In the block of flats in the middle of Lørenskog, assistant Helen Marie Bentseng spreads crackers for Bjarni Dagbjartsson. – Do you want a lot of cheese? she asks. – That’s right, replies Bjarni. He was 24 when he was diagnosed with MS. For many years, Dagbjartsson had a successful career as an economist in the oil industry, and worked for several years in London. Now the 37-year-old sits in an electric wheelchair and is disabled. The disease has gradually gotten worse. He gets help from his user-controlled personal assistants (BPA) for almost everything. – Everything from getting dressed and brushing your teeth, to eating breakfast and drinking coffee. I have some challenges with my hands. I start to eat and drink myself, but when I run out of energy, I get help for that, he explains as assistant Bentseng sets out the plate. At home in the apartment in the center of Lørenskog with the dog Saga. Photo: Eirik Pessl-Kleiven / news Enormous costs The group of younger users with a great need for care is now putting strong pressure on the municipalities’ budgets. Dagbjartsson receives help from BPA 74 hours a week, an average of 10 hours a day. The key to an independent life, he believes himself. – I feel I have the same opportunities as other people in society when I have BPA. The bill is paid in a joint venture between the municipality of residence and the state. The challenge is that the costs for this group are increasing, while the municipalities have increasingly tight finances. The group of users under the age of 67 who need a lot of help (resource-demanding users) cost the public NOK 35 billion in 2023, according to figures news has obtained from the Norwegian Directorate of Health. The amount has grown steadily in recent years. HAIR FINISH: A little wax in the hair is needed. Dagbjartsson needs help with that too. Photo: Eirik Pessl-Kleiven / news The sum only includes salary costs for health and assistance, and covers several user groups with different assistance needs. Of this, NOK 22 billion was charged to the municipalities’ budgets, while NOK 13 billion was covered by the state. Sarpsborg municipality, for example, spends more money on young people with special care needs than on the entire primary school combined. – I think it’s disgusting But Dagbjartsson is not enthusiastic about such comparisons. For him, the help is about having the opportunity to live a normal life like everyone else, at home with his wife and cocker spaniel Saga. The assistants also make it possible for him to act in a position of trust as deputy chairman of the MS association: – Either you get the help you need, or someone else has to get less help. It seems impossible to help both. While the politicians are faced with tough priorities about what the money should go to, Dagbjartsson believes it is not right to pit users in need of help against other false goals. – I think it is disgusting, or unfair, to be met in that way. The Directorate of Health does not have an overview of what the BPA scheme alone costs. Dagbjartsson believes that the BPA scheme is, after all, a cheap alternative: his assistants do not need health education. Thus, their hourly wages are lower than for healthcare personnel. Dagbjartsson lives in his own apartment with his wife Hanne Johnsrud Fjellheim. Photo: Eirik Pessl-Kleiven / news Expensive individual users But for the municipalities, the heavy users pose a demanding dilemma. The most expensive individual user last year received assistance for NOK 22.7 million, according to the figures obtained by news. They also show that: 125 users in municipalities around the country received care services for over NOK 10 million – each. 1,837 users had a cost to the public of over NOK 5 million each. news has not obtained figures on what named people such as Dagbjartsson cost. – Unsustainable Lørenskog municipality, where Bjarni Dagbjartsson lives, spent close to NOK 243 million on such users in 2023, according to figures news has received from the municipality. Part of the amount was paid by the state. The municipality’s part of the bill therefore ended up at NOK 152 million. The services of the most resource-demanding users are largely a statutory right. Lørenskog is in the middle of a cut process in the municipality. Then they essentially have to look at other types of municipal services than the statutory ones, says the municipality’s director of health, Janne Sonerud. MUST CUT ELSEWHERE: Cuts in prevention could lead to higher health costs in the future, fears Janne Sonerud, director of health, care and coping in Lørenskog municipality. Photo: Eirik Pessl-Kleiven / news – Yes, it will be the big challenge. There are also opportunities within statutory tasks to look at scope and level. But the service must be rendered. And when the cuts are to come, we will turn our attention to more health-promoting and preventive services where there are fewer statutory tasks. The challenge in Lørenskog is the same as in many other municipalities now. There is a lack of both money and people. Sonerud clarifies that she does not comment on individual users: – Within health, it is not sustainable to deliver services on the scale and at the level that we do today. And I think that may apply in many areas of society, says Sonerud. – Must organize differently Storting representative Alfred Bjørlo from the Liberal Party has himself faced the dilemma as a local politician. As a former mayor, he saw how users with major support needs were scattered throughout the municipality. Bjørlo says that he took the initiative to gather them in their own health centers with joint staffing. But that also meant less freedom to choose where to live. WANT A HEALTHCARE: Alfred Bjørlo (V) believes that help for heavy users should be organized differently. Photo: Eirik Pessl-Kleiven / news According to Bjørlo, money is not the biggest problem with the current organization of care services, but having enough people to do the job. – In the future, will we have enough people to organize the services exactly as we do today? Otherwise, we will have to think again. We are going to run out of people, says Bjørlo. This is the “younger wave” In many of the country’s municipalities, the cost growth in services for younger users under the age of 67 is among the biggest concerns in municipal budgets that are no longer increasing. Many of the services are rights-based and required by law. This means that the municipalities themselves cannot decide whether the service is to be provided, and users can appeal the municipality’s decision to the state administrator. The most expensive individual user of care services last year cost NOK 22.7 million, according to figures collected by news. A total of 125 users cost over NOK 10 million each. 1,837 users received care services for over NOK 5 million each. In total, resource-intensive users cost NOK 35 billion last year. 22 billion was covered by the municipalities, 13 billion was paid by the state. The figures from the Norwegian Directorate of Health only include salary costs, and not costs for equipment, medicines and other adaptations. – Losing control over his own life In Lørenskog, Bjarni Dagbjartsson gets help to drive his wheelchair into the specially built van in the garage. He believes that the proposal to move users like him into a health center or housing association is a return to the institutions. They were discontinued in Norway in the 90s. OUT FOR A TRIP: Assistant Helen Marie Bentseng follows Bjarni Dagbjartsson out into the car. Photo: Eirik Pessl-Kleiven / news – Once more parts need help, it means that you have to wait for help. That wait is incredibly frustrating. Then you won’t get help when you need it. – Then you get it when those around you have time, and then you feel that you are losing control over your own life. It’s not a good feeling. Bjørlo disagrees: – There is no going back to institutions if there is a better and more sustainable way of organizing services, says Bjørlo. Dagbjartsson believes that the solution to tight municipal finances does not lie in savings among the most resource-demanding users. Then the politicians must look elsewhere: – The weakest in society must be prioritized. Because that is simply the kind of society we want to live in. – And then you get to allocate more to the municipalities so that they don’t have to cut. Or you have to take the cuts elsewhere. Photo: Eirik Pessl-Kleiven / news Published 17.11.2024, at 22.03
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– The weakest in society must be prioritized – news Norway – Overview of news from different parts of the country
