<doc.id=3503.b1>
<title> The number of elderly in great need of treatment has increased. </title>
The number of elderly in Stockholm who are in need of help in their homes during eveningsand nights has increased. The home help service in Stockholm has witnessed how this development has had an impact upon their work. Despite the fact that the number of pensioners in Stockholm has been on the decrease between 1993 and 1998 those in need of help at home have increased by 43 percent during this period. 1There are several factors that could help to explain this development. 
 Today the pensioners get much support from the home help service. This service makes it possible for disabled and others with minor handicaps to manage their day-to-day lives at home. Yet the quality of the public medical service has deteriorated in Sweden. Certain economic measures taken by the government during the 90s could be seen as one reason for the impairment.
One could say that elderly people choose to stay at home out of ideological reasons. That is, they are comfortable in their homes and are aware of the fact that there has been a deterioration of the public medical service. Another due to a shortage of staff, relatives of the elderly have made considerable contributions in order to sustain the quality of the service at home. 2 Yet there must be another explanation of the problem, since there has been an increase of the number of patients staying at home who would benefit from help at a nursing home. 
The development of technical facilities in society has made it possible to install technical means of assistance in the homes. These facilities have made the patient more able to manage day-to-day life and they have also helped to decrease the number of occupational injuries amongst the keepers. Another practical reason why such a large number of elderly remain in their homes is the development of medical treatment. The course of the disease can now be slowed down and the patient is no longer in need of emergency treatment. But there are patients who are unaffected by this development and still in need of a different kind of help. 
I would rather say that this phenomenon could be seen as an economical question for all parts involved. Today it costs 1000 SKr for each patient to stay in a service home for 24 hours. This sum could be compared to 1500 SKr, which is the cost for the most demanding patients. Even if it costs more in some cases to remain at home, the patient is less demanding for a service home that already has a shortage of staff. This also leaves another bed vacant for a patient who is in need of emergency treatment. 
There has not yet been any investigation concerning the question whether pensioners staying at home have chosen to be in this situation or not. Even if they have made a personal choice I find it hard to imagine that this decision has been unaffected by the difficult economical situation of the national public health service. 
The home help service in Stockholm has also got problems with shortage of personnel. Only 75% of the staff have a relevant education and 50% are trained nurses. When considering the fact that the elderly stay at home until they are ill enough to get a place at a service home, this lack of skilled nurses seems to be an acute problem.
, as long as it is their choice. As the situation is today, the question of finances is too dominant to be ignored. 
Perhaps this will be a much-debated question in the future when the number of pensioners will increase and create more job-opportunities and hopefully also creative solutions to the problems.
</doc>