Response to interpellations 2024/25:510 and 524 on measures to promote 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 measures to promote elderly care. M argues that the municipalities have a far-reaching responsibility and that the economy is strengthened through growth and the work principle 1. M prioritizes the work environment, skills supply, and welfare technology 1, emphasizes municipal self-government 2 and wants to lower sickness absence rates by strengthening leadership 3. S argues that the government does not take sufficient responsibility for economic challenges 4, that the municipalities lack economic conditions 5 and that the state must take greater responsibility for an equal elderly care 4. S wants a national elderly care law 5 and higher staffing 5 6. V argues that the quality is the worst in ten years 7 8 and demands national staffing guidelines 7 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.
Statsrådet Anna Tenje (M)
Madam Speaker! Mikael Dahlqvist has asked me whether the government will guarantee that the municipalities receive increased state grants to manage elderly care in the future and in what way I and the government intend to improve the working conditions for staff within elderly care. Mikael Dahlqvist has also asked me how I and the government intend to ensure that all elderly people in the entire country receive equal and high-quality elderly care in all the country's municipalities.
Nadja Awad has asked me if I intend to take any initiatives to improve the working environment within elderly care.
Madam Speaker! In Sweden, we have a system of local self-government. Elderly care is 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 revenues. 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' finances and the conditions to finance elderly care in the long term, increased growth and a re-established work line are therefore of great importance.
The Government has a high level of ambition for the work environment policy. Everyone, both women and men, shall have the strength, ability, and desire to work throughout an entire working life. The Government has tasked a special investigator to produce proposals for a new work environment strategy for the years 2026–2030 (dir. 2024:56). The assignment shall be reported by June 11, 2025, at the latest.
The work environment is an important part of strengthening the competence supply in elderly care. According to the work environment legislation, it is the employer who has the responsibility for the work environment. It follows from the Work Environment Act (1977:1160) that the employer shall take all measures necessary to prevent the employee from being exposed to ill health or accidents, as well as systematically plan, lead, and control the operations in a way that leads to the work environment meeting the prescribed requirements for a good work environment.
The Swedish labor market model implies that employer and employee organizations sign collective agreements on wages, working hours, and other employment conditions, as well as cooperate on the work environment. The municipalities are responsible for taking measures to ensure the supply of personnel and skills. The economy of the municipal sector as a whole is expected to strengthen during 2025, compared to the last two years, as a result of the successful fight against inflation. The Government is also implementing measures to reduce sick leave and strengthen rehabilitation, which is significant for the skill supply in elderly care, where reports show high sickness rates.
Elderly care is a priority issue for the government, which has also taken several measures to strengthen the quality of care. The municipalities also continue to receive state grants specifically for elderly care, partly the sector grant which the municipalities can use freely to ensure good care and nursing for elderly people and which can also be used for measures that improve the staff's working environment, and partly the Elderly Care Boost (Äldreomsorgslyftet) which has been extended until 2026.
In the budget bill for 2025, several proposals are submitted to strengthen Swedish elderly care, for example, a fixed care contact in assisted living, 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, to making it more attractive to work in elderly care, and to the work being organized more efficiently. For 2025, the government expands the Elderly Care Initiative to strengthen competence in the Swedish language within elderly care.
Early in the term, the Government appointed several inquiries to strengthen both medical competence in municipal health and medical care as well as knowledge of the Swedish language in elderly care. The reports are being prepared in the usual order in the Government Offices. Another important aspect of elderly care is leadership, which can affect the organization and quality of elderly care, and the Government assesses that leadership has a great significance for the working environment in elderly care. The Government also assesses it to be important that managers take part in the opportunities to increase competence that exist within the framework of Äldreomsorgslyftet.
In addition to this, there is the supply of personnel and competence, which obviously cannot be solved simply by more hands in healthcare. There, supplementation must occur with the help of welfare technology. Furthermore, there is the new important Social Services Act, which will complement and improve the quality.
Mikael Dahlqvist (S)
Madam Speaker! I thank the Minister for the answer.
During the pandemic, all parties spoke about elderly care and healthcare. We discovered major deficiencies, and we saw the cracks in our welfare. All parties promised the moon and the stars. Now, the problems in elderly care were to be taken care of.
I wrote the interpellation, Madam Speaker, to demonstrate that the cracks remain, that there is an economic challenge, and that we must take a serious grip on elderly care moving forward.
I am a bit concerned about the picture the government conveys in its response. Despite all the fine words about ambitions, work lines, and welfare technology, the reality of elderly care is still missing from the response.
The Minister refers time and again to the municipalities' responsibility, but the reality is such that more and more municipalities are now sounding the alarm that they cannot fully manage the task. It is not strange. We face, among other things, a demographic development which means that the proportion of people over 80 years of age will increase by 50 percent by 2035. There will be enormous needs that require more than municipal self-government to manage to meet.
Madam Speaker! The Government also highlights the work environment policy and emphasizes that they prioritize elderly care. On paper, it sounds like powerful promises. But when compared with reality, several questions arise.
The government promises high ambition in the work environment policy and has conducted an investigation and produced a new strategy for 2026–2030. But concrete measures to improve the work environment based on today's situation are missing.
Despite the high ambitions, it can be read in, for example, Kommunals' member survey that every third employee in elderly care is considering leaving the profession due to unsustainable working conditions such as stress, low staffing levels, and low wages. This indicates a discrepancy between rhetoric and practical measures. It is therefore not about a lack of ambition or will among the staff, but a lack of political responsibility from above.
Madam Speaker! The Minister also brings up Äldreomsorgslyftet, which is an important initiative that we Social Democrats were involved in introducing. But that it is being used as a main argument is worrying. It is a temporary educational initiative that is neither permanent nor sufficient to meet the future enormous need for competence.
Madam Speaker! When I ask how the government intends to secure an equal and safe elderly care, I am told that it is the municipalities' responsibility. When I ask about the working conditions for the staff, I am told again that it is the municipalities' responsibility. When I ask about the financing, the answer is that economic growth is important.
The government must stop shifting the blame. We Social Democrats believe that the state must take greater responsibility for safer and more equal elderly care throughout our country. For that, both resources and governance are required. It is about security for our elderly and respect for those who go to work in care every day.
Nadja Awad (V)
Madam Speaker! Thank you, Minister, for the answer!
Madam Speaker, please excuse my lack of decorum. This government seems to think that one should watch one's tongue when one does not at all share their policies or ideologies, and we in Vänsterpartiet share neither their policies nor their ideologies. They involve prioritizing tax cuts for millionaires and billionaires over the nursing assistant and the single mother of two, Sandra Gunnarsson, 39, in Malung. She works full-time in elderly care but is forced to hunt for food on sale. She skips meals to make it through the month and worries about getting sick or needing to stay home with her children. Then the budget breaks.
The government prioritizes grants for kitchen tiling and cleaning assistance for billions and again billions of kronor before Roland Bergendal, who is now unfortunately dead. But according to his son Niklas, he could have lived for ten more years if he had received the companionship and care that a senior housing facility can provide.
The government's ministers gave themselves tax cuts of several thousand kronor every month instead of supporting the nursing assistant Anna Brandenberg. She has worked in home care for 20 years but has completely destroyed her body. She works when no one else is working and has extremely rarely celebrated a whole long weekend with her children or had a coffee break at work.
How can the government treat welfare workers in this way? How can the government treat the elderly in this way? These poor priorities are completely unacceptable, Madam Speaker. The policy must prioritize differently and take greater responsibility for elderly care.
Digitalization and efficiency, as the Minister for Health and Social Affairs has mentioned here, will not succeed in creating the revolutionary change required within elderly care. Will digitalization and efficiency improve the working environment and working conditions for the staff and provide good care and treatment for the elderly? Will those solutions lead to being able to hire the 130,000 people needed by 2033, according to Sveriges Kommuner och Regioner, SKR?
Madam Speaker! They will not do that. Therefore, I want to ask Minister for Pensions Anna Tenje: Will digitalization and streamlining give Sandra better working conditions? Would it have given Roland the care and attention he needed? Will it give Anna the coffee break that she has never had?
Statsrådet Anna Tenje (M)
Madam Speaker! During the pandemic, everyone talked about elderly care. Sometimes it feels like I am the only one left. I am truly passionate about Swedish elderly care. It is about improving the working environment so that the professions become more attractive and more people apply for them, given the competence shortage we see. But it is also about strengthening the quality from several different aspects, not least those that emerged in the Corona Commission's report and Ivos' various reviews.
I was pleased when these two interpellations were submitted to me. I am always pleased when I get the opportunity to come here to the chamber and discuss elderly care. However, it does not happen particularly often. I also do not get to come to the committee particularly often to tell what the government is doing regarding elderly care – unfortunately, I say. We have, in fact, very much to tell.
I thought that this would give me an opportunity to talk about the important investigation regarding the language requirements within elderly care that is currently being prepared. The previous government chose to do precisely nothing, despite knowing how large the problems with language barriers within elderly care were.
I thought that this would give me an opportunity to talk about the investigation on reinforced medical competence that I have just received on my desk. We need to close the gaps between municipality and region and ensure that elderly people who live in a special housing facility or for that matter take part in home care can receive the medical competence that the Corona Commission clearly pointed out as one of the biggest deficiencies in Swedish elderly care.
I thought that I might have the opportunity to speak about the new dementia strategy that we have now presented to improve the quality of dementia care. We shall ensure that it is not the zip code that determines what diagnosis one can receive at all, or for that matter, whether one can receive good and equal care.
I thought we could talk about the new Social Services Act, which in many different ways will focus on strengthening the knowledge-based management of elderly care and ensuring that it is research and proven experience that should strengthen elderly care.
We could also perhaps talk about the new proposals regarding a fixed care contact, not only in home care but also in special housing, which I have now presented. We know that it strengthens the quality incredibly much for the most vulnerable.
Madam Speaker! For that part, we could talk about permanent relative contact, which we have also put forward in the budget, because we know that 20 percent of all Swedes are some form of relative caregiver. Furthermore, a quarter of them unfortunately become ill themselves because the support for them is so poor. Ever since we wrote our Tidö Agreement, it has been an important part that relative care in Sweden must become much better.
We could also talk about welfare technology. I have just come from a press conference this afternoon where we showed that we will get new tools and new legal support if we choose to proceed with the proposals submitted by the investigation. Not only those with somatic illnesses should be able to take part in welfare technology, but also people with cognitive impairment. We know, after all, that welfare technology can improve quality and increase safety, but above all increase freedom for our elderly, so that one can retain their self-determination and their integrity. It can also strengthen and improve the working environment for those who work within elderly care and complement the employees' important work.
But instead, we ended up in a discussion about tax. I regret this, because elderly care deserves more space.
Mikael Dahlqvist (S)
Madam Speaker! I thank Anna Tenje for the answer.
The Minister says that she feels alone in speaking about elderly care in our country. I shall provide some explanations. I personally think that the government and the Minister should be given time to demonstrate decisiveness. Now, more than two years of the mandate period have passed. That the Minister is not called to the Committee on Social Affairs to the extent she wishes perhaps depends on the fact that we do not see any sharp reforms from the Minister's side.
It is interesting, Madam Speaker, that the Minister, in his response both in writing and orally, refers to most of the reforms that the Social Democratic government was involved in developing: protected professional title – the Social Democrats together with the coalition parties, Äldreomsorgslyftet – the Social Democrats together with the coalition parties, fast care contact – the Social Democrats together with the coalition parties.
Madam Speaker! It is clear that there is a lack of reforms and a lack of action. But the most important question remains here today: the economic conditions for elderly care here and now. Already today, the municipalities are on their knees and are struggling to fulfill their mandate. When I meet municipal representatives, I am often told that it is extremely difficult to make the money last.
The second major problem is the competence shortage. Work within elderly care and care in general does not constitute high-status jobs. Many use it as a transitional job. Many lack adequate education. Many are people with a foreign background. I can agree with the Minister that the language is a challenge. But in order to be able to provide reasonable working conditions, reasonable wage conditions and so on, it is required that the municipality as an employer has good economic conditions.
I agree with the Minister on one thing: Money does not solve all the challenges we see now and in the future within elderly care. But a baseline was needed to manage to provide dignified conditions. If we get staff who increase their competence, get better conditions and feel that the status of the profession increases, it will naturally also benefit the residents. We will then automatically get higher quality.
My question to the Minister is whether she herself is satisfied with how elderly care looks in the country today. More and more reports are coming in about irregularities: that one is alone at night as staff, that one does not get to go out enough in home care, and other forms of neglect. That was why we Social Democrats proposed a national elderly care act. It was primarily because we wanted to ensure a quality regardless of where one lives in the country. Just as the Minister herself said, it is a postcode lottery. What conditions one receives depends on which municipality one ends up in.
Madam Speaker! When it comes to the basic foundation and the economy, I remain interested in the Minister's answer, as it is the basis for being able to develop elderly care here and now.
Nadja Awad (V)
Madam Speaker! I repeat myself in order to be able to correct some factual errors. I have attended two budget debates on elderly care. Minister for Health and Social Affairs Anna Tenje was not present at either of those debates. I have called the Minister for Health and Social Affairs to the committee twice to talk about elderly care. No other member in the committee has done so. I have had interpellation debates with the Minister for Health and Social Affairs. We have even been in the same panel discussion about elderly care. We have, therefore, pointed out the shortcomings in elderly care during this parliamentary term in various debates, in the committee, in written questions, in panel discussions, and so on.
But nothing that happens in this area makes elderly care better. The National Board of Health and Welfare notes in its latest situation report that the quality of elderly care is the worst in ten years. Obviously, something very terrible has happened with elderly care. The National Board of Health and Welfare also notes in its latest report on staff in elderly care that there is currently an imbalance between work requirements and resources. That is why the Left Party brings up taxes. The government prioritizes tax cuts for millionaires and billionaires over resources for the municipalities' elderly care.
Today, the poor working environment within elderly care has a direct impact on the staff's health and the quality of the care and treatment provided to the elderly. Assistant nurses are on sick leave more than any other professional group. Staff are fleeing from elderly care, and the workplace is not directly attractive for new staff. The health of the elderly is jeopardized, and when the care and treatment fail or are not available, it falls on the relatives to take an increased responsibility. It is a fact that women are overrepresented both among the staff and among those who take a large responsibility for elderly family members. An expanded and functioning elderly care is therefore also a prerequisite for an equal society.
All this requires political accountability and funding, Madam Speaker. It creates the transformative change that elderly care needs to meet today's and future challenges.
This is nothing new – the Minister for Elderly Care has heard it before: Vänsterpartiet thinks that we need to introduce national staffing guidelines. Full-time and permanent employment shall be offered. The number of employees per manager needs to decrease. People need to be given the opportunity for recovery through reduced working hours with maintained salary and be offered professional and competence development. 100 percent of the staff shall be professionally trained within health and care or be undergoing training. Split shifts with a long unpaid gap in the middle of the day and stress-inducing minute-management within home care are obsolete and must be removed.
This would improve both the working environment and the supply of personnel and skills. But it requires associated funding. Does the government want to take increased funding responsibility towards the municipalities? Does the government want to take greater responsibility and introduce national staffing guidelines? Does the government want to invest in elderly care for real? These are my remaining questions to the Minister.
Statsrådet Anna Tenje (M)
Madam Speaker! Let me begin by pointing out that no shadow should fall on either Member Awad or Member Dahlqvist. We are here tonight to discuss elderly care specifically. It is also very true that I have been in the committee on two occasions thanks to Member Awad inviting me. No shadow should fall on these committee members. I can only state that initially in this discussion it did not feel like we were going to discuss elderly care. Now we seem to be back on track, and I am very happy about that.
Let us then discuss the high rates of sick leave within the public sector, which on one side of my portfolio concern me very much, and how we shall improve the working environment within elderly care.
It is exactly as the members have pointed out. The National Board of Health and Welfare recently issued a report that is a situational description. In it, a description was made of what the current situation is for the working environment within elderly care. It is noted that it looks the same now as it did 20 years ago. That can make me very provoked.
It matters completely regardless of what colors the different governments have had in between, or for that matter what impact the municipal and regional governments have had on that part. I leave that there. I can only state that it is provoking that we have let things proceed for 20 years, and that we have nevertheless let it remain as it is.
I do not think we can do that. That is exactly why I was very quick to invite regional and municipal representatives and also SKR to discuss the situation with high sickness absence rates within the public sector and to point out the importance of the fact that it is now time for us to do something.
We have a substantial battery in the budget for 2025 with various measures for return to work. It concerns the employer's obligation to de facto establish an action plan when one has someone who risks being away for longer than 30 days.
Given that our municipalities and regions, SKR, are the largest employers for many of the women who are currently on sick leave, this was a most pressing issue to address and discuss with them.
There we have now gotten properly started. Now it is a matter of us putting on the political leadership jersey and asking in committees and boards: Is this how we are going to have it with the high rates of sick leave?
It is a matter of not only having the goal of lowering sickness absence rates but also de facto linking a proper action plan to those goals so that we can move the needle.
Madam Speaker! I am extremely eager to improve the working environment, not least for the employees in elderly care and for many hard-working women within the public sector.
It is important that we create good conditions so that more people can manage and want to work longer. It is important from a pension perspective but also important from a skills supply perspective for elderly care.
It is important that more people can move from part-time to full-time and can live on their wages. It is important that more people can move from part-time to full-time, so that we get more hours worked. That is where leadership is incredibly important. I specifically mentioned in my opening statement that we have opened for Äldreomsorgslyftet precisely to secure and strengthen leadership.
In the current situation, a unit manager or a middle manager within elderly care has 48 employees under them whom they must help, support, and develop, while simultaneously running an operation of good quality. It goes without saying that it becomes very tough if one hasn't even had a full leadership education in their luggage.
We are working feverishly here to strengthen elderly care, including regarding the work environment. It is not just about qualitative measures to raise the quality.
Mikael Dahlqvist (S)
Madam Speaker! Thank you, Minister, for the answer!
There is an expression: When everything is everyone's responsibility, it eventually becomes no one's. That is exactly what I experience when I listen to the Minister and read the interpellation response.
When it comes to the economic development for the municipalities, we must first and foremost ensure that we achieve growth. In that way, we can give the municipalities the opportunity to obtain more resources. When it comes to quality and equality in the country, it is municipal self-government. When it comes to the challenge of competence supply, it is also an employer's responsibility.
Madam Speaker! At its core, the Minister is correct. It is the municipalities that are the employers for elderly care. But there is nevertheless an equally large, if not even greater, responsibility for us who represent the state level to provide the conditions for the employers, that is, primarily the municipalities and the private providers.
The Minister spoke in his latest speech almost the entire time about sick leaves, which is a huge problem. One of the reasons why we have high sick leave rates within elderly care is that the staff have schedules that are far too tight.
The staff do not have sufficient opportunity for rest and are understaffed and stressed. Therefore, a higher staffing level on the schedule is required to achieve a better schedule, more employees and more recovery. Then a good portion of the high sick leave numbers will decrease.
But that is what this entire debate has been about. Then we must ensure that the municipalities receive more money. With that, I would like to thank you for the debate.
Nadja Awad (V)
Madam Speaker! Thank you, Minister, for this debate!
As I have noted before, it has been shown by the Socialstyrelsen's latest situation report that the quality of elderly care is the worst in ten years. It is a result of cuts in elderly care across the entire country.
I have been very clear about what I believe has been wrong in the government's priorities regarding tax cuts, the increase in the ministers' own salaries, and providing subsidies for tiling in the kitchen and cleaning help for the wealthy.
Digitalization and efficiency will not give Sandra better working conditions. Nor will it provide the care that Roland would have needed or the coffee break that Anna would so gladly want to have.
It requires political responsibility to create a new norm within elderly care. It is about the right to full-time and permanent employment, better wage conditions, and other important changes to the working conditions.
It would improve the working environment and cause the supply of staff and skills to increase. But it requires an increased financing responsibility from the state level. The municipalities' municipal tax is not enough.
It applies especially to the smaller municipalities in the sparsely populated areas and in the countryside. They do not get the tax revenues to suffice. They simply cannot manage.
That is why this debate was very necessary. It was nevertheless stated from the side of the government that the government does not intend to take an increased financing responsibility towards the municipalities, or create a new norming within elderly care with national staffing guidelines.
This debate was very clear. It distinguishes how things look with a bourgeois government and how they would have looked with a left-wing government. There, the differences are enormous. Thank you for the debate!
Statsrådet Anna Tenje (M)
Madam Speaker! I want to begin by establishing that elderly care is the responsibility of the municipalities. It is a part of the local self-government and the competence that the municipalities have.
I truly do not want either Vänsterpartiet or Socialdemokraterna to abolish the Swedish model or municipal self-government. The interpellants must nevertheless accept that the state in all its parts cannot intervene and micro-manage the municipalities.
This is part of their competence and their local self-government. So I think we should have it. But that being said, the government or the state are in no way helpless and can strengthen the different parts.
I have been very clear that we can now, point by point, almost like on a checklist following the Corona Commission's rather far-reaching criticism, check off area after area where there have previously been major deficiencies within elderly care. We can now, point by point, rectify just those deficiencies and improve the quality within elderly care.
When it comes to the working environment specifically, I see that we have a common great interest from municipalities and regions and from the state's side. This applies in particular from my own side, given that it is important to reduce the sickness absence rates.
In this way, we can get more hours worked and get more, often women, to be able to move from part-time to full-time so that they can stand on their own feet and support themselves. It is primarily about contributing to the skill supply to an even greater extent, given that one works full-time.
These questions are very close to my heart. I am once again very pleased that the questions have been raised in the chamber again, and I look forward to more debates. It is very beneficial. Many thanks!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.