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Demokratiskolan
The Seniors card from MethodKit for Society and Politics
Card 128 of 128 · MethodKit for Society & Politics
  • AreaWelfare & health
  • Centre of gravityThe municipality
  • Points of influence3 on the journey
  • Decisive electionThe municipal election
Welfare & health

Seniors

Occupation, pensions & care when getting older

Old age is steered by two systems that rarely meet in the debate: the pension, which is run by the central government and follows you wherever you move, and elderly care, which is municipal and looks different in every municipality. The quality of home care (hemtjänst) and the queue for a care home are decided in the municipal election, the pension in the general election.

Where does the power lie?1

  • Municipality · home care, care homes & support decisions · approx 45 %
  • Region · healthcare & geriatrics · approx 15 %
  • State · pension, laws & oversight · approx 40 %

Care is municipal and the pension central government, two heavy systems with one election each. In everyday life the municipal election shows the most.

How it works: the breakdown

The municipalityThe care · centre of gravity
The regionThe care
Central governmentThe pension & the law
Who decides?
The municipal council (kommunfullmäktige), the social welfare committee (sometimes an elderly-care committee) and the needs assessors.
The regional council (regionfullmäktige) and the healthcare committee, with geriatrics and the health centres.
The Riksdag, the Pensions Agency (Pensionsmyndigheten), the National Board of Health and Welfare (Socialstyrelsen) and IVO.
What do they decide?
Home care (hemtjänst), care homes, day activities, support for relatives and in most counties also home healthcare.
Hospital care, doctors' input in elderly care and the health centres' responsibility for elderly patients.
The pension system, the guarantee pension and housing supplement, the social services act's right to support and the oversight of care.
Where are decisions made?
In the social welfare committee, and in each individual case with the needs assessor.
In the regional council and in the care services.
In the Riksdag and at the Pensions Agency, which pays out the pension every month.
Who pays?
The municipal tax. You pay a fee with a central government ceiling, the care fee cap.
The regional tax pays for healthcare, also for the oldest.
The pension system and central government grants to elderly care.
Fastest way in?
Municipal election Application and appeal, pensioners' councils, relatives' councils, a citizen's proposal (medborgarförslag).
Regional election The patients' committee, email to the committee's politicians.
General election The general election steers the pension. Complaints about care go to IVO.
EUThe EU has no direct power over the pension or elderly care. The coordination mainly concerns someone who has worked in several EU countries.

Read the table by column to understand one level, or by row to compare the levels. The green level is the area's centre of gravity.

How it works: follow the decision

The case A care home is granted
  1. State

    The social services act gives the right

    The social services act says that older people with needs that cannot be met at home have the right to support, for example a place in a care home. The law is central government, the assessment municipal.

    Point of influence

    The general election steers the law and the central government grants to elderly care.

  2. Municipality

    The application is submitted

    You or a relative apply to the municipality's needs assessor. The assessor investigates the needs: how everyday life works, what home care manages and what the medical certificates say.

  3. Municipality

    The decision is made

    The needs assessor decides under the social services act and the committee's guidelines. A refusal must be in writing and give reasons, and it can be appealed to the administrative court (förvaltningsrätt).

    Point of influence

    Appeal a refusal to the administrative court. It costs nothing and needs no lawyer.

  4. Municipality

    The place is offered

    With a granted decision, a place is offered, sometimes after queue time. The home is run by the municipality or by a procured company, but the municipality always keeps the responsibility.

    Point of influence

    The municipal election steers how many places are built. Views on a home go to the social welfare committee or IVO.

  5. Region

    The care comes along

    The doctor comes from the region's health centre while the nurses are usually the municipality's. The two responsible authorities should cooperate around each home.

  6. Your everyday life

    A room with your own furniture

    A move with the photographs, the armchair and a new safety alarm by the bed. Behind the room lie a law, a needs assessment and a municipal budget.

The journey looks the same in reverse: what has been built came the same way, through the same decisions. Whoever knows where the decisions are made also knows where they can be changed.

Questions to discuss

  1. How do you want to live the day you need help every day, and who should decide that?

  2. What matters most in elderly care: more hands, better conditions for the staff or more freedom of choice?

  3. Is it reasonable that home care looks different depending on the municipality, or should the central government take over?

  4. Relatives provide a large part of the care of the elderly. What should society do for them?

  5. What would make you get involved in how elderly care works where you live?

Glossary

Bistånd
Support granted under the social services act after a needs assessment, for example home care.
Biståndshandläggare
The municipality's public official who investigates and decides on elderly care.
Förvaltningsrätt
A court that reviews appealed agency decisions, for example a refusal of a care home place.
Garantipension
Central government basic protection for someone who has had low or no earned income.
Pensionärsråd
A forum in many municipalities where pensioners' organisations meet the politicians.

Go further

Footnotes

1) This is an estimate of how decision-making power over the issue is split between the municipality, the region, central government and the EU, based on how responsibility is divided in legislation. A teaching guide, not an exact measurement.