Response to interpellation 2024/25:670 on quality deficiencies in profit-driven elderly care homes
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 M argues that the starting point for elderly care should be security, humanity, and increased freedom of choice 1. 1 2 M emphasizes that the elderly want to be able to choose providers and that the government is working to clarify quality requirements through investments in language requirements and medical competence 1 2. 2 3 M has zero tolerance for neglect regardless of the form of operation and argues that quality should be raised generally 2 3. 3 M claims that users are often more satisfied with independent alternatives than municipal ones 3. 3 M emphasizes that staff should also have the freedom to choose employers in order to raise the status of the profession 3. 3 M believes that leadership is crucial to raising quality and that they have joined forces to clear out unserious actors from the welfare sector to protect freedom of choice 3. 4 M emphasizes that the individual's right to choose employer and housing is central and that they do not tolerate neglect regardless of the form of operation 4. 4 M argues that quality is the most important thing and that operations that do not meet the standard should be cleared out from the sector 4. 5 V believes that the quality of working conditions and users' satisfaction is lower in private, profit-driven elderly care compared to municipal or non-profit care 5. 5 V wants to eliminate profit-driven actors because they deliver lower quality 5.
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! Nadja Awad has asked me what measures I intend to take in light of the study Provider Ownership and Indicators of Service Quality: Evidence from Swedish Residential Care Homes. Nadja Awad has also asked me what measures I intend to take in light of extensive deficiencies in care and nursing within profit-driven elderly care companies.
Madam Speaker! The starting point for elderly care shall be security and humanity. A starting point for me and the government is that people, regardless of age, shall have influence over their own lives. We want to promote increased freedom of choice and participation for the elderly. Surveys show that a broad majority of the elderly themselves want to be able to choose who performs their care. From the provisions of the Social Services Act (2001:453) it follows that interventions within social services shall be of good quality and that there shall be staff with suitable education and experience for the performance of the tasks.
Several of the government's initiatives contribute to clarifying what high-quality elderly care needs to include. In the budget bill for 2025, the government announced that those living in special housing shall have the right to a fixed care contact so that the individual's needs for continuity, security, individualized care, and coordination can be met. The matter is currently being prepared in the Government Offices.
In addition to this, the proposals submitted by the Inquiry on language requirements for staff in elderly care and the Inquiry on strengthened medical competence in municipal health and medical care are prepared. The proposed provisions can contribute to clarifying what is required to achieve good quality in elderly care. The inquiries assess that the legislative proposals may entail certain restrictions on municipal self-government but also consider that these can be justified by the proposals' overall objectives.
It is simultaneously important that detailed regulations for elderly care do not hinder the municipalities' conditions to carry out their important welfare mandate. There must be room for the municipalities to adapt their operations to local conditions and needs. A restriction of municipal self-government must be proportionate and therefore requires careful considerations.
The social welfare boards have a great responsibility to follow up on the individual actors who perform social services on the municipality's behalf. On July 1, new regulations will enter into force, which mean that the municipalities will, among other things, have a responsibility to ensure that there are routines in place to prevent, detect, and address risks and irregularities within the social services' activities.
Providers of interventions within the social services will also, upon request, need to provide information to the social welfare committee responsible for the intervention. The information referred to are such as the social welfare committee needs for quality assurance, administration, follow-up, or evaluation. The purpose of the new provisions is to improve the municipalities' ability to follow up on social service activities.
Furthermore, the Health and Social Services Inspectorate, Ivo, is responsible for the supervision of all activities within elderly care, regardless of who operates them. Deficiencies in execution cannot be accepted within either municipal or private operations.
Nadja Awad (V)
Madam Speaker! I thank the Minister for the answer. I wonder, however, if Minister for Health and Social Affairs Anna Tenje has actually read my interpellation. Research is mentioned there which clearly and explicitly states that profit-driven companies within elderly care have the worst quality. Of all 2,639 non-municipal elderly care homes, those operated by listed companies, venture capital companies, or private companies with a clear profit motive have the worst quality. They have lower staffing density and fewer qualified staff. They have the lowest wages and fewer with full-time employment or permanent employment. They also have fewer satisfied users and elderly people. A full-time employee in private elderly care earns almost 2,500 kronor less per month than a full-time employee in municipally run elderly care. At the same time, a company within health and care with housing has an average result of 43 million kronor in a year. It is fact. It is reality, Madam Speaker.
Why does it look like this within Swedish elderly care? These companies save on wages and other working conditions in order to maximize profits. It affects the care staff, and it affects the users and the elderly. Still, the minister and the government pretend as if it is raining, Madam Speaker.
Does Minister Anna Tenje think that profit-driven companies should get away with this? Obviously, she does, because the government is doing nothing to stop the pursuit of profit in welfare. They like this system. Shareholders' profit maximization is more important than nursing assistants getting a good salary and a pension to live on. It is more important than the elderly avoiding waiting for two hours to go to the toilet because of a lack of staff, or that the elderly avoid walking around hungry because there is no food in the refrigerator. It is that kind of neglect that has been alerted to at private, profit-driven elderly care homes.
Sweden's government is very alone in its view on profit-seeking within elderly care. All other Nordic countries have a smaller proportion of profit-driven providers than Sweden and a larger proportion of non-profit actors.
Madam Speaker! If the choice system is so important for the Minister and the Government, then they can well let the non-profit organizations and foundations continue to be providers alongside the activities conducted under municipal management. They reinvest their financial surplus into the operations.
Abolish profit as the steering signal for private operators! The real freedom of choice, Madam Speaker, is that as a user, elderly person, employee, or taxpayer, one should be free from being exploited by companies.
Where there is a pursuit of profit, there are also criminal actors who defraud the elderly and staff and waste the municipality's tax money. That is, the risk of welfare crime increases by the government continuing to allow the pursuit of profit within elderly care.
My question is: What does the Minister think? Does the Minister believe that for-profit operators should be allowed to continue operating within Swedish elderly care?
Statsrådet Anna Tenje (M)
Madam Speaker! I am almost entirely convinced that the interpellor and I share the same view regarding the care and support that shall be provided within elderly care. It shall maintain high quality and be medically safe. It shall also be individually adapted.
What I believe sets us apart very much is the belief that the elderly also have the right to choose, in the same way as they earlier in life have chosen childcare for their children, chosen their health center, or for that matter chosen their dentist. The will to choose does not disappear just because one becomes older. All persons, regardless of age, have the right to choose what they desire – where they want to live, who shall perform the home care they need, and which special housing they desire when that kind of need arises. Surveys also show that a broad majority of the elderly themselves want to be able to choose who performs the care. It is what the elderly want, and it is also what I want the elderly to be able to do.
Let me be clear: I have zero tolerance for neglect. I have zero tolerance for what is sometimes reported in the media and which shows that the elderly have not received the care and attention they are entitled to and that the care has been performed in an incorrect manner. This applies when individuals have made mistakes. It also applies in cases such as the one in Gothenburg that the media recently reported on, where a municipal residence perhaps did not do quite as it should have.
For me, it is important that one gets to choose. Within the municipal operations, there are very many good examples with very high quality. Among the non-profit alternatives I have visited, I can in particular mention Ersta diakoni, which has very high quality in many of its residences and in the activities it conducts.
I was recently at Judiska Hemmet here in Stockholm, where the Jewish congregation runs a high-quality elderly care home where our Jewish minority can continue to practice their religion, their customs, and their cultural habits throughout their lives precisely because that is how they choose to live their lives.
For me, it is extremely important that these opportunities exist, but that being said, they must not exist at any cost. If one does not have a good operation – an operation of high quality that meets the requirements we set – one should not conduct the operation.
I have zero tolerance for neglect and for the fact that the elderly are not given the help and support they need. However, that does not mean that we cannot have any alternatives at all, as the member seems to want. One must manage to keep two balls in the air at the same time. It is possible to ensure the freedom of choice for the individual while simultaneously condemning grant fraud, working against welfare crime, and being on everyone's back regarding all providers so that they improve the quality. One does not have to exclude the other. That is how I intend to continue to act.
Nadja Awad (V)
Madam Speaker! It is true that the elderly have a right to freedom of choice, but that does not mean that profit-driven companies have the right to exploit the elderly and staff to maximize profits.
In those areas of elderly care where profit is the steering signal, we see lower staffing density, fewer qualified staff, lower wages, fewer full-time or permanent positions, and fewer satisfied users and elderly people. Research shows this. Why should Sweden continue to be the country in the Nordic region with the largest proportion of profit-driven providers when there is evidence that this system delivers the worst quality both for the staff and for the elderly?
It is not defensible that full-time employees in private elderly care earn almost 2,500 kronor less per month than full-time employees in municipally run elderly care, or that the elderly get pressure sores because there are so few staff members that it affects the care and the attention of the residents, while companies within care and elderly care with housing have an average result of 43 million kronor in a year.
We have not missed that in recent days reports have been made about very serious deficiencies at several elderly care homes operated by Forenede Care, which is one of the Nordics' largest care and service companies with, among other things, around 50 elderly care homes across Sweden. It concerns horrific information, such as that elderly people have not had their teeth brushed for months, that people with dementia have disappeared without the staff noticing, and that a woman was forced to amputate a leg after being left in scalding hot water. At an elderly care home in Österåker, the problems have been ongoing for a long time, and in the autumn, the staff alerted that the refrigerators were empty, that the elderly were losing weight and getting pressure sores, and that there were so few staff members that it affected the care and nursing. Some of this company's elderly care homes have not carried out a single self-inspection to ensure that the elderly actually receive the care and nursing they are entitled to.
After these revelations, the company's CEO has had to resign, but that does not mean the underlying problem is solved. That profit-driven companies prioritize profit over quality increases the need for control and supervision, and it is a costly bureaucracy in an already rotten system. Why should our tax money go to more controls and more supervision when we could just as easily abolish the profit motive in elderly care?
Many of the over 21 municipalities that have abolished the LOV since 2018 have done so by referring to the fact that the municipalities, i.e., the clients, have poor oversight and that the costs of establishing a control apparatus are high. Even Moderate-led municipalities have chosen to abolish the LOV.
We are facing a personnel and skills supply crisis within elderly care, where we must be able to attract and retain competent staff, and it then becomes paradoxical to defend private, profit-driven elderly care, which is a system with a built-in inefficiency. Despite an alleged labor shortage, it is obviously not the case that everyone who works part-time is offered full-time employment, or else the employer does not organize the work in such a way that one can and can manage to work full-time.
My question remains: Why do former minister Anna Tenje and the government continue to defend this rotten system at all costs?
Statsrådet Anna Tenje (M)
Madam Speaker! I can hardly be any clearer. I have a total zero-tolerance policy when it comes to the neglect of the elderly, regardless of the form of operation. But it seems that the member thinks it is okay when it occurs under municipal management, for it is a Tourette's by the grace of God when it concerns the individual, private alternatives the member wants to pursue.
For me, the form of operation is secondary. What I look at is the quality, i.e., that the elderly receive the care and support they are entitled to, that the staff enjoy their work, that the sickness absence rates are low, that the work environment is good, that there are no major problems recruiting, that the leadership is good and that the user survey speaks its clear language. There is research that shows exactly the opposite of what the member states. Even the user survey shows that users and relatives in most municipalities are more satisfied with the independent alternatives than with the municipal ones.
My ambition is that the quality shall be raised generally, regardless of whether it concerns private or municipal providers, and that users and relatives shall become even more satisfied with the activities being conducted. Furthermore, the work environment must be improved significantly.
Speaking of freedom of choice, surveys show that nine out of ten want to be able to choose who they hire as a provider in home care and which housing they shall live in.
The staff also want to be able to choose an employer. We must not underestimate this freedom of choice, not least because there is a major shortage of skills and it is important to raise the status and attractiveness of the profession. It must be possible for nursing assistants to make a career, to change employers and to influence their own everyday lives.
We have, as we have said, made many different investments in elderly care to increase the quality. It concerns language requirements, medical competence, relative support, and the development of Äldreomsorgslyftet.
At the same time, we are improving the economic conditions for municipalities and regions by having increased the general state grants by 16 billion, which will remain even in 2025 and onwards. We have repeatedly developed Äldreomsorgslyftet so that more will benefit and to get more bang for the buck, which we see that we really do get.
We have focused on the managers in the first line so that they can attend leadership training, because we see that leadership is essential for increasing the quality within an operation.
When it comes to welfare crime, we have recently really joined forces to clear out unserious actors from the welfare sector, one by one, in order to safeguard the freedom of choice for both the elderly and the staff.
Nadja Awad (V)
Madam Speaker! This debate concerns quality deficiencies within the profit-driven private elderly care. I and Minister Anna Tenje have had several other debates about municipal elderly care and about elderly care in general, regardless of whether it is private or municipal. In those instances, I have been very clear with my criticism of the government's austerity policy, where, in stages, millionaires and billionaires have been prioritized through tax cuts and RUT and ROT grants before a well-funded welfare system.
But this debate, as said, is about private, profit-driven elderly care, and here the study from the University of Gothenburg and Kommunals' reports show that the quality of the staff's working conditions and work environment as well as the users' satisfaction is lower in private, profit-driven elderly care compared to elderly care performed by non-profit organizations and foundations or by municipalities.
I can agree that it is important to be able to choose the provider, but that does not mean we should allow staff and the elderly to be exploited for profit maximization. Keep the idea-driven organizations and foundations within elderly care! Remove the profit-driven actors because they deliver poorer quality! But that is what the minister and the government do not want to do. It is this decisiveness and prioritization that I and Vänsterpartiet lack. This is extremely concerning.
Statsrådet Anna Tenje (M)
Madam Speaker! I believe in the individual. I believe in the employee and in the elderly. Regardless of age, one wants to choose for oneself. One wants to choose an employer. One wants to choose a residence. Precisely for that reason, we safeguard the freedom of choice and choose to actively hunt down the unserious actors and those who engage in welfare crime.
I do not focus exclusively on the private, the municipal, or the non-profit sector, because I do not tolerate neglect anywhere. For me, the form of operation is secondary. It is the quality and what the elderly, the relatives, and the employees say that is what is important.
I am the first to say that if the operations do not meet the standard, they must be purged from this sector, regardless of whether they are municipal, non-profit, or independent. I believe this is very important, especially when we see that welfare crime has made its way into the state, regional, municipal, and private spheres.
For me, it is not about whether something is private or municipal, but for me, it is about quality and safeguarding freedom of choice. Above all, the quality must be as high as possible.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.