Swedens

A wave of death in Sweden’s nursing homes has exposed holes in a famously generous safety net.

In the popular imagination, Sweden does not seem like the sort of country prone to accepting the mass death of grandparents to conserve resources in a pandemic.

Swedes pay some of the highest taxes on earth in exchange for extensive government services, including state-furnished health care.

Yet among the nearly 6,000 people whose deaths have been linked to the coronavirus in Sweden, 2,694, or more than 45 percent, had been among the country’s most vulnerable citizens — those living in nursing homes.

That tragedy is in part the story of how Sweden has, over decades, gradually yet relentlessly downgraded its famously generous social safety net.

Since a financial crisis in the early 1990s, Sweden has slashed taxes and diminished government services. It has handed responsibility for the care of older people — mostly living at home — to strapped municipal governments, while opening up nursing homes to for-profit businesses. They have delivered cost savings by relying on part-time and temporary workers, who typically lack formal training in medicine and elder care.

Sweden has also substantially reduced its hospital capacity over the last two decades. During the worst of the initial outbreak, elderly people in nursing homes were denied access to hospitals for fear of overwhelming them.

Some nursing home operators assert that residents have been the victims of the government’s failure to limit the spread of the virus. The country avoided the lockdowns imposed in much of the rest of Europe. Though the government recommended social distancing, it kept schools open along with shops, restaurants and nightclubs. It did not require that people wear masks.

“There’s been more society transmission, and it’s been more difficult to hinder it from entering the care homes,” said Joacim Rocklov, an epidemiologist at Umea University. “The most precious time that we lost, our mistake

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How cuts to Sweden’s social welfare state led to a wave of death in nursing homes.

Among the nearly 6,000 people whose deaths have been linked to the coronavirus in Sweden, 2,694, or 46 percent, had been among those living in nursing homes.

That tragedy is in part the story of how Sweden has, over decades, gradually yet relentlessly downgraded its famously generous social safety net, report Peter S. Goodman and Erik Augustin Palm.

When the pandemic hit, the nursing staff at the Sabbatsbergsbyn nursing home in the center of Stockholm found itself grappling with an impossible situation.

It was the middle of March, and several of the 106 residents, most of them suffering dementia, were already displaying symptoms of Covid-19. The staff had to be dedicated to individual wards while rigorously avoiding entering others to prevent transmission. But when the team presented this plan to the supervisors, they dismissed it, citing meager staffing, said one nurse, who spoke on the condition on anonymity, citing concerns about potential legal action.

The facility was owned and operated by Sweden’s largest for-profit operator of nursing homes, Attendo, whose stock trades on the Nasdaq Stockholm exchange. Last year, the company tallied revenue in excess of $1.3 billion.

On weekends and during night shifts, the nurse was frequently the only one on duty. The rest of the staff lacked proper protective gear, said the nurse and a care aide, who spoke on condition of anonymity for fear of being fired. Management had given them basic cardboard masks — “the kind house painters wear,” the nurse said — while instructing them to use the same ones for days in a row. Some used plastic file folders and string to make their own visors.

By the time the nurse quit in May, at least 20 residents were dead, she said.

“The way we had to work went against everything we learned in

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