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Our commission in relation to attendance allowance

Text Rätten till assistansersättning

If you are interested in understanding Försäkringskassan’s commission in relation to attendance allowance, this page provides information on who pays attendance allowance, laws that regulate who is entitled to assistance, and what other support is available to individuals with a permanent disability.

The commission in brief

Försäkringskassan and the municipalities of Sweden have a shared responsibility to provide support to individuals with disability. We are tasked with investigating and making decisions about the right to receive government attendance allowance. We are to do this based on applicable legislation, so that we can make decisions based on equality and that are compliant with the law and we can ensure that the right person receives the right compensation at the right time.

Who can receive attendance allowance from Försäkringskassan?

In order to receive attendance allowance from Försäkringskassan, the person must be categorised into one of the groups described in the Act regarding Support and Service for Persons with Certain Functional Impairments (LSS). These three groups are called categories. In addition to being in one of these categories, the person must have a basic need for at least 20 hours a week.

Shared responsibility with the municipalities

Försäkringskassan shares the commission to pay compensation for personal assistance with the municipalities. Försäkringskassan takes over responsibility for paying personal assistance compensation from the municipality when the person’s basic need exceeds 20 hours a week. We pay attendance allowance, which the person then uses to choose how the personal assistance should be organised. The assistance can be organised by a municipality, a cooperative, or an assistance provider. It is also possible for the person to employ their own assistants.

Support from the municipality

There are several support measures available to persons with disability. Examples include attendant service, contact person, relief service, short-term stay, short-term supervision, special housing, and daily activities. The majority of the support to individuals with disability and their families is given by the municipality, which is responsible for 88 per cent of the measures. If a person needs care as the result of their disability, e.g. enteral nutrition, the healthcare sector takes responsibility for this.

Legally compliant assessments

Försäkringskassan bases its decisions on the laws and rules in force in order to ensure that the right person receives attendance allowance, and to ensure that the assessments are equal and legally compliant. Since attendance allowance was introduced in 1994, the criteria for receiving the allowance have been clarified by, among other things, rulings in the Supreme Administrative Court. Försäkringskassan follows the practice set by the courts. This could lead to changes in the decision of who is entitled to attendance allowance and to what extent.

Rulings that have affected current development

A number of precedent-setting rulings have particularly affected the current development of who is entitled to attendance allowance.

A healthcare intervention that takes place in accordance with the Health and Medical Service Act shall never be included in the assessment of the number of assistance hours a person needs. This is because healthcare is provided and financed by the healthcare system.

Self-care is a measure that the healthcare system has determined that the person or another individual can perform. Self-care can be included in the assessment of how many assistance hours are needed.

The doctor’s statement for attendance allowance shall therefore specify whether the assistance should be provided as a healthcare intervention or through self-care.

Healthcare and self-care 2012PDF opens in a new window

 

Försäkringskassan has interpreted a ruling from the Supreme Administrative Court (HFD 2012 ref. 41) to mean that healthcare interventions in the form of self-care cannot be a basic need.

Försäkringskassan clarified the interpretation in 2016, leading to time for (for example) self-care in the form of enteral nutrition not being categorised as basic needs. Self-care can be included in the assessment of the need for assistance hours, but not based on the criteria for basic needs.

In December 2016, the Administrative Court of Appeal in Gothenburg (3208-16) interpreted the Supreme Administrative Court’s ruling differently. This indicates that the legal situation is unclear when it comes to whether self-care can be a basic need or not when assessing the right to attendance allowance.

Försäkringskassan is obliged to follow practice from the Supreme Administrative Court. Försäkringskassan is appeals rulings to the Supreme Administrative Court when guidance is needed. In that the Administrative Court of Appeal has a different interpretation of the Supreme Administrative Court’s ruling, and since assessment of what constitutes a basic need is crucial for the right to personal assistance, we feel that a new guiding ruling from the Supreme Administrative Court is needed to clarify the legal situation. 

Through clear guidance, we can make legally-grounded and fair assessments, ensure that the right person receives the right compensation, and ensure that there is continued confidence in attendance allowance. Försäkringskassan is therefore appealing the Administrative Court of Appeal’s ruling to the Supreme Administrative Court.

 

When the parents of a child with a disability apply for attendance allowance, Försäkringskassan assesses how much assistance that child needs. The assessment takes into consideration the normal parental responsibility, i.e. how much help and support a child without that disability would need.

To be able to assess the right to attendance allowance for children, Försäkringskassan has relied on different rulings for clarity as to what is part of normal parental responsibility based on normal child development at different ages. This means, for example, that the basic need for personal hygiene is not a parental responsibility for a child who is nine years old.

Parental responsibility 2015

ISF 20143:6 Parental responsibility

 

In 2015, the Supreme Administrative Court decided that the fifth basic need only applies to personals with mental disability.

To be able to assess the right to attendance allowance, Försäkringskassan has interpreted the court’s ruling and clarified the definition of mental disability.

If the need for help is a result of mental disability and the need can be connected to any of the other basic needs, then the fifth basic need can be included in the assessment of the right to attendance allowance.

Fifth basic need and mental disability 2015 PDF opens in a new window

 

The decision is reviewed every other year

By law, Försäkringskassan shall review the decision on attendance allowance every other year. Reviewing involves investigating what need the person has for assistance and assessing the right to attendance allowance based on current laws and practice. When practice changes, the decision on entitlement to attendance allowance could also be changed. This could be the case even if the person’s disability or need has not changed.

If reconsideration leads to attendance allowance from Försäkringskassan being revoked, the responsibility shifts to the municipality. In such cases, the person may be eligible for support measures under LSS or the Social Service Act. Försäkringskassan is obliged to inform the municipality when attendance allowance is revoked.

Frequently asked questions

National attendance allowance is one of several types of support that persons with disabilities may be entitled to. The law states that this type of support is intended to help those who need assistance with five specific needs categories (see below) for more than 20 hours a week to be able to live their lives like everyone else.

While someone who does not reach this threshold may nonetheless be in great need of assistance, such assistance should instead by provided through, for example, the healthcare sector or their municipality.

The increase in the number of people receiving attendance allowance can be largely explained by legislative changes, case law and norms. The increase has varied over time for different age groups and depending on the disability. But, the number of recipients has been around 16,000 since 2009.

Two legislative changes have had a particular impact on the number of attendance allowance recipients:

  • The 1996 introduction of the fifth basic need, i.e. “other assistance that requires in-depth knowledge”.
  • Elimination of the upper age limit in 2001, which means that people can continue receiving attendance allowance even after they turn 65 years of age.

When attendance allowance was introduced in 1994, the average was 67 hours per person and week. This figure was 127.5 hours per week for 2016.