1. www.si.se 1 SWEDEN - GENERAL FACTS Area: 450,000 km 2 (174,000 sq mi) 9.1 million inhabitants Average life expectancy: men 77.5 years, women 82.1 years Capital: Stockholm (1,643,000) Major cities: Göteborg 789,000, Malmö 518,000

2. www.si.se 2 Population 71% live in nuclear families (1990 census) 80% live in urban areas and along the coast Post-retirement age (65+) 18% Very elderly (80+) 4.9% Sami (Lapp) minority of 17,000 – 20,000

3. www.si.se 3 ORGANIZATION OF THE SWEDISH HEALTH SERVICES STATE COUNTY COUNCILS LOCAL AUTHORITIES Hospital and heath centers Housing and care for elderly and disabled §Legislation §Supervision §Evaluation §Finance §Organisation §Follow-up

4. www.si.se 4 Local Government Two types of local government body: 289 municipalities (kommun) with responsibility for schools, social services, elder care, care of people with physical or intellectual disabilities, physical planning and building, certain environmental tasks and rescue services

5. www.si.se 5 Local Government 18 county councils (landsting) + two health care regions and one municipality. Their main areas of responsibility are: -health care services at hospitals, outpatient medical care at local health centers -public dental services -psychiatric care

6. www.si.se 6 The Financial Circumstances of Swedish Households Gainfully employed: 62% of adult population. Transfer payments to households (27% of GDP): pensions, child allowance, housing allowance, sickness benefit, parental leave etc. Universal state pension system Social assistance for those below the poverty line

7. www.si.se 7 Housing policy Allow families with low financial capacity to be able to acquire accommodation with good standard Programs for renewal and maintenance of flats and housing areas Housing allowances for those in need

8. www.si.se 8 Taxes 51% ceiling on mariginal income tax Local and state tax on income from employment, real estate, companies, pensions, capital and capital gain Taxes on alcohol, tobacco, petrol etc VAT on goods and services

9. www.si.se 9 SOCIAL ISSUES The Swedish welfare state – a social democratic project that has enjoyed broad support Universal welfare system covers everyone regardless of income or occupation. Some benefits are needs-based, however. The social insurance system, health care, schools etc are financed mainly via taxes and employer payroll fees

10. www.si.se 10 Social Insurance Uniform social insurance system providing: -health care -parental insurance -cash benefits during illness -occupational injury insurance -unemployment benefits -pensions -other support for families with children

11. www.si.se 11 Care of the Elderly Care of the elderly outside the family is a public responsibility Costs for pensions, housing benefits, institutional care, home-help services etc account for some 16% of GNP Local variations in service levels An estimated 4 out of 10 elderly people do not receive any form of public assistance

12. www.si.se 12 Care of the Elderly 10% of care is provided by private organisations (public funding) 7,000 home-help providers for the elderly (often less than 20 hours/week) Around 7,000 close relatives receive cash grants for care of the elderly The family is the most important care provider

13. www.si.se 13 Health Care System County councils responsible for health care Primary care sector comprises health centres, district nurse clinics, child and maternity health care Hospitals, nursing homes and service apartments with 24 hours service a day 80 county and district hospitals and 9 regional hospitals 1 physician per 340 inhabitants

14. www.si.se 14 Health Care System Reductions in inpatient care. More outpatient care. Freedom to choose health centre, doctor or hospital About 8% of Sweden’s employees work in health services

15. www.si.se 15 Distribution of public health care costs, 2001 Somatic short-term care Psychiatric care Primary care Dental care Other

16. www.si.se 16 Child Care Municipalities obliged to provide preschool care and school-age care. Grants provided to non- municipal childcare. Preschool care for children aged 1-5 is provided at preschools, family daycare homes and open preschools Childcare for children aged 6-12 is provided at leisure-time centres, in family daycare homes and at open leisure-time centres

17. www.si.se 17 Child Care Almost 75% of all children aged 1-5 are registered with preschools and 60% of children, aged 6-9, with leisure time centres or family daycare Children needing special support are entitled to a place irrespective of whether parents work or not Four staff categories: preschool teachers, leisure-time teachers, daycare attendants and childminders in family day-care

18. www.si.se 18 Disability Policies Disability policies aim at full participation and equality. Organizations for disabled people are run and dominated by people with physical disabilities Institutional living replaced by group accommodation, service housing and adapted homes

19. www.si.se 19 Disability Policies Local authorities have ultimate responsibility for personal assistance, preschool places, housing, home-help service etc. for the functionally disabled The majority of children with disabilities attend ordinary schools Rising unemployment has restricted functionally impaired people’s chances of obtaining work

20. www.si.se 20 Housing modification grant Was introduced in 1959 A complement to building regulations People with disabilities should be able to live in ordinary dwellings Every local authority are by law obliged to provide the grant Is provided regardless of financial situation Cover all costs for adaptation needed For persons with all types of permanent disabling conditions

21. www.si.se 21 Housing modification grant Permanent housing Permanent structure of the building property Not finance ordinary building maintenance For building materials – a standard ordinary type will be financed by the grant

22. www.si.se 22 A four part assessment The applicant’s self assessment of her/his problems and needs The occupational therapist's assessment of the applicant’s ability, disability, and handicap, and ways to solve the functional problems The engineer’s technical assessments of adaptive solutions to solve the problems of structural barriers Examination of legal guidelines about how the grant can be used and what can be financed by the grant

23. www.si.se 23 Home modification Automatic door opener Stair case elevator

24. www.si.se 24 Approved grants 1998-2002 1998 1999 2000 2001 2002

25. www.si.se 25 Home modification - total costs 1999 2000 2001 2002

26. www.si.se 26 Distribution of home modification grant 2003 (%)

27. www.si.se 27 Assistive devices Based on need Regardless of the person's age, economic status, or place of residence Free or almost free of charge Every county council and/or local authority have their own guidelines for how to provide these services

28. www.si.se 28 Assistive devices Assistive technology centres Low vision centres Hearing centres Orthopaedic centres Intrepretation services (non-hearing, non-speaking persons)

29. www.si.se 29 The Swedish Handicap Institute A national resource centre on assistive technology and accessibility Is run by: – the Ministry of Health and Social Affairs – the Federation of Swedish County Councils –the Swedish Association of Local Authorities

30. www.si.se 30 The Swedish Handicap Institute Improving the quality of assistive technology Stimulating research Stimulating development of new assistive technology Testing assistive technology products Improving the provision National and international co-operation Information

31. www.si.se 31 Prescribed wheelchairs 2002 related to age

32. www.si.se 32 Assistive devices 70 % are prescribed for persons over 65 years of age