By Lennarth Johansson and Nazak Salehi
Sweden’s Evolving Long-Term Care System: Governance, Challenges, and Innovations
In a Long-Term Care Policy Interest Group webinar, on the 26th February 2024, Lennarth Johansson from Jönköping University discussed the current state and recent developments in Sweden’s long-term care (LTC) policy. This post provides a summary of the key points from his presentation.
Governance Structure
Sweden’s long-term care system operates within a three-tier governance structure consolidated in 1992 with the community care reform:
- National Government: Responsible for policymaking, economic incentives, legislation, and supervision. It contributes 5-10% of LTC funding.
- Regions: There are 21 regions responsible for hospital and outpatient care.
- Municipalities: Sweden’s 290 municipalities manage a wide range of services, including home health care, institutional care (nursing homes, group homes, residential care), assistive devices, welfare technologies, and day care. They fund 85-90% of LTC services, with 4-6% financed by user fees.
This decentralized system results in significant variations in LTC services across the country.
Trends in Service Provision
Since the early 1990s, Sweden has seen a substantial reduction in service provision due to the aging-in-place policy and cost containment measures:
- Residential Care: Coverage for those aged 80 and older dropped from 23% in 1993 to 11% in 2023, a reduction of over 50%.
- Home Help: Similarly, home help services decreased from 23% in 1993 to 18% in 2023, a reduction of more than 20%.
- Overall, the combined provision of residential care and home help for those aged 80 and older fell from 46% to 29%, a 37% reduction over three decades.
Current Challenges
Sweden faces several significant challenges in its LTC system:
- Service Quality and Level: Ensuring and improving the quality and level of health and social care for older people.
- Cost Containment: Increasing cost-efficiency in the face of rising demand.
- Workforce Shortage: Recruiting and retaining qualified care personnel remains a critical issue.
Strategic Responses
To address these challenges, municipalities are adopting various strategies:
- Promoting Independent Living: Programmes for healthy ageing including self-care, preventive home visits, health check-ups, free review of medication, free flu vaccinations, falls prevention, and physical exercise programs are increasingly common. These are often run by municipalities or volunteer organisations.
- Welfare Technologies: The use of safety alarms with GPS, passive alarms, sensors, web camera monitoring, and medication reminder robots is growing.
- Coordination and Collaboration: Enhanced coordination between health and social care through mobile teams, tele-monitoring, and safe return programmes for post-hospitalisation support.
- Care Work Promotion: Initiatives include care time budgets, task division, competence development, and electronic keys to streamline and improve care delivery.
Conclusion
While Sweden’s decentralized approach allows for tailored local solutions, it also implies significant variations in service provision and access to care personnel across municipalities. To address these challenges, Sweden is actively pursuing innovative strategies to enhance the quality and efficiency of its long-term care system, offering valuable insights for other countries facing similar issues. Lennarth Johansson’s presentation underscores the importance of continuous adaptation and community-focused strategies in addressing the evolving needs of an aging population.
To read the full GOLTC Long-Term Care system profile for Sweden click here
Suggested citation:
Johansson L. and Salehi N. (2024, 2 August). Long-Term Care Policy Update for Sweden: Sweden’s Evolving Long-Term Care System: Governance, Challenges, and Innovations. GOLTC Blog, Global Observatory of Long-Term Care, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://goltc.org/publications/long-term-care-policy-update-for-sweden/