Not Free at All: Home Care User Fees in a Nordic Care System

Abstract

In Finland, older persons are entitled to needs-tested public home care services. Home care mainly assists with personal care, activities of daily living and medical needs. It is complemented with auxiliary services that offer help with instrumental activities of daily living. In Finland, municipalities are responsible for organising public home care services. These services are mainly tax-funded, but user fees are also charged. In this article, we examine the levels of user fees of home care and auxiliary services in Finnish municipalities in 2018. The data analysis consists of descriptive statistics and exemplary cases of costs to the service users. The results show that user fees may represent a significant share of older persons’ monthly incomes. Consequently, home care users, especially those with low incomes, are at risk of economic deprivation and non-take-up of the services. We also found substantial variation in user fees across municipalities, causing regional inequality.