Response to interpellation 2024/25:694 on the working environment in home care services
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 M considers elderly care to be a priority issue where municipal self-government is central 1. M argues that the employer has the primary responsibility for the work environment and that the government supports the municipalities through sector grants, Äldreomsorgslyftet, and increased appropriations to Arbetsmiljöverket 1. M emphasizes the importance of leadership, protected professional titles for nursing assistants, and language requirements 1 2. M admits that managers have too many employees under them and that work environment deficiencies have persisted for 20 years 2 3. M argues that a larger investment is needed within municipal elderly care and leadership training for managers 3. M argues that they have taken many measures to strengthen elderly care and reduce sick leave 4. 5 V argues that the staff is being worn out by minute management and chronic understaffing 5 6. 6 V demands national staffing guidelines and more resources for the municipalities 6. 7 V considers that the staff is becoming sicker, more worn out, and poorer under the government's rule 7.
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)
Mr. Speaker! What a pleasant start to the morning! It is not only beautiful weather, but we also get the opportunity to discuss such important issues as Swedish elderly care and home care. Nadja Awad has, in fact, asked me if I intend to take any initiatives to address the deficiencies in home care and attract more people to the profession.
It is pleasing that Nadja Awad is engaged and returns with questions regarding the supply of competence in elderly care. As I have stated previously in answers to interpellations from Nadja Awad, we in Sweden have a system of municipal self-government, and elderly care falls within the municipal area of responsibility.
Furthermore, Mr. Speaker, there are provisions in the Social Services Act (2001:453) that interventions shall be of good quality and that there shall be staff with appropriate education and experience when tasks within social services are performed. The quality of the operations shall also be systematically and continuously developed and secured.
It also follows from the Work Environment Act (1977:1160) that the employer shall, among other things, systematically plan, lead, and control the operations in a way that leads to the prescribed requirements for a good work environment being met. According to the work environment legislation, it is the employer who has the primary responsibility for the work environment. The employer cooperates with the employees regarding the work environment, for example through the safety representatives' activities.
Taking measures regarding deficiencies in staffing and competence is thus a municipal matter in the first instance. Ensuring the supply of competence involves, among other things, improved working conditions, competence-enhancing initiatives, and organizational changes to retain and recruit staff within elderly care. The Government is aware that there is a challenging situation for the municipalities and therefore supports the municipalities with several different initiatives that contribute to strengthening both competence and the work environment.
The Government has a high level of ambition for the work environment policy to meet various challenges in working life. In the budget bill for 2025, the Government proposes an increase in the Swedish Work Environment Authority's (Arbetsmiljöverket) appropriation, which is then scaled up further during 2026 and increased permanently from 2027 onwards. The Government has also tasked a special investigator with producing a proposal for a new work environment strategy for the years 2026–2030 (dir. 2024:56). The assignment has recently been presented, and the matter is currently being prepared in the Government Offices.
Elderly care is, Mr. Speaker, a priority issue for the government. The government supports elderly care, among other things, through the so-called sector grant, which the municipalities can utilize based on their own conditions and needs, for example for interventions that improve the working environment. To strengthen competence in elderly care, the government has extended the Elderly Care Boost (Äldreomsorgslyftet) until 2026 and developed the initiative so that the funds can be utilized in a better way and more can benefit from the funds.
The government is also implementing measures to reduce sick leave and strengthen rehabilitation, which is significant not least for elderly care, where reports indicate high sickness rates.
Language skills are another important part for the quality of care and the staff's working environment to improve. The Government therefore previously during the term commissioned an investigator to analyze and produce proposals on how a language requirement in elderly care can be regulated. The investigation has now submitted its report A language requirement for language development (SOU 2024:78) and proposes, among other things, that a language requirement be introduced in the Social Services Act together with educational initiatives to raise the language level. The proposals have been referred for consultation and are currently being prepared in the Government Offices.
Mr. Speaker! Another important aspect of elderly care is leadership. It is of great importance for the work environment and can affect the organization and quality of elderly care. The Government therefore wants to emphasize that it is important that managers take advantage of the opportunities that now exist to increase competence, not least within the framework of Äldreomsorglyftet.
Nadja Awad (V)
Mr. Speaker! Thank you, Minister for Pensions Anna Tenje, for the answer and yet another debate on elderly care! It is very much appreciated that we can agree on our commitment to these issues.
Mr. Speaker! On July 1, Prime Minister Ulf Kristersson's salary will be raised to 204,000 kronor per month. The other ministers' salaries, including elderly minister Anna Tenje's salary, will be raised to 161,000 kronor per month. Nice that someone gets a proper salary increase in these times! Others, however, must settle for increased interest rates, rents, and food prices – not least nursing assistants within elderly care. This is the prioritization the government makes with the state's tax revenues.
At the same time, the staff within elderly care have the highest proportion of sick leaves in the entire Swedish labor market due to a very poor working environment. The sickness absence among home care staff is twice as high as in other industries. Still, the government and Minister for Health and Social Affairs Anna Tenje say in their response here that elderly care is a priority issue for them. But now, just when this government together with Sverigedemokraterna has power over Sweden, the elderly care staff are being worn down more than ever. The government must protect those who are to care for us, Mr. Speaker.
The staff have lived for too long with having to run faster due to minute schedules and because there is a lack of staff within the home care service. This leads to them not having the energy to work full-time even if they are offered such a position.
Karin Wiktorsson, an employee at the home care service in Bräcke, writes in a blog post on Kommunals website that during a visit to a home care group on one of the summer's hottest days, she sees some of the staff drinking rehydration solution that the manager has very kindly purchased. Some, however, do not want any. When she asks why, she is told that they do not want to drink it because it will make them need to urinate. The schedules are so packed that there is hardly any time to go to the toilet if one were to need it anyway.
Staff are forced to endure during their visits and avoid drinking to avoid time-consuming toilet visits and can almost never take their full legal lunch break. Due to all this stress, staff suffer from heart problems, including heart attacks. There is chronic understaffing with packed schedules within the home care service.
It does not sound like this is a prioritized issue for the government, Mr. Speaker. But the salary increases for the Prime Minister and the other ministers were a priority. To give tax cuts worth billions of kronor in stages and to raise the levels for lyx-rot and lyx-rut by billions of kronor, which primarily benefits the wealthiest in Sweden – millionaires and billionaires – have also been priorities for this government.
Now, Arbetsmiljöverket will inspect over 700 workplaces within home care as part of its latest work environment survey. Vänsterpartiet warmly welcomes that inspection.
We hope that the government can take system-changing measures to improve the working environment within home care and thereby also ensure that the elderly and users receive dignified care and support.
My question is: Are the Minister for Older People and the government prepared to provide the resources needed and implement national staffing guidelines so that municipalities can stop the minute-management and increase the staffing levels within home care?
Statsrådet Anna Tenje (M)
Mr. Speaker! In my previous interpellation debates with Nadja Awad, I have raised many of the initiatives the government is making within elderly care, both regarding assisted living and regarding home care services. For example, the protected professional title for nursing assistants to increase the attractiveness of the profession and strengthen the competence in this important profession is an important piece of the puzzle in getting more people to want to stay in the profession and also to attract more. It is, in many ways, precisely about the competence supply and about the shortage of competent labor.
Since the government introduced the possibility of a protected professional title on July 1, 2023, 127,000 nursing assistants have received their professional title. This is an important step, and it is something that needs to be highlighted. More municipalities need to work actively with this. One should feel both pride and that what one does is important. That is achieved, but the fact that one can also show it off tends to make more people want to apply for these professions.
Nadja Awad mentions the minute management, which is a time planning tool. This also falls within the municipal area of responsibility. The Government can neither nor should interfere if a municipality chooses to do something in a certain way to plan its operations.
However, I can state that I have made many study visits to different municipalities. Some of them have chosen to use this time planning tool, while others have chosen not to do so anymore. I have met many municipalities where it is argued that it works perfectly well to use the time planning tool, but also several that testify that it does not work at all. In some municipalities where they have chosen not to use it, it works perfectly, while some municipalities have major problems in any case.
I can see that this boils down to something I have already touched upon, namely leadership. When one uses a tool in home care that one is in agreement on and has a leadership that is strong – an inclusive leadership that sees and confirms the employees and where the employees are allowed to be involved in discussions about how to plan, whether it concerns care planning or scheduling – it works perfectly. It has nothing to do with whether one has a time planning tool that involves minute-by-minute management or some other system that is trust-based, it is about the leadership. Investing in this therefore becomes one of the most important tasks for Sweden's municipalities moving forward.
I also do not at all share the view expressed by the member that the deficiency in elderly care is something that has emerged now. The report that Socialstyrelsen recently presented actually shows exactly the opposite, and that is something I can only regret.
The National Board of Health and Welfare shows in its report on the deficiencies in the working environment that it is about the same deficiencies in the working environment that we saw 20 years ago. We can only state that this is a major failure and that we have not, at either municipal, regional or state level, succeeded in improving the working conditions within elderly care during these 20 years. This is a lesson that we have had to learn for many years. There is much to do in this area, and I will gladly return to it in the next post.
Nadja Awad (V)
Mr. Speaker! I would like to pick up where the Minister for Health and Social Affairs left off. The Minister says that we are now seeing the same deficiencies in elderly care as we have seen during the last 20 years. The Corona Commission has also stated that no change has occurred since the pandemic. The Government and the Minister for Health and Social Affairs say that elderly care is a priority issue for the Government.
But why do we have the most sick-leaved and most absent staff within just elderly care, if elderly care is such an important and prioritized issue for this government? I cannot make that equation work. I believe those listening to the debate cannot make that equation work either, and neither can those who work within Swedish elderly care. That is also why we have repeatedly called the minister to the Committee on Health and Welfare to account for how the government will ward off the deficiencies that we see within Swedish elderly care.
Often the Minister for Health and Social Affairs refers to Äldreomsorgslyftet. That is welcome. But nursing assistants and healthcare assistants are being laid off today due to savings. There are such figures. These are savings that are a result of too little state funding being provided by the government to both smaller and larger municipalities.
It is important to educate and further train the elderly care staff so that we achieve a solid supply of competence for the challenges we see for the future. But we in Vänsterpartiet also want to see that they also get to keep their jobs and that there are even more of them within elderly care. How is this going to be possible when the state and the government do not provide sufficient resources to the municipalities so that they can keep their elderly care staff and hire more?
I am not saying that it is solely the government's task to abolish the minute-based schedules, but I want to emphasize that it is precisely these schedules that safety representatives across the country have described as a clear villain in the workplace environment problem. It is also something that Arbetsmiljöverket is specifically to look at in its review.
I just want to get an answer to my question. In light of the audit's conclusions, is the government, from its statutory area of responsibility, prepared to do what is required to ensure that municipalities can remove the minute-based schedules so that staff get a better working environment and thus also want to stay or can be lured back to elderly care?
The Minister for Health and Social Affairs also mentions how important leadership is. That is also why I highlight the importance of national staffing guidelines, where the government issues a clear staffing norm for elderly care regarding the number of employees under each manager.
There are far too many employees under each manager today. The employees do not have time to meet their manager, and the manager does not have time to meet their employees. In what way can one be able to solve important work environment problems if there are far too many employees under each manager? This is something that trade unions have pointed out repeatedly, and we have also discussed it in debates and in the committee when the minister has been there. It is therefore why I emphasize the importance of national staffing guidelines from the government. How does the senior minister Anna Tenje view this?
Statsrådet Anna Tenje (M)
Mr. Speaker! I shall begin where the member left off.
I completely share the view that first-line managers within elderly care have far too many employees under them. This is also something that appears in the report that Socialstyrelsen has prepared. In the report, it is shown that first-line managers have an average of 48 employees. That is twice as many as the average in the labor market. Here, the conditions for the managers need to become significantly better so that they get the opportunity to develop, lead, and support their staff. A major change needs to take place here.
I am not entirely sure that it will solve the problem if one regulates this in exact figures, but I believe that a much larger effort needs to take place. A larger investment is needed within municipal elderly care, and not least, one needs to invest in leadership training for first-line managers, but also for other parts.
I usually liken elderly care to the school system, where there is extensive training for principals, assistant principals, and so on – leaders within the school world. I do not believe that any of us would want to remove the important principal training, precisely because so much is required within a complicated organization.
But corresponding education does not exist within elderly care. I think this is something that we really should consider, because the situation that one has as a first-line manager or as a leader within elderly care today is not sustainable. It is also clearly shown by the figures we receive from Försäkringskassan regarding sick leaves within the public sector, especially within female-dominated occupations, where the sick leaves are significantly more numerous than they are in other areas. It is not sustainable.
If we were to tackle the sick leaves and create a better work environment and better support and backing for the employees from the manager's side, we would not have the same competence shortage within elderly care. If more people are able to move from part-time to full-time or, for that matter, return from a sick leave, the competence supply issue is no longer so great. It would also increase the attractiveness so that more people want to seek out these important professions.
When I received the report from Socialstyrelsen and the figures from Försäkringskassan regarding sick leaves within the public sector, I therefore called upon SKR, Sveriges Kommuner och Regioner. They are the largest employers and those who have the vast majority of these employees under them.
I called the chair. But I also chose to invite leading representatives for the regions who sit on the personnel committees from the political side and also leading municipalities – precisely to discuss the importance of that it is now high time that we take on the leadership role, completely regardless of political party, to truly tackle the work environment issues within Swedish elderly care with also the Swedish public sector, which stands out significantly when it comes to the sick leaves.
That is what I did, and it is a task that I will continue with. The measures we take will collectively lead to an improvement of the working environment.
We spoke about protected professional titles. We spoke about the great advantages of Äldreomsorgslyftet when it comes to investing in the competence supply. The municipalities themselves have an enormous responsibility to educate their staff but also to ensure that it pays off to be educated – to choose to undergo a training – and that one can then build a career within these important professions so that one sees a broad future.
We are investing in language requirements to improve the working environment. We have increased medical competence so that one can work more across professions and receive help and support in making good assessments. We are investing in support for relatives. But above all, we are passionate about improving the working environment within these important professions.
Nadja Awad (V)
Mr. Speaker! I would like to begin by thanking you for the debate and conclude with some reflections from my side.
Under the government's and the Sweden Democrats' rule, we see in black and white that the elderly care staff, especially within home care services, are becoming sicker, more exhausted, and poorer. The experience is that the power – the politicians, those who rule the country – has abandoned them and prioritized something else. That was why I began the debate by pointing out that it becomes a slap in the face to the home care staff, who are sicker and more absent from their workplaces, when the Prime Minister and other ministers receive a pay raise, when the billionaires and millionaires receive a tax cut, and when one receives state subsidies and can use luxury-rotbidrag and luxury-rutbidrag.
I think this prioritization also becomes prominent when we hear from Minister for Health and Social Affairs Anna Tenje about which priorities and investments are being made within home care – at least from the state level. There is no talk about the importance of increasing resources to both smaller and larger municipalities. It is difficult to retain staff. It is difficult to recruit new staff, and it is difficult to train and further educate staff. That is why we have the planning tool regarding minute-management within elderly care. When resources are lacking, one must streamline, and it harms the elderly care staff.
Statsrådet Anna Tenje (M)
Mr. Speaker! Many thanks to Nadja Awad for submitting this interpellation!
I think, as I have said, that this is extremely important. What does, however, make me a bit concerned, Mr. Speaker, is: Despite the fact that we have had several debates here in the chamber regarding elderly care, it does not seem that all the information is really sinking in.
When Nadja Awad claims that I or the government are not investing in elderly care, one almost expects Nadja Awad to come up with other proposals from Vänsterpartiet, which we then choose not to pick up. But one can observe that Nadja Awad has not once, when we have stood in these speaker's chairs ourselves, presented any proposals or said what she lacks from the government's side, which we are not investing in.
At the same time, we can state that we have appointed the language requirements inquiry and that we will come forward with proposals to specifically strengthen the language and tackle the language barriers within elderly care so that the elderly can understand and make themselves understood.
We have the major investigation regarding medical competence. Already last week, we announced that it will now be mandatory for the municipalities to have a MAR, a person medically responsible for rehabilitation, alongside a MAS in order to increase the quality within elderly care and ensure that the elderly do not fall through the cracks but receive the rehabilitation they are entitled to in order to be able to maintain their functions.
We have also made a major investment in relatives to support many of the elderly relatives' caregivers so that they can manage for a bit longer.
At the same time, we have a full battery of issues regarding return to work, reducing sick leaves within elderly care, and ensuring that more people can return to these important professions, move from part-time to full-time, and above all, feel that these are future-proof professions that they want to invest in.
Overall, there are very many measures that strengthen Swedish elderly care in a difficult and challenging time.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.