Inadequate Swedish Language Skills in Elderly Care in Three Out of Four Municipalities

Language deficiencies among staff in elderly care are a recurring problem in large parts of the country. A survey shows that more than half of the country’s elderly care managers experience misunderstandings related to language at least once a week. In one quarter of municipalities, this happens daily.

The consequences can be serious. Municipalities report situations where the elderly have received the wrong medication due to misunderstandings about instructions, where staff and care recipients have had difficulty understanding each other, and where communication with ambulance staff has been hampered during urgent interventions.

According to several elderly care managers, such misunderstandings can affect both the quality of care and the safety of the elderly. In Sundsvall municipality, Director of Care and Welfare Lars-Ove Johansson describes the language issue as an important challenge. He believes problems arise when staff or care recipients think they have understood each other even though information has been lost. At the same time, he calls for higher language requirements in assistant nurse training programs.

Umeå municipality, too, states in Kommunalarbetaren’s survey that language sometimes causes difficulties in operations. HR manager Rebecca Andersson points out that work in elderly care requires documentation and the ability to receive instructions, for example, from nurses. At the same time, she notes that multilingual staff can be an asset when older people with a native language other than Swedish need care.

The background to the situation, according to the municipalities, is the persistent recruitment problems in elderly care. Low wages and a stressful work environment have made it difficult to attract staff, which has contributed to many hires having foreign backgrounds.

According to the Swedish Association of Local Authorities and Regions, today 37 percent of municipal assistant nurses and 53 percent of care assistants were born outside Sweden.

New law

On July 1, a new legal requirement takes effect, meaning that municipalities and private providers must work to ensure that staff have sufficient knowledge of Swedish. The requirement targets employers rather than individual employees, but exactly how the rules will be applied in practice still varies between different organizations.

As a result of the new rules, more and more municipalities are choosing to introduce language tests. According to the survey, 27 percent of municipalities already use such tests, while a further 29 percent plan to introduce them. This is a clear increase compared to 2022, when only seven percent stated that they used language tests.

Uppsala municipality is an example, where around 300 employees were tested during 2024 and 2025. The municipality emphasizes that the main purpose is to identify needs for support and education, rather than to weed out staff.

Language coordinators

At the same time, the development faces criticism from researchers and experts. Researchers at the University of Gothenburg warn that the tests risk lacking legal certainty, as they vary greatly between municipalities and there is no clear definition of which language competencies should actually be measured. The National Board of Health and Welfare also expresses some reservations, noting that several of the tests on the market are of inconsistent quality.

Another way to strengthen language skills is through so-called language coordinators. This means that employees with good knowledge of Swedish receive training to support colleagues who need to develop their language. More than 70 municipalities state that they are working with such solutions.

The government has allocated funding for the implementation of the language requirement, but the Swedish Association of Local Authorities and Regions is simultaneously calling for more long-term financing for the work.