Marta Severhelu, Professor Emeritus, University of Stockholm
At the beginning of the 2020 Corona 19 epidemic, a large amount of damage occurred in a nursing facility for the elderly in Sweden. 45% of all COVID-19 deaths were residents of facilities. These early data put the ‘Swedish model’ on the cutting board, which took an independent method. Marta Severhelu, Professor Emeritus of Stockholm University, is a scholar in the field of social welfare who has been researching facilities for the elderly, care for the elderly, and related social policies since 1980. In December 2020, the Corona Committee published the first report evaluating the ‘care for the elderly during the pandemic’, and Professor Sevehelu wrote a ‘background report’ that served as a reference for this report. He said the fact that many people died in senior care facilities was not a problem in itself. On September 20, in Stockholm, I faced a rather ‘unfamiliar perspective’ looking at the lives of the elderly during the pandemic.
In any country, senior care facilities are the most vulnerable to COVID-19, but at the beginning of the 2020 pandemic, Swedish facilities saw particularly high deaths. What was the problem?
Compared to other countries, I don’t think Sweden’s older people have been particularly badly affected. During the first epidemic (spring 2020), 46% of deaths occurred in elderly care facilities. Even before COVID-19, in Sweden, 40-45% of deaths occurred in such facilities. The problem with Sweden is that there was too much virus in society. In Sweden, aged care facilities are like homes. Very open. If the overall spread in society is severe, it is difficult to prevent it from spreading even in nursing homes. Nursing home deaths were similar in Norway, but the death toll was lower than in Sweden.
The Corona Committee pointed out that aged care facilities were not responding well to the pandemic “due to long-known structural deficiencies.” One of them was the professionalism and working conditions of the employees.
In the early days of COVID-19, there were not enough personal protective equipment and diagnostic kits provided to senior nursing facility staff. The employees were in a very difficult situation. In the elderly care facility where COVID-19 has spread, employees are left alone and have not received the support they need.
Prior to that, there was a serious problem with the Swedish aged care facility, which said that at least one in four employees was on a ‘zero-hour contract’ (temporary workers who were paid hourly for work without set working hours). I don’t know how glad the Corona Committee pointed out this issue. ). But so far, little has changed.
What kind of employees work?
About 7% are nurses. 60% are nursing assistants with a two-year education. And the remaining 30% are care assistants who have received short-term education or have no education at all.
What is the structure of elderly care facilities in Sweden? Are you using a single room?
All are single rooms. Each room has its own bathroom and small kitchen. Only married couples share a room together. In Sweden, preference for nursing facilities is high. This is because privacy, safety and unity are all guaranteed. Since nursing homes are homes for the elderly who live there, they cannot be locked up or locked unilaterally. During the COVID-19 pandemic, we tried to keep the uninfected inmates staying in their rooms for the sake of safety, but it was not easy. 65% of the elderly in the facility have Alzheimer’s. they keep going During the first epidemic, good nursing facilities had a higher infection rate because those places had more activities to hang out with, such as drinking tea and playing musical instruments. I don’t think the number of deaths per se is the problem.
Isn’t it a problem that a lot of people die? What does it mean?
I hope you understand me correctly. The real question is ‘how did they die’. If you look at the entire period of the COVID-19 outbreak, not the early days of the pandemic, Sweden’s excess mortality rate is not high. This is because the residents of nursing homes who died from COVID-19 were very old and debilitated, so even if they did not die from COVID-19 infection, they were elderly people with little left to live.
What I really think is the problem is that during the pandemic, the elderly died in chaos due to severe infections. Many facilities were unable to work because most of their employees contracted COVID-19, and inmates died without adequate care. I think at that point we should have sent more medically knowledgeable staff and nurses to support them to the nursing facility.
According to data, visits to nursing homes were banned in Sweden from April 1, 2020, and lasted until October 1. So, could families visit the facility after October 2020?
Yes. In some cases, individual facilities asked to refrain from visiting, but the total ban on visits has disappeared.
Sweden had several waves of fashion even after the first wave passed. Why was the visit ban not reintroduced though?
Because I realized that meeting with my family is very important. We are social beings. Social interaction is necessary. In the summer of 2020 (when visiting the facility was prohibited), transparent plastic was installed to provide a place for families to communicate with residents outside the facility by laptop or phone. But it didn’t do much for the elderly with Alzheimer’s symptoms. Of course, it was difficult to find nursing facilities freely as often as before the pandemic, but visits were not completely blocked. At any time, it was not permitted to prevent the elderly living in the facility from going out. Residents were always allowed to go outside, occasionally bringing the virus into the facility. We should try to prevent infection as much as possible, but we must not forget that we are living our lives. The elderly who live in nursing homes are those whose lives are short-lived.
I heard that the background of the visit ban not being re-introduced was the demand from the elderly.
In part it is. However, the opinions of the elderly were not directly communicated to the government. The movement to actively oppose the ban has come from some lawyers. They argued that nursing homes were home to inmates, and that it would be against Swedish law to bar people from visiting someone’s home. And researchers, like me, who emphasize the importance of contact, also voiced their opposition to the ‘no visitation’.
Has anything changed regarding elderly care facilities in Sweden after COVID-19?
It was promoted at the local government level, not the central government, and several local governments extended the working period of ‘0-hour contract’ employees by three months or longer. This was to prevent them from working around various facilities. In the longer term, the central government has made financial investments in the training of nursing facility staff. The number of people receiving training is around 2000-3000, which is quite a lot. A review of the new aged care law has also begun. It is hoped that this law will include provisions to strengthen the medical capacity of elderly care facilities, but nothing concrete has been done yet.
© EPN