Municipalities as personal assistance providers in Sweden

Summary of legislation, court interpretations and reports as of October 2010

Individuals granted personal assistance under the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS) may choose whether their local municipality, a private company or cooperative will provide the assistance. Almost 50 percent have chosen the municipality.  That was in 2010  this number has been in steady decline - in 2013 less than 40% of assistance users have the local council as their provider. When the Assistance Committee asked assistance users in 2005, they stated that private providers allowed greater influence over choice of assistant. Jonas Gumbel, Swedish Association of Local Authorities and Regions (SALAR), explains this outcome by noting that the municipalities set requirements when hiring; for example, they do not allow ethnic discrimination. According to the final report from the LSS committee, municipalities and private providers must compete on a level playing field. The municipalities’ assistants are more expensive due to collective bargaining agreements, according to Gumbel. But according to Josefin Nilsson, The Swedish Competition Authority, VAT rules favor the municipalities. Ulla Clevnert, National Board of Health and Welfare, notes that the municipality's costs for assistance are not publicly disclosed. 

In 2005 the National Board of Health and Welfare criticized the municipalities for restricting assistance. In 2007, the county administrative boards also criticized the fact that almost half of the municipalities had incorrect guidelines for assistance interventions. For example, time limits were set and 25 municipalities had travel restrictions. Thirty-seven municipalities specified tasks (e.g., cleaning, laundry, shopping and gardening) that assistants were not allowed to perform. According to Lars-Erik Gotthard, County Administrative Board in Västra Götaland, the risk of such guidelines is that the needs of the individual do not guide the assistance, which conflicts with the purpose of LSS. Attorney Ellinor Englund, SALAR, responded that the guidelines provide support for administrators and that LSS does not mention cleaning and gardening. However, many municipalities changed their guidelines in response to the criticism. Tierp excluded  tasks such as window cleaning, lawn mowing or snow shoveling, but in 2008 new guidelines were adopted that were acceptable to Maria Knight, County Administrative Board in Uppsala. The maximum allowance for coffee breaks and restaurant meals (SEK 30 and SEK 60, respectively) was eliminated.

In 2009 a public debate was held on Gotland where the municipality excluded gardening and cleaning in apartments larger than two rooms and a kitchen. The County Administrative Board criticized this, but nevertheless excluded certain tasks for work-environment related reasons. The Swedish Work Environment Authority argued that duties should be based on the skills, resources and authority of the assistant. On Gotland, both Gustaf Hoffstedt (social welfare committee chairman) and Lena Lager (head of social services) said that anyone who is not satisfied with the municipality had the option to choose a different provider. Britt-Marie Fagerlund, County Administration Board, noted that some people prefer the municipality as provider and that certain physical disabilities make it difficult to choose. Another restriction was imposed on municipally provided assistance when Sandviken Municipality decided in 2008 that assistants could not drive their own car or a car belonging to the assistance user on the job.

The Swedish National Board of Health and Welfare has been the regulatory authority since 2010. Ulla Clevnert, National Board of Health and Welfare, believes that municipalities may set their own rules for assistance because the ideas underlying the Social Services Act (SoL) have been applied to the interpretation of LSS. Maria Lundqvist Brömster and Linnea Darell, Liberal Party (the party that was the driving force that led to LSS) explain that SoL is  a framework law setting minimum standards for a “reasonable standard of living,” while LSS is a law of entitlement defining “good living conditions.” The assistance decision should not be based on duties, but on number of hours. The user decides what the assistant does, but should be involved (for example, during cleaning). Attorney Mathias Blomberg holds that many administrators do not base their decisions on the living conditions of the population at large, but rather on their own ideas of how people with disabilities should live. According to Stefan Käll at NHR, SoL has deceitfully copied the concepts of LSS, but within SoL, the municipality often charges fees, and municipal autonomy prevails. For example, escorts for the blind are free of charge in some municipalities, but are not even available in others. A few small municipalities offer assistance in accordance with the objectives of LSS, even though the decision for the user is based on SoL. Zeinab Ghailan, Din Assistans has three such customers. The intervention should maintain LSS quality standards, she says: “Those whose assistance is based on SoL should also have good living conditions."