 Märta Grunditz is a recipient of äldrevård, Sweden's distinctive eldercare program. (Grunditz/TYG). Remarkably, Grunditz is not in a nursing home. She lives at home, alone, in her apart- ment. Moreover, she receives all this care for only five to eight percent of its actual cost.
Grunditz is a beneficiary of Sweden’s äl- drevård, or eldercare system, part of a national healthcare program that the World Health Organization has called one of the world’s most responsive systems. While eldercare in the United States is largely privatized, in Sweden local and national taxes cover up to 85 percent of each senior citizen’s needs.
Lately, however, Swedish healthcare administrators and workers have been struggling to hold on to what some consider the program’s defining characteristic: human contact.
Swedish eldercare is executed primarily by home care orderlies, known as vårdgiva- re, who provide need-based care to citizens over 65. Vårdgivare visit wards in their own homes, day or night, regardless of where they live. Vårdgivare tasks range from shop- ping and cooking to staying up all night to comfort a patient who is in pain or dying. Beyond providing basic healthcare, the vård- givare tend to the essential emotional needs of their wards. “To come together and talk makes the pain go away,” explained Ulla- Britt Johansson, one of Grunditz’s orderlies. “It’s the best medicine.”
Johansson has over 30 years of experi- ence working as an orderly, and colleague Eva lileskjöld has over ten. Both care for Grunditz and many other patients, working shifts of up to 24 hours. But neither resents the commitment. To the vårdgivare, health- care is not only about helping their patients live; it is also about helping them continue to live as they choose.
But while äldrevård services have expand- ed over the years, program funding has not increased proportionally. And as the country copes with Europe’s largest elderly popula- tion by percentage, Sweden’s äldrevård faces an economic crunch. Administrators now stress efficiency, pressuring the orderlies to accomplish their tasks in less time. Social- izing, which they do not consider an official service, is viewed as wasteful. This stance is a source of great frustration for Johansson and lileskjöld, who feel their administrators are out of touch with the reality of the job. “The bosses don’t understand how important socializing is,” Johansson explained. “It gives people the will to live. Our medicines are pointless if the patient has no will to live.”
Senior citizens like Grunditz are not immune to the same bureaucratic frustrations. “I can’t blame the orderlies. They’re good girls and I love them,” Grunditz said, taking Johansson’s hand. “But when I need to go higher up, to the hospital or the nurse admin- istrator, I feel blocked,” she continued firmly. “There is no communication.”
Many orderlies, like Johansson and li- leskjöld, are fighting to maintain social visits, frequently donating their own time to simply sit and chat with their wards. “My greatest desire is to go back 30 years and have it how it was when we started,” Johansson said. “We had control over our time.” Rather than sacrifice socializing to increase efficiency, she suggested shifting tasks like laundry and cleaning to the private sector, leaving orderlies more time to interact with the wards.
Despite äldrevård’s shortcomings, Jo- hansson, lileskjöld, and Grunditz all agreed that the Swedish system is worthwhile. “We have to pay taxes, but everybody can live with that,” lileskjöld said. Johansson ex- plained: “With private agencies, all you focus on is increasing capital. But when is comes to health, life, and happiness, it absolutely can’t just be about money.”
As Sweden faces the bureaucratic and financial problems faced by healthcare sys- tems worldwide, the country must hold on to what is unique about the äldrevård model, figuring out how to provide healthcare that does more than simply keep people alive. And as countries around the world debate infrastructural reforms, they would do well to follow the Swedish precedent and remember the patients on the other end.
Naomi Grunditz is a sophomore Sociology major in Morse College.
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