sou · GSB3103 · 2005-01-01 00:00:00 — In the same way as advice and support, special personal support will be an area of activity that is closely associated with certain aspects of health and care. It should be easiest to build up cooperation, create coordinating development measures and achieve common benefits if the county councils are responsible for the organisation and provision of these activities. The special knowledge and skills needed for the provision of these measures normally require a greater recruitment area than the average-sized municipality. Furthermore, county councils generally have a well- developed organisation that can provide a good basis for personal support. The division of responsibilities set out in Section 2 of LSS, whereby the county councils have the overall responsibility for measures pursuant to Section 9, paragraph 1 should therefore be maintained. As with advice and support, special personal support shall be characterised by special knowledge about the conditions governing the lives of, opportunities for and problems of persons with extensive and permanent functional impairments. This support should be provided by experts – individuals or teams – with a broad knowledge of the , psychological, social and educational aspects of various functional impairments. As in the case of advice and support, the measures can only be provided to individuals that qualify under Section 1 of LSS and only at the request of the individual or his or her legal representative. Measures will only be provided if there is an evident need for support measures that are clearly related to the individuals functional disability. This also applies to any indirect support measures to relatives. Special personal support can be seen as a general and coordinating service. For an individual, personal support can play a decisive role in creating the conditions for a good standard of life and opportunities for participation in the life of the community. Special personal support shall strengthen the individuals position as a member of society and make it easier for people with extensive and permanent functional impairments to live independent lives with full participation in the life of the community. The support shall be characterised by self-determination, adaptation to the needs of the individual and continuity, and will be based on each individuals unique situation in life with a special focus on the specific conditions that apply to his or her functional impairment. Among the strengths of the new system of special personal support will be flexibility and adaptation to needs. It will also be characterised by an open attitude towards new research and development findings that can lead to new working methods or measures in the area of special personal support. The aim is to ensure that the functional impairment disables the individual as as possible. Points of departure for special personal support will be each individuals specific needs, the individuals right to self- determination and the objective of the measures. Access to special knowledge and skills is fundamental in ensuring a high level of quality. It would be too restrictive to describe the content of special personal support on the basis of a list of available experts, but the professional categories that are currently used for todays advice and support measures could serve as a basis for the skills needed for the provision of special personal support. Decisions about measures should be based on the, often varying, needs that the individual has and on an overall assessment, where the focus and extent of the measures is weighed against the benefits and the of achieving the desired objective. The measures should be provided on the basis of a holistic approach that aims to fulfil the individuals needs in an all-round . When necessary, it should be possible to coordinate different forms of support measures so that they interlink to provide the best possible quality, with the greatest possible efficiency. The individual should be able to exercise considerable influence over the objectives of the measures. As regards the organisation of the support measures, the experts are responsible for offering adequate help, on the basis of their knowledge, while at the same time taking into account the individuals points of view. In collaboration with the individual, and where necessary with his or her relatives, single or teams of experts shall endeavour to meet the individuals needs. Together the experts special skills and competence and a well-developed working method shall combine to create conditions to achieve the objective of a good standard of life. One aspect of the experts skills and competence is the ability in this process to treat the individual with respect by allowing room for both participation and self-determination. It is important that special personal support is a flexible system of measures that can be supplemented partly according to individual needs, and partly according to changing circumstances arising from technical developments and other knowledge and skills development. There is point, therefore, in drawing up a comprehensive list of measures to be included in the concept. However, based on existing experience of the contents of advice and support, three aspects can be identified as the cornerstones of special personal support: knowledge support, psychosocial support and special supplementary support. It is important not to make a sharp distinction between these aspects, since the greatest benefits can be achieved if a combination of skills and competence can interact in a way that best corresponds to the individuals needs. This cross-cutting working method may continue to cause problems regarding the delimitation of measures, but a demand for clear guidelines and detailed control must be weighed against the individuals need for specially adapted measures. According to the main proposal, a clarification of the measures means that it will be possible, within the framework of special personal support to provide supplementary measures – qualitatively or quantitatively – that can be regarded as habilitation and rehabilitation in cases where these needs fail to be met in other ways. This applies to all four aspects that are normally considered to make up habilitation and rehabilitation – , psychological, social and educational. The Swedish and the Authorities have voiced objections against the main proposal, and it cannot be ruled out that these objections may influence the outcome of a decision about the implementation of the main proposal. For this reason, and since the Inquiry is keen to ensure that a clarification of measures for advice and support will provide a high level of quality, an alternative proposal is also presented as a compromise proposal. When the report is circulated for comments an assessment can be made of both proposals in relation to the current application of advice and support measures. The alternative proposal is also based on three aspects, where knowledge support and psychosocial support have the same content as the main proposal. The third aspect is development and activity support. In the alternative proposal, just three aspects of habilitation and rehabilitation, that is the psychological, social and educational aspects, may be included as supplements. So as not to influence the principles that are considered to guide health and services, the aspects of habilitation and rehabilitation cannot be included as a possible supplement. To compensate for this, in part, some specific measures have been described as regards development and activity support. Individual plans and a coordinating function During the course of the inquiry, a clear connection has emerged between central aspects of special personal support and the provisions on individual plans in Sections 10 and 14 of LSS. This includes information, appraisals, planning, coordination, follow-up and evaluation. The connection has been underlined by responsible authorities, administrators and user representatives. Individual plans have been highlighted as an instrument that should be developed in order to support a cooperation process where the individual is given a real influence over planning and follow-up of various measures. The plans can also give the individual a clear overview of different measures and the need for coordination. Individual plans can be regarded as a between measures in the form of special personal support and other activities intended to provide support to the user. Today, individual plans are used to a very limited extent and the legislators intentions have not been fulfilled. One reason for this may be that it is up to the individual himself or herself to ask for a plan, and that knowledge of this option is lacking. In order to increase the use of individual plans, and consequently to strengthen opportunities for influence and self-determination, the Inquiry proposes that Section 10 of LSS be amended. When a measure is granted pursuant to LSS, the responsible authority shall be obliged to inform the individual of the opportunity to draw up an individual plan. According to the proposal, the plan is to be followed up, evaluated and reviewed at least once a year. For many users, coordination of various support measures is a recurrent need, and an important aspect of measures in the form of special personal support. In particular, families with children that have several functional impairments need to coordinate a number of different support measures. Sometimes parents or other relatives are compelled to take on the task of finding and coordinating these contacts without really having the prerequisites to do so. In order to enhance the quality of the coordination process and to ensure greater continuity, the Inquiry proposes that the individual should have the option of being assigned a specific, named coordinator within the context of special personal support. The coordinator shall help the user and his or her relatives to find what they are looking for among the available health care and social services. The coordinator can help to simplify contacts between various support persons and to increase opportunities for continuity in cooperation with users and their relatives. The Inquirys proposals for clarifications through special personal support mean an enhancement of the existing system of measures for advice and support that can serve to increase the quality of support to persons to whom LSS applies. It is especially important to develop certain aspects of the measures, for example, coordination processes. Other quality criteria which can also be developed are the individuals right to exercise an influence and to self-determination. Regional R&D activities could be a way to develop qualitative methods and follow-up instruments in close consultation with user representatives and staff. has underlined the need for staff skills development and stresses the importance of extending the special skills that are needed in care of the disabled, inter alia, to increase feelings of professional belonging. In this area too, regional or local R&D activities should have the potential to contribute to quality development. Basing these activities in the local community makes it possible to take advantage of the staffs knowledge in order to develop work in the field of special personal support. R&D departments have been set up in the social services and elderly care services with the help of state incentive funds. The Inquiry proposes support to a corresponding development of R&D projects with the aim of elaborating objectives, content, working methods and staff skills in the field of special personal support. It therefore proposes that funds amounting to million per year are distributed regionally for a period of five years. It is probable that the proposal for a clarification of measures will lead to an increased use of resources in the field of special personal support. A central question in the impact assessment is whether or not the need for advice and support measures and habilitation and rehabilitation measures is satisfied today. In financial terms the question can be put as follows: Do the costs exist to satisfy needs today, or will new users mean additional costs? If the costs exist, the clarification will not involve any additional costs, but it is necessary to elucidate who bears the costs today. The county councils bear the overall responsibility for measures in the form of advice and support. Since 1994, when LSS superseded the Care Act, county councils have received a government grant of million per year to cover the additional costs that could be estimated to incur when a larger group was given the right to measures. Among most responsible authorities it is impossible to distinguish these funds, since separate accounts cannot be presented. It is therefore very difficult to analyse how these funds have been used and how they relate to other costs for advice and support activities. One reason is that the responsible authorities work in an integrated with advice and support in habilitation activities and in many cases have the ambition primarily to offer the support in the form of habilitation pursuant to the Health and Act. Surveys show that less than 20 per cent of the government grant is used for advice and support, and that between 60 and 80 per cent is used for habilitation and rehabilitation purposes. The tendency to use the government grant largely for habilitation and rehabilitation purposes means that it is likely that individuals to whom LSS does not apply are also at the receiving end of the additional resources. This also causes a lack of clarity as to the extent to which the resources satisfy the needs of persons to whom LSS does apply. From a financial perspective, the proposal for special personal support should mean a redistribution of funds that are earmarked for advice and support – funds that are largely used for habilitation and rehabilitation purposes today. Presuming that the demand for support measures increases and based on certain assumptions, the projected estimations show that this increase will not give rise to additional costs over and above the government grant. It should also be possible to finance the proposal for support to the development of R&D departments amounting to million per year through a redistribution of funds within the limits of the current government grant. Private activities under LSS Section 23 of LSS regulates, inter alia, the issue of mandatory licences for activities conducted on a commercial basis. According to this provision, no private person may conduct on a commercial basis activities such as are envisaged in Section 9, subsections 6 10 of LSS. This includes housing providing special services. The background to the Inquirys assignment regarding a clarification of the scope of Section 23 of LSS is that the Parliamentary Ombudsmen have informed the Government that there are differences in opinion as to whether the provision on mandatory licences is applicable when a municipality transfers the management of housing providing special services for adults under Section 9, subsection 9 of LSS to a private legal subject. The application of Section 23, i.e., of whether or not licences are mandatory has, at any rate until the summer of 2001, varied between different county councils. In a statement to the Parliamentary Ombudsmen, notes that licences are also mandatory in the case of contract activities, and that any deviations require a direct exemption in the law or some clear form of statement about the possibility of granting exemptions of this kind. Since the announcement of the Parliamentary Ombudsmens decision in the summer of 2001 and the adoption of guidelines by the county councils in the autumn of 2001 relating to licences to conduct activities on a commercial basis pursuant to Section 23 of LSS, provisions on mandatory licences have been applied in a uniform . The Inquiry considers that it seems most logical to adopt the same interpretation of the provision on mandatory licences in Section 23, paragraph one of LSS as . If a municipality, in the case of housing providing special services for adults pursuant to LSS, maintains responsibility for the provision of housing and any common premises – but on the basis of Section 17 of LSS – transfers the management thereof to a private legal subject, the private legal subject must consequently apply for a licence from the county council. Today, all county councils require that persons or bodies conducting private contract activities pursuant to LSS apply for a licence, which means that there is a uniform interpretation of Section 23 of LSS. According to the Inquiry, therefore, there is no need for a clarification of the law. The responsibility of municipalities to provide health and care for persons living in special forms of housing According to the terms of reference, the Inquiry shall clarify the issue of municipalities responsibility to provide health and care for persons living in housing providing special services for children and young people and in housing providing special services or other specially adapted housing for adults. There are currently different interpretations of municipalities responsibility to provide health and care for persons living in housing providing special services pursuant to LSS. This may be due to the fact that this form of accommodation is not mentioned in Section 18 of the Health and Act. The Inquiry has established that it is logical that municipalities responsibility to provide health and care should also apply to housing providing special services under LSS, in conformity with housing providing special services under the Act. The same conditions should also apply to the corresponding forms of accommodation covered in Section 23 of LSS. However, the Inquiry has learnt that there are demarcation problems between health authorities that negatively affect the provision and quality of health and care for the intended target groups. For this reason, it is important to take into special consideration the skills that are required to ensure that the needs of persons to whom LSS applies are satisfied. There is a risk that municipalities – in particular smaller municipalities – do not have the necessary resources to develop these skills. The Inquiry therefore proposes that the municipalities responsibility to provide health and care under Section 18 of the Health and Act should also comprise individuals who have been granted housing providing special services pursuant to Section 9, subsection 8 or 9 of LSS. The municipalities responsibility for these persons should not include health and care that is provided by a doctor or care that requires a hospitals or technical resources or other specialist skills. The term other specialist skills refers to support from experts, inter alia, with knowledge of extensive and permanent functional impairments. Such skills are normally found in the county councils habilitation services for children and young people and for adults. It is proposed that the municipalities responsibility to provide health and care should only include housing with special services for children and young people who need to live away from their parental home pursuant to Section 9, subsection 8 of LSS and housing providing special services for adults, pursuant to Section 9, subsection 9 of LSS. Responsibility for health and care for persons living in a family home pursuant to Section 9, subsection 8 of LSS and for persons living in other specially adapted housing for adults pursuant to Section 9, subsection 9 of LSS rests with the authority responsible for home care. lag om ändring i lagen (1993:387) om stöd och service till vissafunktionshindrade (Huvudförslag) Härigenom föreskrivs i fråga om lagen (1993:387) om stöd och service till vissa funktionshindrade dels att rubriken till lagen skall ha följande lydelse, dels att 9 och 10 §§ skall ha följande lydelse, dels att det i lagen skall införas en ny bestämmelse, 10 a §, av följande lydelse. Lag (1993:387) om stöd och service till vissa funktions- hindrade Lag (1993:387) om stöd och service till vissa personer med funktionshinder. Insatser enligt denna lag skall ges den enskilde endast om han begär det. Om den enskilde är eller uppenbart sak- nar förmåga att på egen hand ta ställning i frågan kan vårdnads- havare, god man, förmyndare eller förvaltare begära insatserna för honom. Insatser enligt denna lag skall ges den enskilde endast om han eller hon begär det. Om den enskilde är eller uppenbart saknar förmåga att på egen hand ta ställning i frågan kan vårdnadshavare, god man, förmyndare eller förvaltare begära insatserna för honom eller henne. Insatserna för särskilt stöd och särskild service är 1. rådgivning och annat per- 1. särskilt personligt stöd som sonligt stöd som ställer krav på ställer krav på särskild kunskap särskild kunskap om problem om problem och livsbetingelser och livsbetingelser för männi- för personer med stora och var- skor med stora och varaktiga sen ingår sådan habilitering och rehabilitering som inte tillgodoses genom insatser enligt hälso- och sjukvårdslagen (1982:763). 2. biträde av personlig assistent eller ekonomiskt stöd till skäliga kostnader för sådan assistans, till den del behovet av stöd inte täcks av beviljade assistanstimmar enligt lagen (1993:389) om assistans- Med personlig assistans enligt Med personlig assistans enligt 9 § 2 avses personligt utformat 9 § 2 avses personligt utformat stöd som ges av ett begränsat stöd som ges av ett begränsat antal personer åt den som på antal personer åt den som på grund av stora och varaktiga grund av stora och varaktiga med sin personliga hygien, mål- med sin personliga hygien, mål- tider, att klä av och på sig, att tider, att klä av och på sig, att ingående kunskaper om per- de behov). (grundläggande behov). Den som har behov av personlig assistans för sina grundläggande behov har även rätt till insats enligt 9 § 2 för andra personliga behov om behoven inte tillgodoses på annat sätt. Som kostnad för personlig assistans enligt 9 § 2 anses inte i något fall ersättning som den enskilde själv lämnar 1.till någon som han eller hon lever i hushållsgemenskap med, 2.till en personlig assistent för arbete som utförts på arbetstid som överstiger den tid som anges i 2 4 §§ lagen (1970:943) om arbetstid m.m. i husligt arbete. I samband med att insats I samband med att insats enligt denna lag beviljas kan den enligt denna lag beviljas skall enskilde begära att en individuell den enskilde erbjudas att en plan med beslutade och plane- rade insatser upprättas i samråd och planerade insatser upprättas I planen skall även i samråd med honom eller redovisas åtgärder som vidtas av I planen skall även redo- visas åtgärder som vidtas av löpande och minst en gång om löpande och minst en gång om året följas upp, utvärderas och samtycke, skall och om innehållet i upprättade pla- I samband med att insats enligt 9 § 1 beviljas skall den enskilde erbjudas stöd i form av en namn- Kommunen får besluta om åter enligt 9 § första stycket 2, om 9 § första stycket 2, om den som den som erhållit stödet eller erhållit stödet eller hans eller hans ställföreträdare genom att lämna oriktiga uppgifter eller på att lämna oriktiga uppgifter eller annat sätt har förorsakat att det på annat sätt har förorsakat att ekonomiska stödet har lämnats det ekonomiska stödet har läm- felaktigt eller med ett för högt nats felaktigt eller med ett för Detsamma gäller om det lämnats felaktigt eller med ett annars har lämnats felaktigt eller för högt belopp och den som erhållit stödet eller hans ställ- företrädare skäligen borde ha insett detta. med ett för högt belopp och den som erhållit stödet eller hans eller hennes ställföreträdare skä- ligen borde ha insett detta.