staff who want nothing more than to work in their professional role and feel that they are making a difference can no longer endure.
Something is broken in Swedish elderly care today. The resources are too few.
According to a survey conducted by the newspaper Arbetet, 63 percent of Sweden's municipalities had deficits regarding elderly care last year. This year, at least 94 of 208 municipalities are forced to make cuts within elderly care. It is clear that these cuts will have consequences.
The risk that patient safety cannot be guaranteed is great. Care injuries occur, and the prevention of the same is insufficient. Resignations of staff occur. Services are not fulfilled because there are too few applicants. More and more people choose to leave their professions due to the working conditions – high workload and working hours that do not allow for recovery and a social life. It is also about part-time work, insecure employment, low wages, and too few colleagues. Sick leaves among staff are increasing.
The Minister states in his response to the interpellator that Sweden's municipalities receive and have received increases in the general government grants. But they are simply not enough. For every year that the municipalities have budget deficits, the possibilities for a good quality in elderly care decrease – every year.
Madam Speaker! Three years ago, the pandemic raged. The Corona Commission's judgment on what was required was clear. Increased medical competence was needed. It is about access to nurses and medical equipment in residential homes and access to doctors and sufficient staffing in special residential homes and in home care, especially when it concerns the care and treatment of persons with dementia. And it is about trained staff.
I know that the Minister has worked for a certain part of these measures. But does the Minister consider that the government has done enough to support the municipalities when it comes to a good quality in elderly care as well as when it comes to securing sufficient staffing?
Statsrådet Anna Tenje (M)
Madam Speaker! The situation within Swedish elderly care is a very pressing issue. More and more people are getting older. We are adding more healthy years to our lives. But the number of elderly people is also increasing. This places new and greater demands on elderly care. It is therefore required that we take in new experiences and new knowledge in a completely different way and ensure that that knowledge, that research, reaches those who need it most, that is to say our employees within elderly care and our relatives, so that they can receive help and support to endure longer. It is, of course, also about our elderly.
As the interpellor pointed out, elderly care is facing several challenges and deficiencies. These have been known for a long time. This applies in particular to the working environment within elderly care. When the Corona Commission submitted its report and when Ivo presented the audits, it was quite clear what the deficiencies were.
This government has truly taken to heart the criticism that emerged in both the Corona Commission's and Ivo's reports and reviews and has also taken measures to tackle the problems that the previous government absolutely failed to manage to address.
The language deficiencies were a clear part of the Corona Commission's report. It was pointed out that they involved major quality deficiencies. This means the previous government did nothing about it, even though it had been known for a long time. We have now appointed an inquiry. It is a matter that has been referred, and we are working on the compilation regarding how we are to deal with the major language deficiencies and establish a language requirement within elderly care.
The elderly must be able to understand and make themselves understood, and employees must also be able to speak with one another, not only because patient safety needs to be guaranteed but also at the coffee table. One must have fun at work, be able to understand one another and in that way also achieve a better working environment.
Now we are acting. The previous government did not. We have also developed Äldreomsorgslyftet specifically for the purpose of providing support regarding language. Pure language training is now possible via Äldreomsorgslyftet and does not need to be combined with another education. Pure language-supporting measures are welcome, and one can therefore use Äldreomsorgslyftet for that. This is part of our broader work to address the deficiencies in elderly care but also to positively influence the working environment.
We are also working with several other measures, for example, strengthened support for relatives, which I touched upon and which Ivos's reports and the Corona Commission have pointed out the importance of. Already today, there is a fixed care contact when it comes to home care, and now we are moving forward with that also for special housing. In the special housing, we see the most fragile, and it is therefore perhaps even more important with a fixed care contact there.
One thing, Madam Speaker, that I have spoken about very much lately is our new and developed dementia strategy. Dementia is not a part of natural aging, but it is a disease just like anything else. Significantly more people are affected by dementia now that more of us are becoming older. Therefore, we definitely need to ensure that we increase knowledge about specifically dementia care and raise the floor significantly, because that requires major commitments. The dementia strategy is the first step to raising the quality even within that area.
Eva Lindh (S)
Madam Speaker! The Minister raised some questions that I intended to address directly. We are in no way against the fact that we should set language requirements within elderly care. We also think that. We also think it is very important that competence is highlighted when it comes to dementia diseases. I and my colleague Zara Leghissa are very engaged in exactly this.
It is not, however, the point-interventions, if I may call them that, that we are talking about here. Language requirements are very important and incredibly crucial, but what we are talking about here is providing sufficient resources to elderly care, which can be converted into concrete activities and better elderly care.
It is absolutely crucial that one can speak the language, but what we are talking about is that the underfunding of elderly care is visible already today, and it has effects, just as my colleague Zara Leghissa pointed out. We see that some municipalities now have insufficient resources because they receive smaller state grants to be able to manage their operations, and then it affects other operations, for example the school. But now we are talking about elderly care.
The challenges are huge. What I and people out there as relatives want is to feel security that our elderly can receive good elderly care. Now the queues are increasing; they have become around six times longer in some places. This means that relatives become worried that there won't be a place when it is needed. One is worried when one arrives at an elderly care home and sees how the staff are running, and it is not just about understaffing – it is also difficult to get hold of competent staff.
We are very happy about higher language requirements, and it is very good that Äldreomsorgslyftet continues. But more is required if we really want that elderly care that is good and that our elderly deserve.
We Social Democrats have shown the way. We have also, in our budgets in opposition, allocated much more resources to welfare, something that also benefits elderly care.
I also want to highlight the work environment. It is clear that we need to be very careful about the competence that exists within elderly care today. We must be careful about the staff who know their work and know what is required. Many, however, leave the profession because of the way the work environment looks. Furthermore, the report from Kommunals, which was produced quite recently, shows that the working conditions are even more difficult in private elderly care.
It works differently on different levels, but regardless of that, we need to prioritize a strong elderly care, because elderly care is not and should not be just a cost item. When Sweden's elderly need us most, they should be met with time, security, and trust – not by queues, lack of competence, and lack of staff. That is why we ask this question, because we want to hear what the government will do to strengthen today's and the future's elderly care.
Zara Leghissa (S)
Madam Speaker! A meaningful life and an everyday life that is manageable and understandable is something we all need and have a right to, regardless of age and state of health. The individual's needs shall be at the center.
The importance of good elderly care with high quality cannot be overstated. It must not be the case that there is a difference in the care and support in our country because the budgets do not suffice in the municipalities and regions.
To work and operate within elderly care is not easy. It requires knowledge, competence, and education. It also requires continuity. It requires laws that provide security, guidelines that show the way, and a government that takes responsibility.
Madam Speaker! One day we will all die. All other days we shall live. The Minister did not answer my questions, but I hope that Minister Anna Tenje is responsive to what is said in this debate and works for elderly care of good quality, where the status of the professions is actually raised so that more people choose these professions and more people choose to stay.
Statsrådet Anna Tenje (M)
Madam Speaker! For the record, it is nevertheless good to highlight for any listeners and viewers and for those who read in retrospect that the Social Democrats in their budget have not allocated a single krona more to elderly care than the government has in its budget for 2025.
The increased general state grants that the Social Democrats often highlight are supposed to cover quite a lot, Madam Speaker. I previously listened to an interpellation debate with Carl-Oskar Bohlin. Then, the extra money for the municipalities in the form of general state grants was supposed to cover both crisis preparedness and more shelters. Last week, the money was supposed to cover expanding the school and reducing the number of children in the preschool groups. There is simply no end to what the increased state grants are supposed to cover, and now they are also supposed to cover elderly care.
If one wants to prioritize and highlight these issues for real, if one thinks that the state should allocate more money and that municipal self-government obviously cannot manage to handle this matter itself, then one should set aside money in the budget for just that purpose, which one is now advocating for. But that is not what the Social Democrats have done in the budget for 2025.
One thing that I agree with both the interpellor and Member Zara Leghissa on is precisely the importance of the work environment, and I would like to dwell somewhat on this. In that regard, I believe that we have all, completely regardless of political affiliation, failed. The National Board of Health and Welfare recently presented me with a report showing that the problems we now see within elderly care regarding the work environment were identified already 20 years ago. Since then, it has not been managed to take many measures.
I am the first to sign that we really need to tighten up. We need, as the government has now done, to proceed with a protected professional title for nursing assistants to raise the status and attractiveness. But we also need to ensure that the working environment becomes significantly better within elderly care, regardless of whether we are talking about individual alternatives or municipal institutions.
I believe that leadership is everything. I make many study visits within elderly care around the country, at individual facilities and at municipal ones. It is clearly noticeable that where they have chosen to invest in leadership, where skilled managers see and confirm their employees and take in and utilize their competence and experience in the best way, the quality within elderly care is significantly better. There, the continuity is higher and the turnover of substitutes is much lower, and one does not have as much difficulty recruiting.
I believe that investing in leadership within elderly care is perhaps one of the most important lessons Swedish municipalities can learn. That is why we have developed Äldreomsorgslyftet. It is, among other things, to invest in first-line managers – but I am not closing the door on the state doing more, because I believe this will be crucial for the future when it comes to the work environment. When I received the figures – not least regarding the high sickness absence rates, often in female-dominated occupations – I did not hesitate for a second but invited SKR's presidium and representatives for both regions and municipalities to discuss the work environment.
From the political side, we must take on the leadership role in a clearer way, request sickness absence figures, request action plans, and follow up on this continuously, because when more people can move from part-time to full-time and more people move from sick leave back to work, the skill shortage will also become less troublesome.
Eva Lindh (S)
Madam Speaker! The ministers in the government should perhaps talk to each other and decide whether they prefer general or targeted government grants. Quite often, other ministers and Members of Parliament from the government parties, just like us, say that general government grants are preferable so that the municipalities can act themselves. That one does not have a specific targeted government grant is not a sign that one does not care about a certain issue. That is exactly what I and my colleague have said here. It is about the fact that the municipalities and regions have such a tough challenge that they cannot meet their commitments – including elderly care.
We had a specific sector grant for elderly care earlier because we wanted to show that targeted interventions were needed. We still think that general state grants are better, when it is possible, so that the municipalities themselves can decide how and when to make interventions. But sometimes targeted state grants were needed. That is all on that.
I want to see a strong elderly care in Sweden. We can manage that, as the welfare state we are. Those who have worked a whole life are worthy of a good elderly care. It is also the people who work within elderly care who are worthy. Many of them are passionate about their jobs and want nothing else than to do something positive but go home crying because they feel they do not have the time and strength to do enough.
What we are requesting in this debate are resources and conditions for better elderly care.
Statsrådet Anna Tenje (M)
Madam Speaker! Let me be very clear. I am every day of the week for general government grants rather than targeted government grants. What we talked about was the sector grant, that is to say a targeted general government grant that goes to elderly care and which can be used in the way the municipality deems most appropriate. I actually did not know that the Social Democrats had removed it in their budget for 2025. I thought it remained with you. We have, in any case, 4 billion in our budget to specifically prioritize elderly care.
Madam Speaker! When the Social Democrats stand at the rostrum and claim that they are putting significantly more money into the municipalities in many different areas, one must be aware that if you add up the various promises and pledges, the account is overdrawn quite significantly if they are to live up to what they have promised. But it is as usual with the Socialdemokraterna: They promise everything to everyone, and then it becomes difficult to deliver.
Madam Speaker! The Government is firmly determined to strengthen elderly care and address the deficiencies that exist there on several different levels. The Corona Commission was clear in its criticism. There, we checked area by area.
I hope to be able to deliver a clear language requirement, something that the previous government failed to even begin – not to mention strengthening the medical competence within municipal health and medical care so that the elderly do not fall through the cracks but receive the care and support they are entitled to.
Our work to get more people to move from benefits to work will, together with other measures to increase growth, also increase tax revenues for the municipalities while simultaneously helping the skills supply within elderly care along the way. I am therefore firmly convinced that we will continue to work for a safer and stronger Sweden.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.