The effects of rationing home-help services in Spain and Sweden: a comparative analysis

Abstract

In both Spain and Sweden the most important public support for older people that is provided in their own homes are home-help services. In Sweden, these programmes were expanded in years of economic growth but recently have radically declined. Spain still strives to expand them in spite of financial problems. Both countries ration these services but in different ways. Spain provides relatively few hours of help with household tasks, primarily to poor old people. At present, one to two per cent of the 65-plus population is covered. Local government is still trying to reach more people to relieve pressure on limited institutional care. Sweden continues to cut down the service from the present coverage of nine per cent of the 65-plus population. It is focusing on the oldest and frailest people of all social classes who live alone. It is gradually being transformed into home health care. Institutional care has not been cut back to the same degree. Spain uses strict needs assessments and eligibility criteria to target clients. Sweden has sharpened its needs assessments and raised fees to discourage users with lesser needs.