In Sweden, elderly care starts at home
Swedish Ambassador to Korea Jakob Hallgren speaks with the Korea JoongAng Daily on Oct. 30 at the embassy in central Seoul. [PARK SANG-MOON]
Focus is on ensuring dignity and comfort with enough support
By paying less than 300,000 won ($260) a month, Sweden's elderly citizens have access to daily care at home, including cleaning, shopping for groceries, help with hygiene matters and taking a walk outside.
"The list of services can grow longer, but the cost is never higher than that," said Jakob Hallgren, ambassador of Sweden to Korea, in an interview with the Korea JoongAng Daily on Oct. 30. "The rest are covered by 290 municipalities in Sweden."
All elderly Swedish citizens are entitled to such services at home when they feel they are no longer able to cope with the demands of everyday life. Once they make an application to their local municipality, it makes an individual assessment to provide specific care catered to the applicant's needs.
The same services in Korea can cost as much as 10 times that amount, unless the recipient of the care is at least 65 years old or is diagnosed with dementia, a brain-related illness or Parkinson's disease. In those cases, the Korean government covers 85 percent of the costs for care at home, but only up to 1.49 million won. Additional costs must be borne by the individual.
Ambassador Hallgren sat down with the Korea JoongAng Daily recently to discuss some of Sweden's welfare policies — often referred to as a model welfare system by policymakers in Korea — in light of the approaching Swedish forum on dementia to be held in Seoul at the end of the month.
The Dementia Forum X is coming to Seoul on Nov. 26, marking the first time that the largest forum on dementia in Sweden is coming to Korea. The forum is hosted annually and supported by the royal family of Sweden.
Queen Silvia of Sweden speaking at the Dementia Forum X at the Royal Palace in Stockholm, Sweden, in May 2019. [DEMENTIA FORUM X]
But the Swedish system of decentralized government, which has been the backbone for financing its welfare programs, has also been called into question recently as Sweden has suffered a high number of deaths, especially in the elderly population, due to the Covid-19 infections.
From Jan. 3 to Nov. 7, Sweden recorded 146,461 confirmed cases of Covid-19 with 6,022 deaths, according to the World Health Organization (WHO). Over 60 percent of the mortalities were in individuals aged 80 years and over, according to Statista.
"The Swedish health care system was not prepared for the pandemic, so for the first two to three months we suffered," Hallgren said. "But Sweden has had much fewer infections during the summer. So there is much debate and discussions on what may or may not have worked."
While per-capita deaths from the coronavirus have risen elsewhere in Europe since the early stages of the pandemic, Sweden still has one of the highest mortality rates on the continent, according to data published by Johns Hopkins University. It lags behind only Belgium, Spain and Britain in Covid-19 deaths per 100,000 residents.
The following are edited excerpts of the interview, in which Hallgren discusses the evolution of the Swedish health care system for the elderly, their Covid-19 response and how Korea and Sweden might work together in the latest health crisis.
Can you walk us through how Sweden has responded to the Covid-19 pandemic from the start?
The Swedish health care system was not prepared for the pandemic, so for the first two to three months we suffered. In the early months we experienced some big problems in the nursing homes. So we had a lot of casualties there — an excessive number compared to the other Nordic countries, but more or less the same compared to other European countries even though they may have had stricter lockdowns.
Sweden has had a decentralized system of governance from as early as the 17th century, when the king created different agencies to focus on tax, defense and other tasks. In line with such traditions, today Sweden has state epidemiologists who advise the government on what to do, and the government would typically rely on their recommendations. And their recommendation was that there was no solid proof that the closing of the borders and lockdowns would work in Sweden. There is a debate out there on whether that was right or not, but interestingly, like in Korea regarding its policies, there is a high sense of public support for Sweden's policies.
Some media reports have referred to the Swedish response a so-called herd immunity strategy.
Sweden does not have an official herd immunity strategy, it's never been part of the official strategy. Our measures, priorities and policies have essentially been the same as the rest of the world. But there are a couple of notable examples. If I compare with Asia — Japan, China, Korea, Taiwan […] the idea is to eradicate the virus. But in the rest of the world there has never been an outspoken policy to completely eradicate the virus. The focus has always been on managing the situation and making sure that the health system could cope with the infections.
What is typical about Sweden is we have had very few laws and lockdowns, which is not so unlike Korea actually. There is a high level of trust among the Swedish population in the agencies and the agencies in the people.
In Sweden, the decision to distance oneself socially was left to the individuals to make voluntarily. And there are constitutional reasons for this, because according to the Swedish Constitution, curfews are simply not allowed. It would actually require quite intrusive legal changes.
Very early on, the Swedish government, based on state epidemiologists' assessments, said that we need to devise routines and policies which are sustainable in the long term because we're going to live with this for a very long time. So you cannot keep changing the policies back and forth too much, because that might lower the adherence or understanding for these policies. It was better to have simple rules and not to change them too often.
There is currently a national probe into Sweden's initial response to the pandemic. What kinds of questions are they asking?
One of the questions they're asking is if the decentralization of powers at the municipality level — which has been our huge strength — was a drawback in this case, when the rest of the world was scrambling to get protective gear and applying other measures in a centralized manner. Another question is if we had enough health and medical expertise available for the elderly at this particular point in time. The preliminary findings are expected to be announced in November or December.
Putting the pandemic aside, Sweden's health care policies for the elderly have been recognized globally for its inclusivity and affordability. What were some of the milestones in the Swedish experience of institutionalizing elderly care and making it one of the national initiatives?
From as early as the 1960s, the Swedish population increasingly grew older and their life expectancy increased. One of the major reforms in elderly care for Sweden came in 1992, called the Adel reform. The key idea behind that was that as an elderly person, it is important to keep the dignity — and most elderly people want to stay at home as long as ever possible. A whole new system of care and support at home was made available.
The administrative responsibility was shifted from the county-regional level to the municipal level. Sweden is a country with 290 municipalities. They have their own right to [establish taxes], so they have their own income, which is a constitutional difference between Korea and Sweden. I would say that the first 30 percent of the income tax would go to municipality and any above that would be levied by the national or state level. With that tax base, municipalities are supposed to run schools, take care of elderly care, the arts programs and other services.
Sweden has some 138,000 assistant nurses working with home care and at retirement homes. [MASKOT/FOLIO/IMAGEBANK.SWEDEN.SE]
Were you able to witness these changes in the way your family members were cared for?
In the 1980s my grandmother suffered from Parkinson's disease, and she had to spend her last years in one of these institutions from when she was in her 70s to her 90s, run by the county councils at the time.
That became more and more untenable — it was a feeling they just spent time there, they weren't really treated and some were almost forcibly moved from their homes. Many elderly citizens were spending time in these institutions as if they were ill, but old age is not an illness.
So when the reforms on elderly care came in the early 1990s, they tried to make sure that as an elderly person you had the option to stay in your own homes for as long as you wished and receive care at home.
These changes were visible in how my mother was cared for in her last years. She passed away this year, at the age of 92. She started receiving services at her home eight years before her passing. My father had passed away at the time. In my mother's case, she had difficulty with her eyesight. A person from the municipality would come and make an assessment on her needs and provide care catered to her specifically.
It was only in her last year that she was admitted to a nursing home, after she had a fall and broke her hip. In the last year she also had Alzheimer's Disease. But she thrived at the nursing home, as she made friends there and was surrounded by the caregivers.
What do these services at home look like?
They would help you with your daily routines — whether it is taking a shower, cooking meals, shopping for groceries or just taking a promenade in the neighborhood. And many appreciate this a lot, to be able to stay at home and be close to friends and families, have their own gardens and such.
And once you are at this age, you also get some forms of mobile impediments. There is a program that the elderly can apply for to get taxi rides almost anywhere, at affordable prices, around 5,000 won [$4].
How affordable are these services at home?
There is a maximum threshold on what the [recipient] needs to pay. It would typically be less than 300,000 won per month, regardless of how much services you are receiving. The costs beyond that would be covered by your taxes.
Sweden's health care for the elderly is often studied as an example for Korea. As ambassador of Sweden in Korea, do you see the specific practices of Swedish health care that may be effective in Korea?
We have different cultural and historical backgrounds. I think Korea has a slightly more collectivist culture and Sweden is slightly more individualistic in culture, if such comparison is apt. In Sweden it makes perfect sense that if you are an elderly person and you'd like to stay in your apartment or home as long as ever possible, that is really what people want. I don't know fully if that is also the case in Korea.
But maybe this idea of offering services in home for people who are otherwise forced to move into their son's or daughter's family, or into a care home, that is maybe something to explore if that doesn't already exist.
In Sweden, most people choose to stay in their own homes, where they can have access to public support, home meal delivery, help with cleaning and shopping, transportation services among other social services. [SOFIA SABEL/IMAGEBANK.SWEDEN.SE]
Dementia is an illness often coupled with aging. Sweden's royal family has had a strong interest in developing the nation's dementia care programs, and most recently is said to be working with IKEA to design homes for people with dementia. Could you tell us more?
Queen Silvia's programs on dementia grew out of her personal experience with her late mother, who suffered from dementia. So she has been supporting the cause of better understanding the causes of dementia, but also how you develop better ways of dealing with persons who suffer from dementia. They would deal with questions like, "How do you relate to the fact that all of a sudden your father or mother starts to repeat herself or himself?" and "How do you talk to kids about it?" Part of her initiatives include a special institution called Silvia Home, a training center for nurses who work with dementia patients.
The royal family, through a personal donation by the late founder of IKEA, also developed a program called SilviaBo, which are a series of apartments or houses adapted to people who suffer from dementia, so you can still live at home with your relatives. Because when a spouse suffers from dementia while their partner does not, that is one of the cruelest things that can happen to an elderly couple who lived together for 40, 50, 60 years, and they have to live apart because of the illness.
Her Majesty has also funded and exported the conference, Dementia X Forum, which is coming to Korea in November.
Last year was an exciting year for business and trade relations between the two countries, with two state visits — one led by President Moon Jae-in into Sweden and another led by Swedish Prime Minister Kjell Stefan Lofven to Korea. What were the results of those visits?
One was the Korean start-up center that we opened in Stockholm this year. There have been agreements in the health area — huge investments from AstraZeneca in Korea and there has been other kinds of top-notch agreements between Hyundai and Swedish companies on fuel cells. Companies including Storytel have discovered Korea as a partner to develop their businesses in. There was a huge mutual curiosity on the political level. President Moon and Prime Minister Lofven have been speaking, our two foreign ministers have met, our trade ministers have met, we had the Korean speaker of the National Assembly went to Sweden a month ago. These state visits provided the eye-opening opportunities for both nations to see each other as innovation-focused partners.
Korea's Minister of SMEs and Startups Park Young-sun, center left, and Sweden's Minister for Business, Industry and Innovation Ibrahim Baylan, center right, sign an agreement on bilateral cooperation on SMEs and start-ups at the Grand Hotel Saltsjobaden in Sweden on June 15, 2019. Korea's President Moon Jae-in, far left, and Swedish Prime Minister Kjell Stefan Lofven, far right, congratulate the occasion. [JOINT PRESS CORPS OF THE BLUE HOUSE]
It's been two years since the start of your tenure as ambassador of Sweden to Korea. What have been your observations about the Korean society so far?
The way Koreans respect experience and age is really nice. Sometimes I think we lack this [in Sweden] where we can be more almost focused on youth only. I see that sometimes this [culture in Korea] leads to excessive hierarchies, and there are drawbacks, but I think the way Koreans respect their elderly is quite dignified.
BY ESTHER CHUNG [firstname.lastname@example.org]