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The Ädel reform is implemented


The Elderly Reform (Ädelreformen) of 1992 was Sweden’s most recent major legislative change in elder care. A lot has happened on the way from poorhouses and “exceptions” to the “stay-at-home” principle and freedom of choice for residents.

The Elderly Reform supports a healthy overall view of older people – not just in medical terms but also in terms of ensuring that their social needs are met within health and social care. The antiquated, institutional thinking of long-term care and homes for the elderly was left behind in favour of special forms of accommodation for the elderly, in a new collective concept including group homes, assisted living and nursing homes. Based on private homes, various types of accommodation were suitably equipped and many new accommodations were also built. Prior to the reform, county councils and municipalities shared the responsibility for elderly age care, but the lack of coordination in this system led to the Elderly Reform – giving county councils collective responsibility for accommodation, service and the majority of care.

The “stay-at-home” principle: A milestone

In 1947 the Swedish government decided to initiate a large expansion scheme of residential homes for the elderly. However, the idea met with stiff opposition. Under the slogan of “home care, not care homes,” author Ivar Lo-Johansson ran a successful campaign against such old people’s homes. He viewed them as inhospitable environments, unworthy of older people. Political pressure grew and the government changed its mind. It embraced the idea of home care instead and agreed to a “stay-at-home” principle – in other words, the right for the elderly to receive help and support to be able to remain in their own homes. Home care was launched, with the first providers being the Red Cross in Uppsala in 1950. More organisations followed suit and Sweden gained a new group of professionals – home helpers. The stay-at-home principle still influences decisions within elder care today.

Elder care was previously called care for the aged and came under the jurisdiction of the board for poor relief. The 1918 Poor Relief Act gave municipalities the responsibility for running homes for the elderly. Often, to meet this need on paper, municipalities simply changed the name of existing institutions such as workhouses. The harrowing conditions of places like these is something many Swedes have read about in books such as Astrid Lindgren’s Emil in Lönneberga, in which an evil pauper called the Commanderess ruled over the other wretched, terrified residents of the parish poorhouse. The only good thing to be noted about life in these conditions was that residents had a roof over their heads.

Huts for the poor

“Poor huts” came into being in the 1800s following a dramatic increase in the number of older people in Sweden. Housing for the poor was the responsibility of parishes – forerunners of municipalities – and was provided in small huts where poor were left to fend for themselves. The occupants of these huts did not own the land on which the huts were located. People who ended up in these huts were called crofters. An alternative was to be placed as a dependent tenant with the family offering the lowest bid to the parish to provide housing. If elderly people owned a farm, however, it was common for them to remain there even after their children had taken over farming operations. In old age, these people had a guarantee of board and lodging on their own property, through a so-called “exception”.

The idea of collective responsibility for the elderly has a long history in Sweden. As early as the 1300s, the duty of families and relations to look after their relatives was enshrined in national law.

Today, Vardaga is part of the Ambea group of companies, one of Sweden’s leading providers of elder age care, with around 80 homes throughout the country.

Read more about Vardaga