This is us – through time and space
These are the english translations for the exhibition ”This is us”. Scroll down to find the correct number for the text you want to read. You can also use the links below.
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1. The nurse
Sweden’s first trained nurse was Emmy Rappe (1835-1896). She was educated in England in 1866 and was taught by the famous nurse Florence Nightingale. Emmy was a pioneer with the ambition to elevate the status of the profession. Through her work, she contributed to starting up the Swedish nursing education.
In the beginning, the profession was considered to be a calling. A nurse was expected to be sacrificial, selfless, and unmarried in order to dedicate herself completely to patients. This is a view that has likely affected both the salary and status of the profession. From 1958, nursing has required professional certification and third-level studies.
Nurses are needed within both the region and the municipality. More and more people receive care in their home, which has increased the need for care professionals.
2.
Public schools and compulsory schooling
1842 – General four-year public school education is introduced
1882 – Compulsory schooling is introduced for children aged 7 – 14
1889 – Deaf children are subject to compulsory schooling
1896 – Blind children are subject to compulsory schooling
3. The family and the parish
Family and relatives took care of each other as far as possible. If a family was unable to do so, the parish was there as a safety net. The parish had a system for “transient parish paupers” (rotegång) where the very poorest had to move around between a number of farms. Depending on their ability, they could work in exchange for food and accommodation. There were also auctions of poor children and seniors. These auctions were banned in 1918.
4. The poorhouse
For those who could not be supported or cared for in some other way, there were the poorhouses. They were introduced in the 1680s and were run by the church congregations. Poorhouses were home to the healthy and sick, young and old. The poorhouses were replaced by old people’s age homes in 1918.
5. Every hand counts
In an agrarian society, generations often lived together and took care of each other throughout their lives. Much of the work was physical, which meant that everyone could contribute to the prosperity of the farm depending on their abilities and capacity to work.
6. Expressions and points of view
Terms and names are not simply words. They signal indebtedness, views, and responsibilities. In the past, expressions such as idiot, imbecile, backward, fool, cripple, invalid, and handicapped were used.
Nowadays we talk about disability or functional impairment. Today, society’s design and accessibility are decisive for whether a disability becomes an obstacle.
7. Exemption contract
At the end of the 19th century, those who owned their homes could use so-called exemption contracts as a way of guaranteeing their care later in life – a kind of pension system of the time.
8.
When the farmer’s wife Anna Lovisa Andersdotter became a widow in 1879, she transferred the farm to her son and grandson. They signed an exemption contract in which they pledged to support her for the rest of her life. Anna moved into a smaller cottage on the farm, the so-called exemption cottage.
9. Statistics 1900
Sweden’s population is about 5 million
40,000 emigrate mainly to America, 10,000 immigrate
Life expectancy: 54 for women, 51 for men
Urbanisation: 1.1 million live in urban areas, 3.7 million in rural areas
10.
“If you imagine a small shabby cabin with a couple of rooms, and the cabin is packed with poor, worn out old people living there together in a big pile of filth and lice and starvation and misery, then you know what poverty and the poorhouse are.”
– From Astrid Lindgren’s Emil in Lönneberga
11. Institutions and facilities
For long periods during the 20th century, the elderly and people with disabilities were placed in big institutions and facilities.
Some of these buildings were located a bit outside the city, where fresh air and open areas would have a positive effect on health. Despite these good intentions, these environments were often characterised by overcrowding and poor sanitary standards. The dormitories were cramped and there was no possibility of privacy when washing or using the toilet.
During the 1960s, conditions improved for patients who were given greater freedom and space. Now everyone was given their own bedside table and could wear their own clothes. During the 1980s and 1990s, these institutions were closed down.
12. Protect the person or society?
At the turn of the century, people with disabilities were protected by being placed in special institutions and schools. The purpose was to give them a more dignified life than they could have out in ordinary society.
When racial biology later gained a foothold, the argument changed. The institutions remained, but now the view was that it was the society that should be protected from these individuals who were considered to have a harmful influence.
At this time, laws were also enacted on sterilisation and the prohibition of marriage.
13. Sewing box made at Sankta Maria
14. Sankta Maria Hospital – a city within a city
In 1927, Sankta Maria was built, one of the country’s largest psychiatric hospitals and a workplace for hundreds of Helsingborg residents.
This was a place where the ”insane and mentally retarded” were cared for. Structure, work, and discipline would help to cure patients. At this time, medication was not as effective and was mostly based on trial and error.
The days at the hospital were monotonous, where routine and order were an important part. In the morning, the patients were woken and dressed, followed by washing and shaving. Once a week they could have a bath.
For the patients, there was much work to do in the hospital’s laundry room, tailoring workshop, bakery, shoemaking workshop, and gardens. The hospital was virtually self-sufficient for a long time. Sankta Maria was shut down in 1997.
15.
“We nurses often evolved into people experts, as we became skilled at reading and assessing people’s body language. We also learned to recognise different behavioural patterns and to evaluate the patients’ current state of mind and the situations that would trigger them.”
– Nurse at Sankta Maria during the 1960s.
16. Homes for chronic invalids, nursing homes, and long-term care
From the home for chronic invalids to long-term care
In addition to the municipality’s old age homes, there were also the county council’s homes for chronic invalids. These homes were for long-term patients, the chronically ill, and people with dementia.
The boundary between old age homes and homes for chronic invalids was often unclear. In old age homes, people could be as ill as those in care for chronic ailments.
As a development of the homes for chronic invalids, nursing homes were created, also called long-term care. Here, you could find doctors and other medical staff. The environment was reminiscent of hospitals with dormitories in long corridors. In conjunction with the Elderly Reform Act, the municipalities took over responsibility for long-term care.
17. Retirement homes
An alternative to the old age homes was retirement homes. These were often smaller apartments with simple standards and subsidised rent. This form of housing suited those who could manage on their own. They could avoid the institutional rules and the stamp of poverty that old age homes could entail.
18. ”Home care instead of care home”
Critical voices began to speak out against the old age homes and how they were run. One critic was the author Ivar Lo-Johansson. During the 1950s, together with photographer Sven Järlås, he documented various old age homes around Sweden which resulted in the publication ”Ålderdoms-Sverige”. Here he describes neglect, poverty, vulnerability, and coercion. ”Home care instead of care home” became his slogan.
19. Old people’s homes
The public pension insurance was introduced in 1913. The payouts were low and many older people could not support themselves and had to rely on society’s care services.
With the Poverty Relief Act of 1918, old age homes were introduced to replace the system for “transient parish paupers” (rotegång), auctioning the poor, and poorhouses. The old people’s homes housed a mixture of people with very different needs – the chronically ill, healthy, elderly, and people with disabilities. For most, this meant a better standard of living. As a resident of an old age home, you were categorized as receiving “poor relief” and therefore did not have the right to vote.
20.
The days are spent ”sitting on the edge of the bed and waiting for death”.
Ivar Lo: sit and wait for death.
21.
Interior from Sankt Lars Mental Hospital, Lund, 1910
22.
Painting of patient at Sankt Lars Mental Hospital
23.
Auxiliary nurse
The job of auxiliary psychiatric nurse has changed over the years. At the beginning of the 20th century, the main task was to monitor patients.
Today, the nurse’s main task is to support and motivate the individual to cope with their everyday life through conversation and practical cooperation. As an auxiliary psychiatric nurse, you need a degree in specialist nursing.
24
Freedom to decide for yourself
A man had spent his entire adult life in various wards in Sankta Maria Hospital. He had experienced some challenging periods, but over time he became healthier. When Sankta Maria was shut down, he moved to a group home in Helsingborg. There, he and the others residents managed their everyday lives with limited support. Now the man was able visit his family grave in the cemetery whenever he wanted, and not only when the staff had the opportunity to come along.
Smiling, he said:
”Now it’s me who decides what I want to do.”
25.
Pension
1913 – Public pension insurance was introduced for those aged 67 and over
26.
Restrictive laws
1915 – Those considered “insane” were not allowed to marry
27.
Right to vote
1918 – Voting rights for men
28.
Right to vote
1921 – Voting rights for women
29.
Restrictive laws
1935 – The Compulsory Sterilisation Act encompassed certain persons with disabilities, and the law was valid until 1975
30.
The “ageing in place” principle was the answer to the criticism
Criticism of old age homes was heeded and new perspectives guided the developments. No one should have to move to an old age home due to poverty. The “ageing in place” principle safeguarded the right to grow old and remain living in your home. It has since then been of central importance within Swedish elderly care.
31.
Physiotherapist
Physiotherapy has its origins in the 19th century when Per Henrik Ling founded medical gymnastics.
In today’s municipal organisation, physiotherapists work with rehabilitation, exercise programmes, and adapted physical activity for people with disabilities or mental illness.
To become a licensed physiotherapist, a university degree is required.
32.
Occupational therapist
An occupational therapist helps the individual to perform activities in their daily life. It is about supporting people in maintaining and developing their physical, cognitive, and social abilities. The occupational therapist helps with the testing, adjustment, and prescribing of physical and cognitive aids.
Occupational therapy came to Sweden in 1944 when Countess Estelle Bernadotte af Wisborg held the first course together with the Red Cross. Today, a university degree is required to become a licensed occupational therapist.
33.
Better living conditions make us healthier
During the beginning of the 20th century, housing standards improved when lighting, heating, water, and sewage became available. Hygiene improved when more people could wash themselves more regularly.
Modern medicines and the introduction of vaccination programmes made the population healthier in general as many serious diseases could be cured and disappeared from society.
Together with increased literacy and more exercise in everyday life, the Swedish population has become healthier and lives longer.
34.
Right to vote
1945 – Voting rights for people receiving “poor relief”
35.
Pension
1948 – National pension, payouts are raised to a reasonable level
36.
1944 – Children with developmental disorders who were considered educable are subject to compulsory schooling
37.
Statistics 1950
Sweden’s population is about 7.3 million
20,000 emigrate, 20,000 immigrate
Life expectancy: 73 for women, 70 for men
Urbanisation: 5 million live in urban areas, 2.5 million in rural areas
38.
“Home Samaritan” and residential care
Residential care originated in 1950s Uppsala when the Red Cross began to offer home help to the elderly. The so-called “home Samaritans” would help out with daily chores such as cleaning, cooking, walks, and health care. It was often housewives and unemployed women who performed the services. The salary was low as society considered the women’s husbands to be responsible for the family’s livelihood. The concept of help in the home was successful and residential care services was created.
39.
Increased demand for residential care
During the 1960s and 1970s, home care services became more popular and gradually expanded. In the early 1980s, the municipalities were given more responsibility for the design of these services when the Social Services Act (SoL) and the Health and Medical Services Act (HSL) were introduced. In order to receive home care, a means test and assistance decision was now required – and this is still the case today.
40.
”Working with residential care means that we do our job in someone’s home.”
41.
Karl Grunewald
Karl Grunewald (1921-2016) was a professor and child psychiatrist who wanted to improve living conditions for people with developmental disorders.
During 25 years at the National Board of Health and Welfare, he had an active role in ensuring the discontinuation of institutional care for people with developmental disorders. He was one of the driving forces behind the 20th century’s transformation from institutional care to family support, daily activity centres, and group homes.
He has written many acclaimed books on disability issues that have been praised nationally and internationally.
42.
In his book “From idiot to citizen”, Karl Grunewald describes the Swedish history of children, young people, and adults with developmental disorders.
”A fair and dignified life for all people.”
– Karl Grunewald
43.
New perspectives
In the 1960s, the health and social care of the mentally ill and people with cognitive disabilities underwent change and adopted a more optimistic view of their abilities.
They were allowed to wear their own clothes and they could receive conversational support and participate in psychotherapy. When institutions were opened up, excursions and social training became a part of everyday life. During this time, the ”small group principle” was also developed which proposed that a limited number of relationships can make life easier for these individuals. The principle still applies today and has influenced, for example, the introduction of group homes.
As the institutions opened up, these people became part of society. The first Care Act was enacted in 1968 and gave them new rights, which have only increased in number over time.
44.
In a way, Christoffer was lucky! He was born after Karl Grunewald, after a long struggle, succeeded in implementing the reform which meant that all institutions were closed down. Now children born with Down’s Syndrome, among other things, were allowed to accompany their parents home from the Maternity Hospital, like any healthy child.
– Anne-Marie, about her son who was born with Down syndrome.
45.
Rights
1968 – The Care Act gives new rights to people with developmental disorders
1969 – People with epilepsy are allowed to get married
46.
1962 – Children with reduced mobility are subject to compulsory schooling
47.
1968 – Children with developmental disorders are subject to compulsory schooling
48.
Assistant nurse
In the 1940s, there was a shortage of nurses in Sweden. To provide support, health care assistants were trained as assistant nurses. The assistant nurse usually performed the nursing while the nurse was given more administrative tasks.
As the municipalities became more responsible for the care of the elderly, the need for more assistant nurses also increased.
To become an assistant nurse requires completion of a three-year upper-secondary school programme. From 2023, “assistant nurse” will be a protected professional title issued by the National Board of Health and Welfare.
49.
Assistant nurse – Sweden’s most common profession!
There are 132,300 assistant nurses in Sweden. The future of the profession is very bright. The population is growing and living longer, creating a greater demand for assistant nurses.
50.
Special housing
Special housing, known as SÄBO, became a collective term for all types of housing that the municipality offers. Continuing to live in one’s own home is now called ordinary housing.
51.
Assisted living facility
An assisted living facility is for active elderly people. Helsingborg resident Bengt is one of the many who moved into an assisted living facility in 2021. The home is an apartment without thresholds and with a cooker that shuts itself off. In another part of the building there is one of the City of Helsingborg’s meeting points which continuously organises activities, including boule in the courtyard.
Accessibility and a feeling of security in both the local environment and at home are important to Bengt. He believes in thoughtful living environments for everyone.
52.
Crisis and the Elderly Reform Act
The health care crisis during the 1970s and 1980s was largely a crisis where chronically ill elderly people took up too much space in the emergency hospitals over longer periods. Many of the patients were actually ready to be discharged but remained in the hospitals because there was nowhere else where they could be given continued treatment and rehabilitation. There were fewer spaces available for the acutely ill in society and the workload for the staff at the hospitals increased.
The solution to that crisis was the so-called Elderly Reform Act in 1992. The municipalities now had greater responsibility for long-term service and elderly health and social care.
53.
”I want to try to get everyone to believe in themselves.”
Sofia, support teacher
54.
Freedom reform
In 1994, the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS) and the Act concerning Compensation for Assistance (LASS) were introduced.
The LSS Act shall guarantee good living conditions and ensure that the individual is given the opportunity to live like others. The LASS Act entitles the individual to compensation for personal assistance and the opportunity to influence the support they receive.
These laws emphasise everyone’s equal value and were seen as a freedom reform.
55.
Support teacher and support assistant
These two roles work with people who receive support under the LSS Act. They provide educational support and care to promote the individual’s independence and ability. The work also includes following up on the person’s development.
Support teachers are responsible for quality, development, and coordination in the assignment. To become a support teacher, you must complete a higher vocational education programme. You can become a support assistant by completing a three-year upper-secondary school programme.
56.
Personal assistance
Personal assistants became part of the range of care provided in Sweden when the LASS Act came into effect. The individual themselves could now be an employer and hire assistants.
Assistance is also provided via the municipality or another organisation, which then becomes the employer for the assistants.
57.
1981 – Sign language is recognised by the Swedish Parliament as the first language of the deaf
58.
1989 – Voting rights for people with cognitive impairment over the age of 18 – the concept of a “declaration of incapacity” is abolished
59.
Support for relatives
There are approximately 1.3 million people in Sweden who regularly care for, support, or assist a family member, relative, or friend at home. The municipality is obliged to offer support to make it easier.
60.
To live together
In Helsingborg you can find SällBo – a community housing concept where young and old live together. Here, generations and cultures meet and the focus is on the social experience. Perhaps this is a way to work with integration and involuntary loneliness?
61.
Ageism – do we paint everyone with the same brush?
Society’s prejudices about age can affect the right to services, care, and respectful treatment. These prejudices and notions lead to discrimination and are today called ageism.
The corona pandemic made this very clear when it was recommended that everyone in the age group 70+ isolate themselves. This entailed a disregard for the health of the individual.
A person’s chronological age is a number that does not say anything about the individual’s capacity, health, and role.
62.
Today there is a shortage of nurses, assistant nurses, and other care professionals.
63.
From poor relief to self-determination
Until the middle of the 20th century, elderly care was under the category of poor relief, and for most people this corresponded to old age homes.
The so-called “stay in your home” principle, which was introduced in the middle of the 20th century, made it possible for people to remain living at home to an increasing extent. There was now more focus on the individual’s self-determination and the right to shape their own lives.
Today, this is still a guiding principle and the freedom of choice has increased. The Act on System of Choice in the Public Sector (LOV) means that the customer themselves can influence which care provider they want.
64.
Whose responsibility?
Over the years, the division of responsibilities within health and social care has changed, and at times it has been unclear. This can affect the individual recipient who can find it difficult to get an overall picture of their care.
It can also be complicated and difficult for the care staff to know what applies in the cooperation between the municipality and region.
65.
The corona pandemic
The corona pandemic has shown us what has worked well but also what can be improved within health and social care.
Society was unprepared and became vulnerable through a lack of readiness for crises. There was a lack of knowledge on what actions were to be taken and our stores of protective equipment were not replenished at the rate that were needed. The division of responsibilities between region and municipality proved to be unclear, both organisationally and financially, which affected the ability to handle the pandemic.
The health care staff’s work environment and conditions for providing considerate care in the midst of a raging pandemic represented a major challenge. Everyone was affected, including staff who did their utmost to adapt to the situation and help reduce the spread of infection.
66.
Technology and digitalisation
Technological developments have impacted health and social care over the years. Today, it is obvious that technology is a tool for providing safe and secure care. Digitalisation means that more services are provided via apps and mobile devices. Welfare technology can contribute to increased security, activity, and participation in society.
We need more knowledge to become better at understanding, trusting, and using technology. Today, most employees within Helsingborg’s health and social care department have a smartphone. This is an important tool for them to be able to perform their tasks efficiently and securely.
67.
Statistics 2020
Sweden’s population is about 9 million
60,000 emigrate, 35,000 immigrate
Life expectancy: 83 for women, 78 for men
Urbanisation: 7.5 million live in urban areas, 1.5 million in rural areas
68.
1994 – Assistance reform
1999 – Discrimination legislation begins to cover persons with disabilities
69
Statistics 2022
Sweden’s population is about 10.5 million
50,000 emigrate, 80,000 immigrate
Life expectancy: 85 for women, 82 for men
Urbanisation: 9.1 million live in urban areas, 1.4 million in rural areas