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In Sweden, as in Italy, Long Term Care was strictly hit by the Covid-19 pandemic. During Covid-19, the Sweden government issued new legal guidelines to cope with evident gaps in the Long Term Care sector, such as those related to understaffing in hospitals, hygiene routines, and medical staff skills. The local level plays a central role in managing the healthcare system. A more efficient integration of services’ provision is now on the future public agenda.

Paula Blomqvist, Professor at Uppsala University (Sweden), told us about the situation of Long Term Care in Sweden before and after the Covid-19 pandemic. The Swedish government supports Long Term Care at both national and local levels since it is deemed to be a “public and collective responsibility”. A more efficient integration of services’ provision is now on the future public agenda.

How is Long Term Care managed and structured in Sweden?

Long Term Care is available for anyone who needs it and who is a Swedish resident. Sweden’s elderly care is part of the universal welfare system. It is a well-developed part of the welfare state and is publicly funded. There are fees for the users , but they are comparatively low and income-related. Individuals access Long Term Care through an assessment provided by local governments. They are called municipalities, and there are 290 across Sweden. Universality is a strength of Swedish welfare states. LTC is accessible to everyone, regardless of income or where you live in the country. It is standardized across the country. I mean that it is regulated by several laws and guidelines issued by the central government. This is something that everybody knows that they have access to. If the regulation and financing are public, then the provision is mixed. Most providers are public ones, but there are also private actors who are then contracted by the municipalities to provide care services and Long Term Care. A relevant part of Swedish Long Term Care is aging in place; these services are provided at the elderly’s homes by various teams of carers, nurses, and doctors to allow long-term dependent people to stay at home. The focus on aging in place has intensified in the last 30 years. Fewer and fewer elderly are in institutions, and more are staying in their homes.

What is the main pillar of Sweden’s LTC services?

We have residential care, home-based and short-term care. The short-term care is a sort of rehabilitation after spending a period in the hospital. All recipients can choose the home-care provider among competing companies, private organizations and public providers. [PB1]  The role of families is still very Important in practice, but the system is built on the idea that Long Term Care should be a public and collective responsibility.

Which was the impact of Covid-19 on Long Term Care in Sweden?

Covid-19 led to a big debate about Long Term Care in Sweden.  LTC was perceived to be the weakest link in the   chain of preventing mortality from covid Generally, healthcare worked fairly well, and it was common knowledge among political actors and civil society. Despite this, the elderly care system was criticized for not being able to prevent the spread of the disease in care institutions and for not providing enough medical competence and equipment to LTC institutions. The LTC Institutions were overwhelmed. The debate was mainly about the under- supply of medical staff.

Paula Blomqvist, Università di Uppsala
Paula Blomqvist, Uppsala University

Did Covid-19 bring new policy issues to the public agenda?

Yes, it did. The government launched a big policy program to strengthen medical staff skills in Long Term Care institutions.  There have also been Initiatives to improve sanitary routines, ensure hygiene in LTC Institutions, and secure a higher staffing level of medical staff in Long Term Care institutions. Another debate concerned the language skills of the staff. Many of them have immigrant backgrounds and do not speak Swedish fluently, which has been known to cause communication problems After the pandemic, some municipalities introduced language requirements for people working in Long Term Care. That was a direct effect of this criticism. So, several legal proposals and new recommendations have come out of the pandemic debate.

How would you interpret this “path acceleration” of Long-Term policies? Was the debate there even before Covid-19?

 None of these policy topics were completely new. The new debate concerned the hygiene routines in the LTC Institutions[PB2] , as they were not enough to prevent the spread of the virus. Also, the discussion about medical equipment – to a certain extent – was new. However, most of these elements – like understaffing and staff language skills – have been discussed for a long time.

Is there a geographical divide in LTC services’ provision?

There is no clear picture of how – and if – municipalities are more skilled or efficient in providing LTC services to the North or South. You do not really see clear geographical patterns. If you look at quality indicators, they vary across municipalities and individual care institutions, rather.  The services’ allocation is not a problem in itself, as access to services for all in need is guaranteed by national legislation

We have many quality indexes. We have a broad reporting system where all the municipalities and all the elderly care institutions are required to report quality data into a government dataset, published on a yearly basis. There is a lot of quality reporting going on. We have at our disposal a sort of quality register for Long Term Care with many indicators. The quality indexes are well-developed.

The Swedish municipalities have a strong tradition of independence. In addition, to national framework legislation, the government releases a sort of general guidelines about quality standards and working routines. Then, the central government monitors the performance of the municipalities, and they publish quality data. There is relatively a good system of transparency and benchmarking, I would say.

Is LTC considered to be a priority among voters?

Voters rank elderly care as one of the top priority issues in Swedish politics. Politicians are aware that this is a big concern for voters. All the municipalities, at the local level, have their own municipal parliaments with elected politicians, and they are directly responsible to their local voters for organizing elder care. Political parties and politicians are thus the main drivers of these changes. The issue is not divisive in policy and decision-making, except for the issue of for-profit providers, which left-leaning parties are more skeptical of.

What’s the next step of Long Term Care in the public agenda?

The big public issue is now how to achieve better coordination between health care and Long Term Care. The attempt is to achieve more efficient coordination between regional healthcare and municipal elder care services. The aim is to improve coordination between regular healthcare and Long Term Care, overcome this institutional gap between regions and municipalities, and shift resources away from hospitals into the outpatient health care sector. So, these are some reforms that are underway.



Foto di copertina: Smögen Municipality, Sweden Ⓒ David Taljat, Pexels