New country report: The COVID-19 Long-Term Care situation in Sweden

Marta Szebehely, Professor Emeritus, Stockholm University

The full report is available here:

Key findings:

  • Sweden has been badly hit by the COVID-19 pandemic. In mid-July, more than 5,500 individuals had died from the infection, corresponding to around 550 deaths per million inhabitants. While there was a clear excess mortality in April and May, since June the death rates in Sweden are back to normal.
  • Of those who have died of COVID-19, 47 per cent were care home residents and 25 per cent were homecare users, corresponding to 3.1 per cent of all care home residents and 0.8 per cent of all homecare users.
  • The regional differences are striking: in the Stockholm region, 7 per cent of the care home residents have died while there have been hardly any COVID-19 deaths in care homes in several other regions.
  • Sweden has a tradition of voluntary measures on infection control based on recommendations, with an emphasis on individual responsibility. During the pandemic, the authorities’ recommendations to stay at home when sick, to wash hands frequently, to keep physical distance and to limit travelling have largely been adhered to.
  • To avoid people going to work when sick with mild symptoms, on March 11 the government introduced pay also for the first day of sick leave (normally in Sweden, sickness benefit is paid only from the second day).
  • In the management of the pandemic in the LTC-sector, a combination of recommendations and legally binding rules have been applied including a ban on care home visits (from April 1).
  • According to a survey of care home managers in mid-April, the infection probably entered care homes through residents returning from hospital, family visiting (before banning visits) and infected but asymptomatic staff.
  • Once the infection got into a care home, the managers reported difficulties in restricting the spread because of staff shortages, a scarcity of testing equipment and Personal Protection Equipment and the physical layout of the homes with limited possibilities to stop infected residents with dementia from moving around and meeting with other residents.
  • One quarter of the care workforce are employed by the hour, and in the beginning of the pandemic, staff shortages due to ordinary workers being on sick leave or in self-isolation, led to an even higher use of casual workers, with less or no formal training. As problems following hygiene routines were reported, a national e-training program focusing on hygiene was developed early on and has been completed by more than 140,000 care workers.
  • The government has appointed a commission to investigate the Swedish COVID-19 strategy. One of the tasks for the commission is to investigate the recommendations and actual measures taken to limit the spread of infection in eldercare services and to evaluate whether problems in work organisation, working environment and employment conditions, have contributed to the many cases of death in the sector.

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