The right to assistance must not be determined by a budget that does not add up

Personal assistance is fundamentally not about schedules, reimbursement levels, or operating margins. It is about something much simpler: the right to decide over one's own life. Being able to shower when you want, eat when you are hungry, go out when you want to go out, without being dependent on who happens to have time. That is why LSS (Law regarding Support and Service for Persons with Certain Functional Impairments) exists, and that is why personal assistance is one of the clearest human rights issues we have in Sweden. Not just one budget item among others.

Right now, that right is more fragile than it has been in a long time. Vårdföretagarna's latest Assistansbarometer (June 2026) shows how close to the edge an entire industry has come, and it is the users with the most extensive needs who risk being left without when the margins run out.

Where the limit is drawn

The operating margin in the assistance industry was 2.5 percent in 2024, the lowest in 16 years. A quarter of the companies were below 0.6 percent. Reimbursement has been increased by 1–3 percent per year in recent years, while labor costs have increased faster. The gap has existed for a long time, but it is now clearer than ever: three out of four assistance companies expect zero profit or a loss during 2026. Two out of three say they may be forced to close down operations during 2027 if the reimbursement is not increased.

Those are not just figures in a spreadsheet. It represents hundreds of operations at risk of disappearing. Operations that provide support to people with the most extensive needs: help with breathing, tube feeding, and personal hygiene—the most fundamental things one can need help with in life.

We believe this is wrong

We want to be clear about where we stand: it is wrong that the system is built so that the financial risk primarily falls on the providers, while the consequences of a shutdown affect the users who are most dependent on the support remaining. Someone who needs assistance to breathe, eat, and dress should not have to worry about their provider going bankrupt because the reimbursement has not kept pace with cost developments.

The figures in this post come from Vårdföretagarna, the industry organization for private providers specifically. This is worth stating outright, as they naturally have a self-interest in the reimbursement being raised. The fact that municipal assistance costs more than 30 percent more per hour than the state reimbursement is also not the whole picture: the municipality is obliged to accept all users regardless of profitability and therefore often carries the most complex and costly cases. Part of the cost difference is about that, not just efficiency.

Nevertheless, it does not change the fundamental problem. Regardless of how one calculates municipality versus private provider (and regardless of the fact that two out of three companies point toward closure), an operating margin of 2.5 percent is not a figure that can be ignored. Vårdföretagarna estimates that the state's costs could increase by around 8 billion SEK if serious private actors disappear; this is their own estimate, not an independent calculation, but the logic behind it still holds: a need that already exists does not disappear just because a provider does.

Trust has not always been earned

Personal assistance also has a history of fraud and over-utilization that cannot be ignored. IVO and Försäkringskassan have over the years revealed serious cases of private actors charging for assistance that was never provided. This is an important part of why trust in the industry as a whole is sometimes low, and it is reasonable for the state to set requirements and perform checks. But a historical problem with individual unscrupulous actors is not the same as questioning the entire principle of freedom of choice. The vast majority of providers do the right thing every day, and it is precisely the serious actors who are now being squeezed hardest by a reimbursement level that does not keep up.

This is not a minority problem in the industry

It is easy to think that a report like this is about the poor business management of individual companies. It is not. When two out of three actors in an entire industry say the same thing, it is not individual operations being poorly managed. It is a systemic failure. And almost eight out of ten Swedes, regardless of political party, believe that those entitled to assistance should also be able to choose who provides it. Support for freedom of choice is broad. It is the funding that is not keeping pace.

What we think should happen

Assistance reimbursement must follow actual cost developments. Not primarily for the sake of the providers, but so that the people who are most dependent on functioning assistance do not become a balancing item when margins are squeezed. The right to live like others cannot be conditional on whether the reimbursement is indexed by 1 or 3 percent in a given year.

Every day, we meet operations that do this job with great commitment, under increasingly tough economic conditions. They deserve a system that does not force them to choose between running at a loss and stopping the acceptance of users who need the most help. And above all: the people who rely on personal assistance deserve for that right to actually be reliable—not just on paper, but in practice, year after year.

Source: Vårdföretagarna's Assistansbarometer, June 2026 (Försäkringskassan, SCB, Vårdföretagarna's member survey spring 2026).