Decentralizing healthcare responsibilities
Henning: "In 1992 we had a big reform, transferring the responsibility for elderly care from the state to the municipalities. We have three levels in Sweden: the state, the county and the municipal level. The county is responsible for the healthcare connected to hospitals. When it comes to healthcare at home or for people needing facilities, it is the municipalities who have that responsibility."
Henning: "Organising a smooth transition was not easy in the beginning. Still we have some problems with primary care in residential housing that is run by the municipality because the doctors from the primary care have to visit these places and this is not always functioning very smoothly. Also the staff was transferred from the county to the municipality, and some staff thought that it was less prestigious to work in the municipality than for a national organisation."
How to finance Healthcare and keep the costs low?
Henning: "The municipalities get money transferred from the state, but they also get taxes from their citizens. There are also fees; people have to pay for their home care. Municipalities try to be more cost-effective, that is why they opened up for alternative private providers, to have more competition. People have to pay for the service. Even if it is heavily subsidised there are fees for housing and care. Before, you could get more services from the Home Care organisation. Now there is a priority towards a smaller group of people with heavy needs. There is a shift from home help to other kinds of support that make it easier for people to live more independently like security alarm devices and transportation services. This is also a strategy to keep your costs low: preventive measures."
Different kinds of support to independent living
Henning: "There is a shift now from extensive care to prioritising heavy needs. I would say the costs are almost the same. Now we have to shift from home help to other forms of home care. Home help is a person who comes in and helps you doing the different tasks. Within home care you can get other types of support, like transportation service, adaptation of your flat or security alarm. Such kinds of support have increased very much."
Linking housing policy to social policy: "Ageing in place" policy has gone too far
Henning: "What is interesting in the Swedish example is that we have had a very decisive policy towards Ageing in Place, but we have found that we have gone too far. The thing is that we have closed a lot of residential facilities. To get admitted there you need to go through a needs assessment. Many of such facilities have been closed because the politicians and the municipalities think that we should not have so much residential care, we should have ageing in place. So instead, we give home care in people’s homes. But at a certain point old people want to go to residential care units because they feel insecure and lonely."
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