Box 1 Organisation of homecare services in Sweden

• Homecare services are largely funded by municipal taxes and government grants and organized locally by the 290 municipalities. The Social Service Act [22] regulates how the municipalities are to organise homecare services but give them a high level of autonomy to decide about their service based on their economic resources.

• Homecare services are either provided by the municipalities themselves or contracted to private providers. The case manager at the local municipal authority approves type and extent of services based on individual assessments of needs. Services include both personal care, such as help with showering or help to dress, intake of medicines, help with eating and assistance with household tasks, for instance cleaning or grocery shopping. Assistance is provided around the clock.

• More than half of Sweden’s municipalities have agreements with private homecare providers. Consequently, older individuals may choose between private, and municipality driven homecare providers. Both are regulated and followed up by the municipality [22]. If the potential client does not make an active choice, he or she will automatically be offered municipal homecare services.

• In 2022 approximately 9% of Swedish citizens aged > 70 received homecare services authorized by municipalities [10, 23].

• Many older individuals also receive home healthcare provided by the local primary care center. In Sweden healthcare is financed by taxes in 21 regions. Primary care is either provided by the Region or by private providers. Homecare and healthcare services are managed by different authorities with little or no collaboration [24].

• Since the 1990s there has been a significant change in the structure of the eldercare system in Sweden. Changes include shorter hospital stays, decrease in the numbers of beds in nursing homes [25], decrease of formal care and an increase of informal care such as support by family [26]. Furthermore, homecare workers report deteriorating working conditions with reduced time with the client, shortage of staff and rapid staff turnover [27].