Inequalities in attendance allowance among people with substantial and durable disabilities

Abstract

BackgroundIn 1994, the personal assistance reform that gives support to people with substantial and durable disabilities, took effect in Sweden. Today, two decades later, we can conclude that differences in the number of hours of assistance granted regionally and between various subgroups remain. This indicates that the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS) is not implemented equally and that there is a lot of uncertainty to what extent the law’s intent of equal rights for men and women, different age groups and certain diagnoses, etc. is met. A central question is what contributes to inequalities in granted assistance between persons with disabilities.The aim of this study was to analyze, which factors are associated with a large number of hours of attendance allowance.MethodsThe study consists of a quantitative cross-sectional analysis based on data from the Swedish Social Insurance Agency as well as data from a questionnaire survey of a sample of people entitled to personal assistance (total of 15,515) conducted in 2010. The number of responses (10,200) corresponds to a response rate of 67 %. The main outcome was a large number of hours, defined at median, and was analyzed by multivariate logistic regression, involving three empirical models.ResultsThe results showed that double assistance had the strongest association with a large number of hours (OR = 3.98, 95% CI = 3.26-4.36), but that the strength of the associations varied by both county and gender. There was also a strong association between a large number of hours and the use of assistants who were not family members, as well as the type of the assistance provider. Help by a trustee or legal guardian during the application process was related to a large number of hours. The same held true when a family member helped a male client with the application. According to the results, an acquired disability was associated with a smaller number of hours.ConclusionsThe factors associated with the differences in attendance allowance indicated potential inequalities in being granted large number of hours across the country and between men and women. The analysis also suggests that there may be other factors, which are difficult to quantify, related to differences in attendance allowance that were not included in the survey.Key messageAwareness of the factors contributing to inequalities in attendance allownace can lead to improved health and living conditions among people with substantial and durable disability.