Swedish Older Persons Welfare System
10 October 2007
Sweden faces a future characterised by a shift in its population age structure. In the years ahead Sweden will face an increase of people who are advanced in age. In 2003, Sweden had a greying population of 8.9 million inhabitants, in which 17.2 per cent were aged 65 years or older and 5.2 per cent had reached the age of 80 years or older. It is estimated that the number of elderly people in Sweden will rise sharply in the decades ahead, particularly of the old persons aged 65-79. This is the population born between 1944-1948 during the post war baby boom. In 2010, the estimated proportion of over 65 will be 18.6 per cent and in 2030, it is likely to be as high as 22.6 per cent. The population increase in Sweden in the twentieth century can largely be attributed to a reduction in mortality at all ages, which raised average life expectancy. In 2004, average life expectancy for women was 82,7 years and for men 78,4 years. This can be compared with the figures of 55 and 53 respectively in 1900.
Due to the fact that greater numbers of elderly people live to an advanced age, many suffer illness, disability and become dependent on help from other people for their daily existence. Increased life expectancy indicates the need for policy not only to provide provisions for old age but also to link it with disability as well as other health needs. As people advance in age their ability to function on their own becomes limited as they gradually suffer from hearing and sight impairment. Furthermore, elderly people become more vulnerable to safety threats such as crime, robbery, rape, assault, and self sustained injuries. Also, they face a number of health problems, such mental health problems, which often results in depression and anxiety, cardio-vascular diseases, Alzheimer's disease, and osteoporosis.
They also need constant supervision and assistance in their daily activities. All of these factors have important implication for the housing structures and policies for the elderly. Housing structures should be accessible, located in safe and central areas and they should be safe in terms of personal accidents.
The Swedish policy for the elderly makes provision for the above-mentioned factors. It provides for the establishment of accessible housing, transport services for the elderly, pensions and allowances care for the elderly, home help service and home nursing, daytime activities and short-term care, and special housing accommodation.
2. National objectives on policy for the elderly
The policy for the elderly aims at enabling older persons to live independently with a high quality of life. Older persons in need of care and social services are entitled to help of high quality. Elderly care is provided in accordance with democratic principles and is mainly financed out of taxation revenue. The Swedish Parliament (Riksdagen) has defined the following objectives for national policy for the elderly:
Older persons shall
· Be able to lead active lives and have influence in society and in issues affecting their daily lives,
· Be able to age with security and with their independence preserved,
Be met with respect and
· Have access to good health and social care services
One of the most important principles of Swedish policy for the elderly
is that society's initiatives are to be framed in such a way that older persons
can continue living in their own homes for as long as possible, even when in
need of extensive care and social services. An accessible society, good
housing, transport services and home help services are examples of important
measures to realise that principle.
3. Swedish welfare system for the elderly
3.1 Housing and accessibility
A great majority of the elderly in Sweden (about 93 per cent) lives in ordinary homes. The housing conditions of older persons do not differ significantly from those of the population generally. Most elderly persons live in modern, centrally heated homes with well-equipped kitchens, hot and cold running water and an indoor toilet. The great majority of older persons live by themselves or with their spouses. Very few live with their children.
Grants for housing adaptation make it possible for persons with functional impairment to undertake the individual adaptations to their homes and immediate vicinity that they need to stay on in their own homes. Common adaptations include removing thresholds and rebuilding bathrooms. In addition, the Parliament (Riksdagen) in May 2000 passed the Government Bill, "From Patient to Citizen, a national action plan for disability policy". The Bill outlines a number of measures to improve access in the society for persons with disabilities. Among other things, it proposes straighter stipulations in the Planning and Building Act on the subject of accessibility and also that public transport is to be made accessible to persons with disabilities by 2010.
3.2 Special housing accommodation
The Swedish Government also makes special housing provisions for elderly persons who require special care. This provision is done at the municipality level. This responsibility was transferred from the county council to municipalities in early 1990s. Municipalities have control of community care, which includes care of the elderly. The emphasis is on home nursing care, with 24 hour provision of home assistance, such as shopping, hygiene and nursing intervention. In 2001, around 7% of these services were provided by the private sector, but paid for mostly by the municipality, with some resident/patient co-payments.
3.3 Transport services
The municipalities offer special transport services to persons that are unable to use public transport because of functional impairment. This service enables persons with functional impairment to travel by taxi or in specially adapted vehicles at prices on the same level as public transport fares.
3.4 Pensions and allowances
In January 1999 a new pension system was launched. The pension system is designed to guarantee elderly a basic measure of economic security. The reformed pension scheme has a number of different components, namely, an income-related pension, a pre-funded pension and a guaranteed pension. A person's income-related pension is based on a person's full lifetime earnings. The pre-funded, or premium pension is the portion of a pension that a person may invest in a fund of his or her own choosing. Persons who have had little or had no earned income are guaranteed basic protection through the guaranteed pension. The guaranteed pension is also payable as a supplement to the income-related pension. The new pension scheme is designed to be viable in the face of demographic change. Pensioners with low incomes can also obtain a state housing supplement for pensioners and special housing supplement. This is a means-tested allowance, which guarantees a reasonable economic standard of living, with provision made for housing costs. The rules for eligibility are determined by the State.
In January 2003, the Maintenance Support for the Elderly Act came into effect, Maintenance Support for the elderly is intended for persons who are 65 years and older, whose basic maintenance needs are not fully covered by other benefits in the national pension system. Most of those entitled to this support are elderly persons who have not lived in Sweden for 40 years and they qualify for a full guarantee pension. This support is an income-tested benefit.
3.5 Pensioners' organisation
Sweden has five nationwide pensioners' organisations and these have local branches in nearly every municipality. The pensioners' organisations are interest organisations for the elderly that, among other things, arrange recreational and educational activities for their members and others. Nearly 50 per cent of the elderly in Sweden belong to these organisations. Also, there are pensioners' councils at national level and in the majority of municipalities and county councils. The councils act as advisory bodies to the Government and the pensioners' organisations are represented in them.
3.6 Home help service and home nursing
Home help service is service and personal care in the home provided by the municipality under the Social Services Act. Service tasks include cleaning and laundry, help with shopping, post office and bank errands and preparation of meals. Personal care also includes assistance with eating and drinking, getting dressed, personal hygiene and moving around. For those in need, municipal security alarms are available, which are usually linked to the nearest special housing, where personnel respond and attend to alarms they receive. In 2004, 9 per cent of persons aged 65 and older were entitled to home help services in ordinary housing. The corresponding figure for those 80 years and older was 20 per cent.
During the 1990s home nursing was provided for persons in need of extensive care and attention. Home nursing means qualified care and highly specialized medical care as well as terminal care for 24 hours. About one third of the persons that receive home help services also receive home nursing care. About half of Sweden's municipalities have taken over responsibility for home nursing from the county councils.
3.7 Daytime activities and short-term care
Daytime activities and short-term care are provided as stipulated by the Social Services Act and/or the Health and Medical Services Act. The support of daytime activities is given in the form of treatment and rehabilitation during daytime for persons suffering from senile dementia, persons with mental functional impairment and persons in need of treatment and rehabilitation. In 2004 approximately 1 per cent of persons aged 65 and older were provided with daytime activities. Short-term care is given in the form of temporary housing, treatment, rehabilitation and care, for purposes of relief and alternate care. In 2004 approximately 1 per cent of persons aged 65 or older received short-term care.
4. The care of the elderly
Responsibility for the care
In Sweden, responsibility for the care of the elderly rests with three authorities acting at different levels, Parliament (Riksdagen) and Government at national level. The two authorities formulate policy goals through legislation and financial control measures. At regional level, the 21 county councils are responsible for the provision of health and medical care. At local level, Sweden's 290 municipalities have a statutory duty to meet the social service and housing needs of the elderly.
Sweden's municipalities and county councils have a high level of autonomy. Activities in caring services are controlled by politicians appointed to policy-making assemblies in municipalities and county councils through general elections. The decentralisation of responsibility for elderly care makes it possible for local and regional conditions to be taken into account when policies for the elderly are formulated. Sweden has national authorities, the National Board of Health and Welfare (focusing on health care issues) and the 21 county administrative boards (focusing on social services issues), which are responsible for supervision, follow-up and evaluation of municipal and county council caring services.
The Elderly Reform (Adelreformen), which came into effect on 1 January 1992, made the municipalities comprehensively responsible for long-term service and care for the elderly and people with disabilities. Among other things, it became the duty of municipalities to provide health care in special forms of housing accommodation and in daytime activities. One of the reform's important components was the transfer of financial responsibility for patients in county council hospitals and geriatric departments, whose medical treatment had been completed, from the county councils to the municipalities. This had the effect of greatly reducing the number of the elderly in county council institutions, simultaneously with an expansion of municipal housing capacity for the elderly in need of care and social services.
Swedish society also has responsibility to ensure that the elderly in need of care or social services receive help of high quality. Society or family members assist towards care for the elderly by make voluntary contributions. These contributions are regarded as an adjunct to public initiatives. Families, relatives, friends and neighbours, provide a considerable proportion of help and support for older persons who have difficulty in managing on their own.
5. Parliamentary committee on elderly policy. SENIOR 2005
The Swedish Parliamentary role over the care of the elderly is carried through the parliamentary committee on elderly policy, SENIOR 2005. This committee is tasked with the responsibility to lay the groundwork for the long-term development of policies for the elderly in Sweden. The committee has 17 members who represent political composition of the Parliament (Riksdag). To carry out its task in an effective and practical manner the committee works in collaboration with experts from different Government authorities, such as the National Board of Health and Welfare and 21 county administrative boards, and organisations, which provide advise to the parliamentary committee on elderly persons issues.
6.1 Population increase
Despite these provisions, Sweden faces a challenge, as indicated earlier, of an increasing aging population. This indicates that during the years ahead Sweden will face a high rate of retirement, coupled with a diminishing numbers of younger personnel in the elderly care. This change in Swedish age structure will in the long run have an impact in the family structure, social relations in general, labour market and economic activity, pensions, caring and other services. For instance, the two main forms of public care - home care and institutional care not keeping pace with the increasing number of very old persons.
6.2 Geographic inequalities
Decentralisation of welfare services for the elderly to municipalities resulted in local variations in the provisions of these services in terms of coverage, costs and accessibility both in the home based and in institutions based care. The kind of services provided to the elderly varies according to where in Sweden the elderly person lives influenced largely by financial well being of local authorities.
Welfare services for elderly in Sweden have been provided through different forms of privatization. The former public provision of services have been handed over to private companies as a result costs and responsibility of care have become a private business. This has caused these services not accessible to poor elderly people. This has in turn resulted in the increase of informal care from families, friends and voluntary organisations.
7. Lessons to be learnt by South Africa
Parliament of South Africa is considering the Older Persons Bill. The above mentioned policy provisions made in Sweden to cater for older persons practical needs can provide useful learning lessons for South Africa. Below are the recommended strategies that South Africa can use to improve its policies for elderly people:
· Special housing accommodation: South Africa should provide housing structures that are specifically designed to specially meet the needs of elderly people who require special care. This includes catering for elderly persons physical needs, that is, ensuring that housing structures are accessible and located in safe environment. The latter particularly refers to availability of 24 hour safety security.
· 24 hour home assistance and nursing intervention: This is a very important provision that South Africa needs to make to improve the care for elderly persons. These should also include provision of assistance for daytime activities of the elderly, such as shopping, taking medication, rehabilitation, ensuring personal hygiene, moving around and other activities.
· Pension scheme: There has been ongoing complaint that pension package for the elderly does not cover all their basic needs. Swedish pension system can provide a useful guide for the South African pension system. Swedish pension as indicated earlier caters for different financial needs of the elderly people.
· Management: The management and administration of the service delivery for the elderly should be carried at the local government level through municipalities. Municipalities are in a better position to carry out this responsibility because they operate close to the communities. Furthermore, this ensures that the delivery of services is decentralized thus ensuring that regional or provincial specifications for the elderly people are accordingly planned for.
The Swedish policy for the elderly provides for a comprehensive care system for the elderly. This system ensures for quality care and that the daily activities of the elderly are taken care of. The Swedish policy for the elderly provides important lessons for South Africa, as it is currently in the final stages of the drafting the Older Person's Bill.