$Unique_ID{COW03466} $Pretitle{441} $Title{Sweden Support for the Disabled in Sweden} $Subtitle{} $Author{Swedish Institute} $Affiliation{Swedish Embassy, Washington DC} $Subject{disabled special care employment service disability children services work government} $Date{1990} $Log{} Country: Sweden Book: Fact Sheets on Sweden Author: Swedish Institute Affiliation: Swedish Embassy, Washington DC Date: 1990 Support for the Disabled in Sweden Sweden is a small, highly industrialized country, which has not been at war for some 180 years, and which particularly during the period after the Second World War and up to the 1970s experienced exceptionally good economic growth. This provided scope for a number of radical social reforms, which have directly or indirectly affected the disabled. A strong central government administration combined with extensive local government is also characteristic. Both the municipalities and the county councils have the right to levy taxes. They elect their own decision-making bodies and are responsible for a large part of public services. Traditionally, public bodies at these three levels-central government, county council, local authority-are responsible for almost all public services within important sectors such as the employment services, education, medical care and social welfare. Private employment agencies are prohibited in Sweden and there are relatively few private schools and hospitals. Within social welfare and medical care the tradition of public care goes back as far as the 16th century. This has meant that charitable organizations with a social objective, which often work for the disabled, have had less scope in Sweden than in many other countries. Another factor of importance is the Swedish tradition of popular movements, which is also reflected in the existence of a strong movement of the disabled. In the municipalities and counties there are at present just over 1,200 associations of disabled people with around 400,000 members. At the national level there are about 30 associations representing different disability groups. The majority of these cooperate within the National Society for Associations of the Disabled (Handikappforbundens centralkommitte, HCK), which has county committees in all the counties and local committees in many municipalities. The Swedish movement of disabled people differs from non-governmental organizations for the disabled in many other countries in that it consists to a high degree of organizations of and not for the disabled. They are dominated to a large extent by the disabled themselves and in the last few years have come to function as social policy pressure groups in relation to society. The organizations of the disabled have come to be regarded by the public authorities as an important consultative partner in the planning of schemes for the disabled. They are given an opportunity to voice their opinion on draft bills, they take part in reference groups, working parties, committees, etc., appointed to carry out special investigations at central government, county and municipal level. In order to increase the opportunities for contact between the authorities and the organizations of the disabled, special coordinating bodies-councils for the disabled-have been set up at the different levels of political decision-making. There are councils for the disabled at local, regional and national levels. The central body is the National Council for the Disabled (Statens handikapprad) in Stockholm. In connection with the International Year of the Disabled in 1981, a Swedish action programme was drawn up to tackle issues concerning the disabled. This was presented to Parliament in 1983. The National Council for the Disabled then carried out a follow-up study to determine how far the programme has been implemented in various social sectors. This study shows that even if the circumstances of the disabled have improved in many respects, a great deal remains to be done before the gap between the disabled and the rest of society is reduced. One important principle in Swedish policy for the disabled is that progress in this field should not be allowed to suffer because of swings in the economy. The study reveals, however, that the contractions of the social economy have nevertheless affected the disabled. There are very considerable differences in the services offered by the different municipalities. This is true of the home help and transport services, among others. Good technical aids are absolute prerequisites if a person with mobility disabilities is to be able to live an active and independent life. The availability of such aids is today greatly affected by the priorities set by the individual county council. The concept of disability The political goal for Swedish measures for disabled people is that they should be part of the community and live like others. They should have the same opportunities to earn a living, have a good home, move about, and have meaningful jobs and leisure activities. Each authority is responsible for the disability issues within its particular sphere. The Swedish view of disability and handicap is defined in several government propositions and Acts of Parliament. A handicap is not looked upon as a characteristic of a person with a disability caused by injury or illness, but as a relationship between the person and the environment. This approach is along much the same lines as the definition of handicap formulated by the WHO and it shifts the handicap from the individuals to their environment. This is important, because it places a responsibility on all organizers, both public and private, to see that the activities they run are accessible to all-including disabled people, thus preventing a disability from becoming a handicap. It is difficult to give statistical data on the number of disabled persons in Sweden. Various estimates indicate, however, that there are about 800,000 persons between the ages of 15 and 75 with more or less pronounced mobility disabilities or limited mobility due to the reduced functioning of motor or internal organs. The number of persons with more severe mobility disabilities is estimated at 290,000 and the number of those confined to a wheelchair at 30,000. It is estimated that 200,000 persons have such severe visual impairments that they cannot read ordinary writing even with the help of glasses. Nearly 10,000 persons are probably completely blind or lack locomotor vision. The number of persons with defective hearing has been estimated at 800,000. About 200,000 of these are reckoned to be dependent on hearing aids. The number of deaf persons is estimated to be 10,000. About 36,000 intellectually handicapped persons receive special care and attention because of their handicap. This represents just over 0.4% of the population. It is estimated that there are an additional few thousand who also need such care. It is the ambition of Swedish handicap policy to avoid special solutions for the disabled as far as possible and instead to make society as a whole accessible to all. Issues regarding the disabled thus become the responsibility of the whole community. Legislation In contrast to many other countries, Sweden has no general law aimed at securing the rights of disabled persons. In accordance with efforts to integrate the various issues concerning the disabled in the spheres where they belong, special paragraphs concerning the disabled have instead been inserted into certain laws (e.g. the Social Services Act). In other laws (e.g. the Education Act, the Work Environment Act) it is considered either to be self-evident or it is stated in the legislative history that disabled persons are also covered by the law. There is one exception to this rule. This is the Act on Special Services for Intellectually Handicapped Persons et al., applying not only to the intellectually handicapped but also to persons who, as the result of a brain injury in adult life, have sustained significant and lasting mental disabilities, as well as persons with childhood psychoses (e.g. autism). This law applies to special services over and above those available to all citizens as a matter of course. The special kinds of services, covered by the law are: - consultation, other kinds of professional personal support and support from a special contact, - daily activities in day centres or other types of occupation for those above school age who lack employment and are not involved in any educational process, - short stays away from home, mainly for the purpose of relieving relatives otherwise responsible for care and supervision, and short-term supervision away from home for schoolchildren over 12 years of age, - residence in foster homes or boarding homes for children and young people who need to live away from the parental home, - group dwellings for adults who are unable to live in homes of their own. In recent years there has been a trend towards framework legislation with less and less detailed government control of the local authorities' and county councils' activities. By means of special government subsidies to activities considered especially important, such as the home help service and transport services (see below), the government has sought to create guarantees for the realization of such activities. The municipalities have the ultimate responsibility for providing for the needs of the disabled. Care, habilitation, rehabilitation, and technical aids The ordinary medical service (responsibility of the county councils) is also obliged to meet the care requirements of the disabled. The Health and Medical Services Act guarantees the disabled the right to collaborate in the planning and shaping of medical care. This helps to ensure that their care requirements are not neglected by the county medical service. The county councils are also responsible for habilitation and medical rehabilitation. They have built up an organization consisting of vision and hearing centres, and employed hearing and vision consultants, physiotherapists, prosthetists and orthotists, etc. for the habilitation of disabled children and the rehabilitation of adults. Technical aids for the disabled are in most cases free of charge to the individual. They are supplied without a means test and there is no upper limit for the cost of the aid. Repair and maintenance of the aid are also carried out without cost to the disabled person. The technical aid service includes testing, prescription, adjustment, information and training. The provision of interpreting services for the deaf, the deaf and blind, and those with speech impediments is also part of the service. The scope of this service varies greatly between different parts of the country. The county councils are reimbursed for the technical aid service by the government via the health insurance scheme with a standard sum per inhabitant per annum. Housing and the physical environment The objective of Swedish housing policy is to provide the whole population with sound, well-planned and practical dwellings of a high standard and at a reasonable cost. In planning housing special regard should be paid to the needs of the elderly and the disabled. The municipalities are responsible for the provision of housing and should plan this so that everyone has a dwelling which corresponds to his needs and fulfills the objective for housing policy. They are also responsible for seeing that residential areas are well-planned and provide their inhabitants with a good environment, services and communications. Experience shows that, with good basic planning in accordance with the guidelines laid down in the building by-laws, it is possible to achieve such a high degree of accessibility that the majority of disabled persons can manage in a normal modern dwelling. For those with more serious mobility disabilities and other severely disabled persons special measures are, however, often required. There is a special government home adaptation allowance to enable the dwelling to be designed to meet the disabled person's individual requirements. It may be granted for the alteration of both old and new dwellings, and allowances may be granted for all types of disabilities, e.g. reduced mobility, defective vision, allergy, epilepsy, psoriasis, colostomy, extremely small stature, intellectual handicap. The home adaptation allowance is intended for such measures as are required to provide for the primary housing functions of sleeping, resting, attending to personal hygiene, preparing food, eating and moving about in the dwelling. In the 1950s the municipalities often built flats for the disabled, i.e., specially adapted flats, which were reserved for people with handicaps. Owing to the change in the building by-laws and the introduction of the home adaptation allowance the need for special flats for the disabled has decreased. In order to provide those with severe mobility disabilities and other severely disabled persons with good housing and adequate service, there are special service flats with a home help service on call. This means that the tenant can obtain the service and care he or she needs 24 hours a day. The municipality is normally responsible for the service flats. Disabled persons may receive a special municipal housing allowance which is subject to a means test. The aim is that housing costs should not exceed around 20% of the tenant's income. Social services Many elderly and disabled persons need help and services of various kinds in order to be able to go on living in their own home and to cope with everyday life. The municipalities are responsible for social services, which consist of several different types of activity and are adapted to needs and local conditions. There is a home help service in all municipalities. This primarily includes domestic help with cleaning, food preparation, shopping, clothes care and personal hygiene. Increasingly, the home help service also provides an escort service, i.e. personal assistance with walks, visits to cultural institutions, etc. The aim is to break social and cultural isolation, which is still a serious problem for the disabled. In addition to the above, chiropody, hair-dressing, gymnastics and recreational activities, together with bath, meals, telephone, library, laundry and snow clearance services are available for the elderly and the disabled in the majority of municipalities. The central government pays a subsidy to the municipalities. This is partly a performance-related sum per year and employee within the home help service, and partly a standard sum per municipal inhabitant drawing an old-age pension or a supplementary disability pension. The fee for home help service is as a rule income-related. A fee is also payable for certain other types of service. Institutional living In recent years there has been a trend towards transferring people from institutions to various forms of independent, integrated housing. This trend is particularly noticeable in the case of the intellectually handicapped. About 7,000 of the intellectually handicapped in Sweden now live in institutions. Most of them are in the upper age bracket. Younger intellectually handicapped persons tend to live in more homelike circumstances, e.g. in boarding homes. About 47,000 persons with mobility disabilities live in institutions. Of these, 9.5% are aged between 16 and 74. Many of those with severe functional disabilities are obliged to live in institutions because ordinary housing is not designed to cater for their special service and care needs. The body responsible for institutions varies. The local authorities have by law the overall responsibility for people's housing. Where medical care is part of institutional living the county council or the government may, however, be the body responsible. Other forms of housing for the disabled, such as collective and group homes, do exist. These serve as transitional and training dwellings for those who have been institutionalized for a long time, but who should be able to manage to live on their own. This is mainly being tried out within psychiatric care and the care of the mentally retarded. Disabled people either live unattended in such homes or together with their nursing staff. Communication Public transport facilities, including platforms, stations, etc., are usually designed in such a way that particularly persons with physical disabilities, such as motor impediments and defective sight and hearing, have difficulty in using them. In order to solve the problem of mobility for these persons, a special communications system, the so-called transport service, has been set up. For this service the municipalities use taxis, or special vehicles for the severely disabled and receive a government subsidy of 35%. The municipalities themselves decide which persons are entitled to transport services by issuing so-called transport service permits. The Swedish Association of Local Authorities (Svenska Kommunforbundet) has recommended that the local authorities should take into consideration the nature and degree of disability in making their decision. More than 300,000 persons have the right to use transport services. The fares charged to the individual vary from one municipality to another. The Swedish Association of Local Authorities has recommended the local authorities to levy a charge which corresponds to the fares in force on public transport. Many local authorities restrict the individual's transport service journeys. The restriction may apply to either distance or number of journeys. Disabled persons may use public transport services throughout the whole of Sweden. The passenger then pays the equivalent of the second class rail fare, even if he needs to travel by air, car, bus or needs an accompanying person. The rest is covered by government funds. In certain cases disabled persons may be entitled to a government subsidy for the purchase of a car. Child care Society's child care provision consists of pre-school and leisure activities. There has been an increasingly strong demand that all children should have the right to a place in a pre-school or leisure time centre. A sharp expansion of above all day care centres began in the mid-1960s against the background of the large increase in the number of working mothers. The Social Services Act which came into force in 1982 incorporates the Child Care Act of 1977 and applies to children of 0-12 years of age. According to the Act, physically disabled children should be given priority to a pre-school place. The priority paragraph marks the disabled child's right to take part in ordinary pre-school and leisure time centre activities and the local authorities' responsibility for giving them the support they need there. Today, almost all disabled children attend the ordinary municipal pre-school. Where this is not possible, the alternative may be a special group attached to an ordinary pre-school. Within the country councils' habilitation organization for mobility-disabled children, resources have been developed for medical investigation and treatment, physiotherapy, occupational therapy, speech training, social counselling and pre-school educational measures in the form of so-called special pre-schools. At present, joint habilitation organizations are being set up by many county councils so that resources can be pooled, primarily for physically disabled and mentally retarded children. Within the county councils' educational hearing service there are specially trained pre-school teachers. These work with stimulating the children's language development and giving support to their families. Children with only slightly defective hearing attend ordinary pre-school. The special teacher from the educational hearing service visits regularly to provide support to both children and staff. Special pre-schools are available for children who are deaf or whose hearing is severely impaired. Activities here are based on the needs of the children themselves. Children with normal hearing also attend such pre-schools. There are also a few groups made up entirely of children who are deaf or have defective hearing. But such groups are rarely found outside the main urban areas, due to the small number of children in this category. Pre-school consultants exist for work with children with defective vision. They go out into the field , providing educational support in the home and pre-school to both children, parents and staff. Close collaboration is necessary between the work of pre-school consultants and the county councils' habilitation programmes. Most children with impaired vision are retarded in their motor development and about 40% are intellectually handicapped. About 90% of Sweden's intellectually handicapped children of pre-school age have been found individual places in ordinary pre-schools. The remainder attend groups, which are usually housed in the same premises as ordinary pre-schools. Children with other disabilities, e.g. epilepsy, asthma and haemophilia, attend the regular municipal pre-school. Education The main principle with regard to the education of the disabled is that they have the same right to education as others and in principle the right to take part in the same activities. This means, for primary and secondary education, an effort above all to integrate disabled pupils in the regular compulsory and upper secondary schools. In order to facilitate this, special facilities are usually required in the form of smaller groups, specially trained teachers, technical aids and personal assistance. These resources have gradually been developed in the compulsory school and to a certain extent in the upper secondary school with the aid of government subsidies. The majority of mobility-disabled children and many pupils with defective vision and hearing now attend ordinary classes or special classes in ordinary schools. There is one special school for the visually impaired which acts as a resource centre to which peripatetic teachers and pre-school advisers are attached. This school gives educational counselling to teachers and visually impaired pupils/pre-school children throughout the country. There is also a special state-run school for visually impaired children with additional disabilities. There has been no corresponding trend within the special schooling of the deaf. There are seven special schools for deaf children. The emphasis on teaching in sign language and thus the need for contact with other deaf children with the same method of communication has meant that the special school has been retained. The pupils, however, no longer live at the school, but at home with their parents or in hotels, houses or flats in ordinary residential areas. The majority of disabled pupils can attend an ordinary school at upper secondary level. There are special upper secondary schools in Stockholm, Goteborg (Gothenburg) and Umea for severely mobility-disabled pupils and in Orebro for deaf and hard-of-hearing pupils. There are special schools for the intellectually handicapped. These include special compulsory schools, training schools and vocational schools. The special school is usually housed in the same building as the ordinary school. At universities and colleges of higher education the disabled take part in the ordinary tuition. Anyone in need of special aids can obtain or borrow these via the centre for educational aids in the place of study. Special support during tuition and personal assistance during the working day are provided by the university or college of higher education. In addition, the disabled person is entitled to attendant services for individual help in his everyday life at home. Attendant services are free of charge for students. The local authorities provide these services and are reimbursed by the government. Many disabled adults received inadequate schooling in their youth. For them the opportunity to take part in various forms of adult education is of great importance. Disabled people are one of the main target groups within this branch of education. All the adult education associations, the municipal schools for adults and the folk high schools arrange courses for the disabled. For several years courses for disabled students have received government subsidies for an increased student-teacher ratio, personal assistants for the students and educational equipment. Attendant services may be offered to severely mobility-disabled students studying at folk high schools as well. Government subsidies are also payable towards the activities for the disabled run by the adult education associations. Culture and leisure-time The co-operation between the adult education associations and the organizations for the disabled has also led to increased opportunities for the disabled to take part in cultural life, and special government aids are available. The training of interpreters for the deaf and the production of recorded books and books in Braille for the visually handicapped as well as easy-to-read books for the intellectually handicapped are also financed in this way. Furthermore, government subsidies are available for the publishing of newspapers for the visually impaired and for theatre for the deaf. Leisure activities for the disabled, long a neglected area, are receiving increasing attention. Government financial support is now available for trying out new methods of making it easier for the disabled to take part in different kinds of leisure activities. Of particular note is the rapid expansion of sport for the disabled and the great successes won by handicapped sportsmen. Working life "Employment for All" is the aim of Swedish employment policy. It also includes measures to further disabled persons' employment opportunities on the open market and to create employment for those who do not obtain such employment. An easily accessible work environment is necessary if disabled persons are to obtain work. In addition to the provisions of the Building Act, which also cover work premises, the Work Environment Act now prescribes that the employer is obliged to adapt working conditions (physical environment, work organization, etc.) to individuals' physical and mental requirements, including those of individuals with various disabilities. The disabled have, like others, the right to assistance from the regular employment office in finding employment. The labour market authorities have at their disposal a number of labour market policy measures which aim to make it easier for the disabled to obtain employment on the open labour market or to create alternative employment: - Work testing, work training and in-depth vocational guidance which take place at employability institutes (arbetsmarknadsinstitut). The government has the entire financial responsibility for this organization, which is part of the Labour Market Administration (Arbetsmarknadsverket). - Vocational training which takes place at labour market training centres. - Training on the open labour market. Subsidies are payable to the employer. The trainee is employed and receives wages and employment benefits in accordance with collective agreements. - If there is a trade agreement allowing appointment on probation-and if the parties agree - probationary appointment may be combined with the training of elderly and disabled persons in a company. The employment service can give subsidies for the individual adaptation of work places and work aids. Special mention may be made of: - special arrangements at the work place (e.g. alterations to an individual work place, work premises, entrances or communications), - special technical aids, - grants for a work assistant. The aim of labour market policy measures for the disabled is to enable a person with disabilities to obtain employment on the open labour market, within sheltered employment or as a self-employed person. In order to make it easier for the disabled to obtain employment, wage subsidies may be paid to the employer. Rehabilitation must not be a lengthy procedure, but rather a short, intensive period of medical, social and work-training with the aim of allowing the individual to return to work as soon as possible. There is no quota for the employment of disabled persons in Sweden. Samhall is a government-owned group of companies responsible for all sheltered employment in Sweden. The group was set up in 1980 through the amalgamation of all sheltered workshops and industrial relief work facilities in Sweden. Today, there are 24 county enterprises, each with an average of 14 workshops (28,500 employees) and responsible for its own personnel development, sectorial coordination, production and marketing. Work organization and product mix have to be viewed in relation to the capacity of the employees. The workshops are concentrated on industrial manufacturing and output. The greater part of the output is based on subcontracts with other enterprises. 46% of income is derived from own sales, and 54% from State grants. Jobs at all workshops are placed at the disposal of the Employment Service. The task of Samhall is to provide employment for disabled persons who are unable to find or retain jobs on the regular market. Employment by Samhall must enhance the prospects of the person concerned to attain employment on the regular labour market. In 1974 two laws came into force with the aim of strengthening the situation of employees on the labour market, and in particular that of the elderly and the disabled. The Security of Employment Act is intended to give all employees increased job security. Elderly and disabled employees are given special protection by rules for the order in which employees are to be dismissed or laid off. The Act Concerning Certain Employment-promoting Measures contains rules which aim to increase the opportunities of the elderly and the disabled to obtain employment on the open market. It enables the labour market authorities to negotiate with employers and trade unions, to demand information and, as a last resort, to order the employer to employ the staff the employment service office indicates. There has been a negative trend in the employment of the disabled during the last few years. Labour market policy is aimed at breaking this trend and increasing disabled persons' opportunities for obtaining employment, above all on the open market. A special social service available for intellectually handicapped adults exists in the form of day centres. Social insurance Within the national insurance scheme there are a number of benefits of special interest to the disabled. The disability pension is intended to provide basic economic security to those aged 16 or over, who have not reached the general retirement age of 65 and who for medical reasons, i.e. illness or other reduction in physical or mental performance, cannot support themselves by employment. A disability pension may be granted if work capacity is permanently reduced by at least half. A full, two-thirds or half pension may be paid depending on the extent to which work capacity is reduced. Disability pensions are found both in the form of a basic pension and a supplementary pension. A full disability pension under the basic pension scheme is the same as the old-age pension, i.e. 96% of the base amount (SEK 27,900 in 1990), which is the basis for indexation and calculation of social insurance benefits. A disability pension under the supplementary pension scheme may be granted to anyone who has had a pensionable income for a certain number of years. Pension supplements are payable to anyone with a low or no supplementary pension. The disability pension is taxable income. Decisions regarding disability pensions are made by the social insurance office. The temporary disability pension is subject to the same rules as the disability pension. It is granted for a limited period and is payable if the reduction in work capacity is not considered to be permanent, but is expected to continue for a considerable period, as a rule a minimum of one year. The aim of the disability allowance is to give the disabled person financial compensation for the extra costs which the disability involves. A person aged 16 or over, who has become disabled before the age of 65, is entitled to a disability allowance. Physical or mental function capacity should be reduced for a considerable period, as a rule a minimum of one year, and to such an extent that the insured: - requires fairly time-consuming help from another person in his everyday life, - requires continuous help from another person in order to be able to work or study, - has considerable additional costs in some other way. The size of the disability allowance depends on how much help is needed and the additional costs incurred, and may be 65%, 50% or 34% of the base amount. Disability allowances are always paid to the blind, the deaf and those with severely impaired hearing. No disability allowance is payable in the case of a person receiving care in an institution belonging to or in receipt of a grant for operating costs from the public authorities. The disability allowance is not taxable. Decisions regarding the disability allowance are made by the social insurance office. Child care allowances are paid to parents taking care of children under 16 years of age, who due to illness, intellectual handicap or other disability require special care and supervision for a considerable period of time. The child care allowance includes both compensation for the care of the child and compensation for the additional costs arising from the child's disability. The compensation for the care is taxable. Child care allowances at 100%, 50% or 25% of the full allowance are paid according to the extent of the need for care and the additional costs. The amounts are the same as corresponding percentages of the disability pension under the basic pension scheme plus pension supplements.