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Normality or care – an inventory ofSwedish municipalities’ responses tounstable accommodation for vulnerablegroupsMats Blid aa Department of Social Work, Mid Sweden University, Östersund,Sweden
Available online: 11 Dec 2008
To cite this article: Mats Blid (2008): Normality or care – an inventory of Swedish municipalities’responses to unstable accommodation for vulnerable groups, European Journal of Social Work,11:4, 397-413
To link to this article: http://dx.doi.org/10.1080/13691450802075576
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Normality or care � an inventory of Swedish municipalities’ responses tounstable accommodation for vulnerable groups
Normalitet eller omsorg � en inventering av svenska kommuners respons paosaker boendesituation for sarbara grupper
Mats Blid*
Department of Social Work, Mid Sweden University, O stersund, Sweden
This article presents an inventory of policies and housing support interventions to thehomeless and those at risk of becoming homeless in a representative sample of Swedishmunicipalities. Two types of intervention are included: various types of accommodationfor those who are already homeless and daily life support for those at risk, eitherprovided or financed by the social services in the municipality. Data were collected in2004�2005 through a questionnaire e-mailed to local authority officials, in a stratifiedsample of about half of the Swedish municipalities (n�147). The results show that twotypes of housing intervention dominate the field: daily life support and sublet contracts,both of which have a relatively high normality factor, with a setting in normal housing.Daily life support includes care and is usually implemented before the tenant is evicted.The level of care related to various interventions fluctuates more between themunicipalities than normality does. The more densely populated municipalities weremore engaged in developing housing policies and administrative bodies to handle these.However, the implementation of housing policies does not seem related to improvementsin the qualities of the interventions. On the contrary, the local authorities that havehousing policies and administrative tools adapted to these policies provided a lowerdegree of both normality and care in the interventions. The results suggest that aspectsof normality and care in the same type of housing interventions vary depending on thetype of municipality, while the existence of policies has no influence on care and anegative effect on the degree of normality provided through the interventions.
Keywords: housing intervention; policy; unstable accommodation; social service; careand normality
Foljande artikel presenterar en inventering av policys och boendeinsatser till hemlosaoch de som befinner sig i risk for att bli hemlosa, utifran ett representativt urval avsvenska kommuner. Tva typer av boendeinsatser ar inkluderad: olika typer av fysiskaboendemiljoer for de som redan ar hemlosa och stod i bostaden for de som ar iriskzonen, antingen tillhandahallna eller finansierade av socialtjansten i kommunerna.Data samlades in mellan 2004�2005 med hjalp av en enkat som distribuerades via e-posttill lokala sociala myndigheter, till ett stratifierat urval av nastan halften av Sverigeskommuner (n�147). Resultat visar att tva typer av insatser dominerar: boendestod ochandrahandskontrakt, bada har relativt hog normalitetsfaktor da miljon for insatserna arnormala lagenheter. Boendestod inkluderar ocksa omsorg och implementeras innanhyresgasten har blivit vrakt. Omsorgsnivan i olika insatser varierar mer mellan olikakommuntyper an vad normalitetsnivan gor. De mer tatbefolkade kommunerna var merengagerade i att utveckla boendepolicy och administrativa redskap for att hantera dessa.
*Email: mats.blid@miun.se
European Journal of Social Work
Vol. 11, No. 4, December 2008, 397�413
ISSN 1369-1457 print/ISSN 1468-2664 online
# 2008 Taylor & Francis
DOI: 10.1080/13691450802075576
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Men implementeringen av bostadspolicys tycks inte vara relaterat till kvalitetsutvecklingi insatserna. Snarare det motsatta, lokala myndigheter som har formulerat bostadspo-licys och har administrativa redskap kopplade till dessa, tillhandahaller en lagre grad avnormalitet och omsorg i insatserna. Dessa resultat indikerar att inslag av normalitet ochomsorg i samma typ av boendeinsats varierar beroende pa typ av kommun, medanforekomst av policys har ingen paverkan pa omsorgsnivan och en negativ paverkan panormalitetsinslag i boendeinsatserna.
Nyckelord: beondeinsatser; policy; osa ker boendesituation; socialtja nst; omsorg ochnormalitet
Introduction
Housing is considered to be one of the most important factors affecting people’s wellbeing
(Bochel et al. 1999, Fitzpatrick 2000, Stafford and McCarthy 2006) and evidence shows
that homeless people or those living in poor housing are less healthy and more likely to be
socio-economically disadvantaged (Thomson and Petticrew 2004, Stafford and McCarthy
2006, Shaw et al. 2006). Consequently, the provision of suitable housing may be one
precondition for solving other problems, such as substance misuse and mental illness
(Tsemberis and Eisenberg 2000, Shinn et al. 2001, Cullhane et al. 2002, Fakhoury et al.
2002, Aidala et al. 2005).
Adequate accommodation as a ‘fundamental human right’ has been recognised at
international, European and national levels (Bengtsson 2001, Edgar et al. 2002, Shaw
2004). Since the state’s role is primarily to make corrections to the market so that it behaves
in a just way, the recognition of this right can be seen as a political marker that housing is
part of the welfare state policy, and a legitimation for state interventions (Bengtsson 2001,
2006). In many European countries, the responsibility for different welfare issues, such as
housing, has been transferred from the state to local authorities (Doherty 2004). Local
authorities therefore have a central role in providing people with accommodation or
shelter. In many countries the allocation of housing has been handed over to the market for
those who can afford it, and to the social service authorities for those who cannot. Local
authorities are therefore responsible for implementing policies and making interventions to
prevent homelessness and for integrating those excluded from the housing market. As will
be shown, there are different models of intervention, based on various assumptions
concerning the need for normality and care, respectively. This article presents an inventory
of the housing interventions provided by local authorities to homeless or insecurely housed
persons in a representative sample of both urban and rural municipalities in Sweden. The
interventions are compared in relation to the levels of normality and care, meaning to what
degree the interventions resemble normal housing and to what degree they include
professional resources for providing care.
Variations in homelessness and housing provision
Edgar and Meert (2005) claim that there are three basic domains that are central for
understanding the home concept: (1) a physical domain for adequate dwelling; (2) a social
domain for maintaining social and private relations; and (3) a legal domain, i.e. having a
legal right to tenancy. The absence of one or more of these domains would place the
dweller on a continuum of more or less homelessness. Further, based on these three
domains and a screening of definitions of homelessness in 10 European countries, they
developed four conceptual categories: rooflessness, houselessness, living in insecure
housing, and living in inadequate housing. These categories can be observed within a
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range of housing situations, spanning from sleeping rough, staying in night shelters or
ambulating between friends, living in insecure housing such as sub-leased flats, to living in
temporary, unfit or overcrowded apartments.
Because of the difficulty of obtaining housing for vulnerable groups on the regular
housing market, a parallel ‘secondary housing market’ of more or less transitional
accommodation has emerged provided by the social welfare agencies (Sahlin 2005).
Furthermore, an increasing number of intervention programmes are being employed to
counteract homelessness. Responses to homelessness have usually taken two forms: policy
frameworks and practical intervention programmes (Christian 2003). Policy may be
important due to the complexity of the problem, and is affected by organisational factors
and external constraints in relation to the housing market and social services (Edgar et al.
2000). In order to achieve positive outcomes for those in need, social welfare agencies have
to co-operate with a range of other service agencies (Orwin et al. 2003, US Department of
Housing and Urban Development 2004, Crane et al. 2006). Furthermore, social welfare
services are supposed to lead the recipients back to normal and self-sufficient housing
stability and to try to avoid simply reallocating homelessness (Shinn et al. 2001). A numberof studies have shown that this is possible, even for severely socially excluded persons (see
Busch-Geertsema 2002, Cullhane et al. 2002, Orwin et al. 2003).
Various intervention programmes have been developed in order to prevent or eliminate
homelessness. Housing interventions to vulnerable groups can be divided into two main
categories. (1) Preventive interventions often take the form of daily life support (support in
order to cope with the activities and challenges of daily life and to enable independent
living, comparable to housing related support in the UK) in order to help people at risk of
becoming homeless to remain housed and to prevent eviction. (2) Those that lost their own
apartment or rental contract need accommodation support. Such accommodation may be
more or less temporary, more or less segregated and include more or less care. Both of
these forms, daily life support and accommodation support, are hereafter referred to as
housing interventions.
Various types of temporary accommodation may be seen as part of a continuum of care
(Bebout 1999, Cullhane et al. 2002). Early in that continuum the accommodation has a
more institutional character, followed by transitional housing and later eventually a morehomelike situation (Hoch 2000). Another model, housing support, regards housing as a
basic right, while other support services are seen as additional services (Tsemberis and
Eisenberg 2000, Busch-Geertsema 2002). The provision of accommodation is accompanied
by case management in order to facilitate the acceptance of these additional services, which
are often needed for the intervention to be successful in creating stable housing. Thus, both
these models include care and support but differ in their view of temporary versus
permanent housing solutions (for a more detailed discussion, see Blid and Gerdner (2006)).
Other models suggest accommodation without the provision of care and support. In
some models it is assumed that integrated living in the community in itself will influence
the individual in a positive manner (Ridgway and Zipple 1990). This can be referred to as
the housing as housing model, offering housing in ordinary flats, sometimes with a contract
of one’s own and sometimes sublet through the social services, but with no or very few
additional services offered. There are two other housing programme models which also
focus on accommodation as an isolated intervention, but differ in their view of the
interaction with the surrounding community. Both these programmes are based on theassumption that homeless people lack the ability to live independently in a normal
neighbourhood. One is the staircase model (see Sahlin 2005), which sees this as an ability
that can be learnt. Different types of accommodation are structured as a staircase which
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the homeless individuals must climb step by step, gradually progressing from shelters or
other low-threshold housing solutions to, if all goes well, training flat, or a flat sublet
through the social services and eventually to securing their own lease. Another model has a
more pessimistic perspective and regards homeless people as unable to live together with
others. Instead they are offered special category housing, i.e. permanent housing together
with persons with similar problems but separate from others, usually peripheral to
ordinary neighbourhoods. This solution can be seen as an expression of ‘institutionalised
resignation’ (Jarvinen 2001). In a previous article (Blid and Gerdner 2006) two such special
category houses were described that provided minimal care. Other category houses may
provide more care (Blid 2006).
The Swedish case
With a population of nine million, Sweden has a population density of 22 inh./sq.km,
which makes it one of the most sparsely populated countries in Europe. One third of thepopulation lives in the three metropolitan cities. There are 290 municipalities. The
economic and demographic conditions vary between different parts of Sweden, which has
an impact on the structure of the Swedish welfare system.
The number of homeless individuals (which includes people who have insecure tenancy)
was estimated in a national inventory in 2005 to be 17,800, i.e. nearly 20 persons per 10,000
inhabitants in the whole country (NBHW 2006). The highest rates of homeless people are
found in the three metropolitan cities, Stockholm (50 individuals per 10,000 inhabitants),
Goteborg (54) and Malmo (35), compared to the rest of Sweden with 14 homeless per
10,000 inhabitants. Evidence leaves no doubt about the heavy concentration of homeless
people in metropolitan areas (NBHW 2006).
The definition used in the national inventory of homelessness in 2005 was based on
four housing situations (NBHW 2006): people who sleep rough or in emergency
accommodation, e.g. shelters and hostels (20% of the homeless individuals); people who
were to be discharged within three months from some kind of institutional setting without
having a permanent residence waiting (11%); the same situation as the second but without
the three-month limit (37%); and those who live with friends or relatives under uncertain
housing conditions (26%). For the remaining 6% the situation was unknown. The first twohousing situations in the Swedish inventory match the first two conceptual categories of
the ETHOS definition (Edgar and Meert 2005): rooflessness and houselessness. The third
and fourth situations, however, do not fully correspond with the third and fourth in the
ETHOS definition, i.e. living in insecure housing and living in inadequate housing.
Homelessness exists in most of the municipalities in Sweden. The demand on the
housing market is mostly governed by changes in the population rate and regional
migration. Metropolitan areas have experienced population growth due to regional or
international immigration. In 40% of the municipalities there is a shortage of housing
compared to the demand, and in another 20% of all the municipalities there is a shortage in
the central areas (NBHBP 2006).
The social dimension of Sweden’s housing policy is based on the goals of integration,
justice and equality (Ministry of Finance 2004), and has a general character with a basic
aim of providing good housing for all, i.e. it encompasses the whole housing market rather
than special household categories or special forms of tenure (Ministry of Finance 2004).
The housing market includes the following forms of tenure (with percentages from 2004 in
brackets): self-owned dwellings (39%), tenant-owned co-operative housing (17%), publicly-
owned rented housing (22%) and private landlords (21%). There is an increasing trend
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towards more self-owned dwellings, partly through the transformation of publicly-owned
rented housing into other forms of tenure, mainly in the cities (Bengtsson 2006). About
one-fifth of all dwellings are owned by municipal housing companies which comprise the
publicly-owned rented housing sector (Sahlin 2005). This sector has decreased by more
than 90,000 dwellings since the mid-1990s due to the demolition of houses and to the
transformation into other forms of tenure. Today, some municipalities have no public
housing sector at all (Sahlin 2005). Social housing with a maximum rent level that is
specifically provided for low-income tenants is not available in Sweden.
Sweden has a long tradition of local government and the Swedish municipal system is
characterised by relatively large municipalities with their own independent powers of
taxation, and municipal self-government is a constitutional right (Bergmark 2001).
National legislation regarding most municipal activities provides a framework, leaving
the local authorities the freedom to adapt their policies to fit the local context. The local
authorities are responsible for housing and social services. However, they have lost the
right to influence the allocation of private rented accommodation through the former local
housing authorities (Sahlin 2005). National research shows that social service agencieshave therefore taken over responsibility for housing issues for people with debts or who are
homeless or have problems in securing a lease. Local authorities have formulated policies
regarding homelessness and the issue has become a social welfare problem rather than a
housing problem (Sahlin 2004, Lofstrand 2005).
The politically appointed Social Welfare Board is the body with primary responsibility
for providing social services and care in the municipality. It is in charge of the social service
agencies, which are organised in different service sectors: individual and family care,
services for older people, for disabled people and services of social psychiatry. This study
focuses on individual and family care and social psychiatry. The agencies for individual
and family care usually organise their work either in specialised functional sectors, such as
children and youth, social assistance and drug misuse, or they can be based on a
geographical division into different districts handling all kinds of social welfare issues
(Bergmark and Lundstrom 2005).
The social service agencies are responsible for assisting those who, for different reasons,
are unable to acquire or retain adequate accommodation, which is regulated in the Act onSupport and Service for Persons with Certain Functional Impairments and in the Social
Services Act. This type of framework legislation allows the local authorities great
autonomy. Although the Social Services Act does not give any explicit right to housing,
local authorities provide various types of temporary accommodation to those in need
(NBHW 2006). The social services assess the situation of the individuals in need and have a
substantial discretion in decisions regarding access to service and support. Decisions are
based primarily on available resources (Lofstrand 2005).
The models of housing support and accommodation presented earlier are based on
different assumptions concerning the importance of care and normality, respectively.
Therefore, it is of interest to study these dimensions as practised in the various
municipalities, and to what extent they are affected by explicit municipal policies and
tools to implement such policies. The purpose of this study is twofold: first to examine the
patterns of housing interventions in a representative sample of about half of the Swedish
municipalities, and secondly, to identify the relationship between municipal policies, the
type of municipality and the type of intervention. The interventions included are thoseprovided to adults who have difficulty in maintaining a stable housing situation. The
following questions are central: what is the amount of housing interventions and what is
the ratio of such interventions in relation to the estimated number of homeless persons in
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various types of municipalities? What types of housing intervention do the various local
authorities provide? What are the characteristics of the housing interventions provided? To
what degree have the local authorities formulated housing policies aimed to support people
with insecure accommodation? How do these policies influence the housing services
provided?
Data and method
In order to examine all housing interventions, a survey was conducted through sending
questionnaires to a representative, stratified sample of about half of the municipalities in
Sweden. The municipalities vary in population size, as well as in trade and industrial
structure, all factors likely to be of importance for the purpose of this study. The following
subdivision made by the Swedish Association of Local Authorities (2004) is therefore
suitable. It defines nine categories of municipalities.
. The metropolitan cities (n�3) with more than 200,000 inhabitants.
. Suburban municipalities (n�36) with more than 50% of the population commuting
to work in another municipality, usually a metropolitan city.
. Large municipalities (n�26) with 50,000�200,000 inhabitants and with less than 40%of the population employed in the industrial sector.
. Medium-sized municipalities (n�40) with 20,000�50,000 inhabitants, with more than
70% of the population living in an urban (densely populated) area and with less than
40% of the population employed in the industrial sector.
. Industrial municipalities (n�53) with more than 40% of the population employed in
the industrial sector and not situated in a sparsely-populated area.
. Rural area municipalities (n�30) with more than 6.4% of the population employed
in the agriculture and forestry sectors, but not situated in a sparsely-populated area.. Sparsely-populated area municipalities (n�29) with less than five residents per square
kilometre and less than 20,000 inhabitants.
. Other large municipalities (n�31) with 15,000�50,000 inhabitants.
. Other small municipalities (n�42) with less than 15,000 inhabitants.
In the first strata, one metropolitan city was selected for convenience, due to previous
research collaboration, since randomisation cannot meaningfully be applied to a group of
three. Six of the other strata were collapsed into three, while two remained as they were.
Half of the municipalities were randomly selected from each of these five strata. The
sampling process is shown in Table 1.
Data were collected in 2004�2005 through a survey that was e-mailed to local authority
officials. The survey consisted of two parts:
. Part 1 was directed to the local authority officials, and concerns the municipality in
general. The questions capture current municipal policies on housing issues and thenumber of persons currently the subject of housing interventions. Part 1 ends by
requesting a list of all the housing interventions provided by the local authority or by
NGOs in the municipality. Totally, 381 housing interventions were reported, which
were then further investigated in Part 2 of the survey.
. Part 2 was directed to the head of each housing service, but could also be answered
by the central representative of the municipality if (s)he had the specific knowledge
(mostly in smaller municipalities). The questionnaire was to be completed for each of
the 381 services in the municipalities listed in Part 1. The questions concerned the
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number of staff and type of staffing, the provision of professional guidance, a
nominal categorisation of the type of housing intervention, characteristics according
to descriptive dimensions, the accessibility and the qualifications of the staff and theexistence of special restrictions.
All 147 municipalities in the sample responded to the questionnaire after extensive
follow-up work (telephone interviews with 70% of the respondents in Part 1). Furthermore,
responses to Part 2 were collected for all 381 housing interventions reported in Part 1.
Thus, there are no missing external data in either of the two parts of the survey.
Nevertheless, there are missing internal data in 75 of the 381 housing interventions (20%).
Imputation was used to handle the missing data for interventions with similar descriptors,
which resulted in 357 housing interventions (93.7%) with complete data sets (see Blid
2006).To investigate the application of municipal housing policies and tools to implement it,
four dichotomous variables (yes/no) were included in Part 1: having an adopted policy for
managing housing problems for vulnerable persons, the establishment of a housing
collaboration group, a housing authority agency, and the application of the staircase model
of housing.
In Part 2 the following variables applying to each of the housing interventions were
used: nominal categorisation of the housing service, the number of persons for whom the
service is provided (expressed as individual services provided meaning available beds,
apartments or number of decisions about housing support) and characteristic variables
applying to each of the housing interventions in order to measure the level of care and
normality.Three indexes are used in the analysis, two of which were presented in an earlier study
(Blid 2006). These measure the level of care and the level of normality in the specific
housing interventions, which represent separate factors in a Principal Component
Analysis. The care index is based on four ordinal scales: degree of care or rehabilitation,
access to staff during various hours of the week, the medical competence of staff, and the
psychosocial competence of staff. The normality index is based on five ordinal scales
showing the degree of home-like accommodation, degree of integration in normal housing
areas, permanence of housing contracts, autonomy within housing and the level of
restrictive rules attached to it. The criteria of the scales were given the same weights, and
Table 1. The sampling process
Nine categories All Six new categories Sample
N� 290 147
Metropolitan cities 3 A. Metropolitan city 1
Suburban municipalities 36 B. Suburban municipalities 18
Large municipalities 26C. Large and medium-sized municipalities 35
Medium-sized municipalities 40
Industrial municipalities 53 D. Industrial municipalities 27
Rural area municipalities 30E. Rural and sparsely-populated area municipalities 30
Sparsely-populated area
municipalities
29
Other large municipalities 31F. Other municipalities 36
Other small municipalities 42
/g
/g
/g
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both indexes varied continually from 0 to 1. The internal consistency of the care index was
acceptable (a�0.62) while the internal consistency of the normality index was satisfactory
(a�0.84). Alpha above 0.50 is acceptable for group comparisons (Streiner and Normann
1989). They were modestly correlated (R��0.13). Thus, they were separate, homogenous
and consistent.
For the present analysis a third index was created to examine the degree to which the
local authorities applied explicit policies for housing problems. The interviews showed
that many municipal representatives reported having a housing authority agency, even if
they only had a waiting list at the municipal housing company. The replies to this
question were therefore not regarded as valid. Furthermore, when tested in a factor
analysis, only the other three (see above) � but not the housing authority agency �formed a common dimension, which can be called ‘the degree of housing policy tools’.
The internal consistency of this scale based on three items was acceptable for group
comparisons (a�0.66). Since the index was based on three dichotomous variables, it
could only vary discretely between 0 and 3, and it is therefore treated as an ordinal
scale.
Statistical analysis
Standard descriptive measures were used to summarise the variables. Group means of the
municipalities do not reflect the fact that the municipalities differ in population size and in
the number of individual services provided. Therefore weighted means were calculated in
the Tables 2, 4 and 5.
Correlations between degree of housing policy tools and the characteristics of the
housing interventions (care and normality) were tested by Spearman Rho, in accordance
with the ordinal character of one of the scales. A factor analysis was conducted, using
Principal Component Analyses. Analyses of variances (ANOVA) and the Kruskal�Wallis
Test were used when comparing groups of municipalities.
Results
The amount of interventions provided can be examined in relation to the extent of
homelessness in the municipalities, according to the national survey (NBHW 2006). Since
those who will be in prison or other institutions for more than three months are not in
acute need of housing services, they were excluded from Table 2. Accommodation services
and housing support were examined separately. Thus, the number of homeless persons
(after the exclusion of long-term institutional residence) can be compared to the number
of accommodation services in the different types of municipalities. This gives us a crude
estimation of whether the number of services provided corresponds quantitatively to the
needs that are known by the authorities.
Table 2 shows that the number of individual accommodation services is close to the
estimated number of homeless individuals in need of these services. In total, the number of
individual accommodation services provided even exceeds the estimated number of
homeless people. Only in the suburban municipalities is it the other way round. However,
many people are still homeless and as the extent of the problem has increased rather than
decreased, the problem is far from being solved. One likely reason may be the lack of
correspondence between the type of services provided and the actual needs of the
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individual. This study does not include data on individual profiles. The type of services
provided and their content, however, will be further analysed below.
The housing interventions provided by the municipalities
A great variety of housing interventions was reported, but in 14 municipalities (10.5% of
the sample) not a single housing intervention was reported. These municipalities reported
no homeless persons to the national survey. The other 133 municipalities, however,
reported a total of 381 interventions provided and these were placed in the following 12
categories by the respondents (Table 3).
In terms of the number of individual services provided, the amount of accommodations
is almost exactly equal to the amount of daily life support provided � 5316 vs. 5377.
Looking at the more specific types, the most common accommodation intervention is
sublet contracts, while daily life support is most often the type administered by the social
psychiatry unit.
In an earlier study based on the same material (Blid 2006), a discriminant analysis
showed that these 12 types of interventions could be separated by various profiles of the
descriptor variables (Blid 2006), and that these 12 types could be described in a simplified
categorisation of the interventions in five groups, primarily based on the normality and
care indexes.
Subletting through the social services in normal housing is the housing intervention
most similar to normal dwellings, with a high level of normality and a low level of care;
daily life support in normal housing combines the two types of daily life support. It is
characterised by relatively high levels of both normality and care; residence and care
Table 2. Average number of homeless individuals in Sweden per 10,000 inhabitants and the
number of individual accommodation services provided and daily life support provided per 10,000
inhabitants in six categories of municipality. Means are weighted by the population size of each
municipality (n�147)
Municipal groups A�F N Number of
homeless
individuals
per 10,000
inhabitants in
2005 (NBHW)
Number of
individual
accommodation
services provided
per 10,000
inhabitants
Number of
individuals
per 10,000
inhabitants
that receive
daily life support
Mean Mean Mean
A. Metropolitan city 1 35.6 37.6 9.2
B. Suburban municipalities 18 13.5 10.9 13.3
C. Large and medium size
municipalities
35 14.3 15.4 16.6
D. Industrial municipalities 27 7.0 8.4 9.9
E. Rural and sparsely
populated area
municipalities
30 5.4 5.7 16.6
F. Other large and small
municipalities
36 8.4 10.2 12.3
Total 147 13.6 14.1 14.3
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institutions comprise a group of interventions that are more institution-like and are aimed
at different stages on the continuum of care. This group includes: residential care, half-
way-house, special category house and welfare lodging homes. It is characterised by a low
level of normality and relatively high level of care. Two groups of interventions have low
levels of normality as well as low levels of care. However, they have different relations to
the continuum of care. Low-threshold housing is a group of interventions outside the
continuum of care that includes shelters, hotels, holiday chalets and low-threshold
housing. Re-entry housing is a group of interventions at the end of the continuum of care
that includes training flats and re-entry housing. Subsequently when studying the
municipality’s provision of housing interventions, we can use these five categories to
examine the range of interventions provided by different municipalities.
Table 4 displays the relative amount of individual housing interventions in the different
municipal categories. On a national level the two most frequent intervention groups in all
the municipal categories are daily life support and subletting through the social services.
Subletting through the social services is the most frequent individual service provided in
the metropolitan city category and exists in more than every second municipality. In rural
and sparsely-populated municipalities the housing intervention group daily life support in
normal housing is the most common type of intervention. However, it is less common with
Table 3. Type of housing interventions (n�381) reported from 147 municipalities divided into 12
categories and the number of individual services provided in each category, and sorted into the two
main types, i.e. accommodation and housing support
Housing intervention
category
Number of housing
interventions
Number of
individual services
provided
Individual services
provided per 10,000
inhabitants
Accommodation
Shelter 22 261 0.69
Hotel and holiday chalets 5 42 0.11
Low threshold housing 34 220 0.58
Residential care 33 441a 1.16
Halfway house 1 10 0.03
Re-entry housing 7 28 0.07
Special category house 28 303 0.79
Training flats 25 431 1.14
Welfare lodging home 1 10 0.03
Sublet contract 88 3570b 9.51
Sum of accommodation
services
244 5316 14.12
Daily life support
Within individual and
family care
24 455c 1.22
Within social psychiatric
service
113 4922d 13.43
Sum of daily life support
services
137 5377 14.65
Total housing interventions 381 10,693 28.77
Notes: a Estimate based on 32 services. b Estimate based on 86 services. c Estimate based on 23 services. d Estimatebased on 110 services.
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daily life support in the metropolitan city and industrial municipalities than in other
municipal categories. The other interventions occur more marginally, although one of the
least frequent of the intervention groups � low-threshold housing � is still provided in every
third municipality.
The two indexes can also be used to compare the municipal categories on the level of
care and normality. Estimates were made using the weighted mean values of care and
normality respectively in all municipal categories and for the five types of housing support
interventions (Table 5).
The distribution of care fluctuates more between the municipal categories than the level
of normality, which is more evenly distributed both within types of housing service
provision and totally. Industrial municipalities in general provide housing interventions
with a higher content of care while rural and sparsely-populated municipalities as well as
other municipalities provide services with less care content.
The metropolitan city provides the highest level of care for the housing intervention
categories subletting through the social services and re-entry housing at the end of the
continuum of care. The exception to a relatively even distribution of the level of normality
in all municipalities and across all housing intervention groups is the category rural and
sparsely-populated municipalities, which has a noticeably higher level of normality in the
housing intervention category low threshold housing outside the continuum of care. Thus
the level of care involved in the same kind of intervention is likely to differ depending on
the type municipality.
Table 4. Individual housing services provided per 10,000 inhabitants in five housing intervention
groups in six categories of municipality. Means are weighted by the population size of each
municipality
Municipality
categories
N Subletting
through
social
services in
normal
housing
Daily life
support in
normal
housing
Residence
and care
institutions
Re-entry
housing
at the end
of the
continuum
of care
Low
threshold
housing
outside the
continuum
of care
A. Metropolitan
city
1 23.0 9.2 1.1 6.3 7.2
B. Suburban
municipalities
18 8.0 13.3 0.7 1.5 0.7
C. Large and
medium size
municipalities
35 11.0 16.6 2.5 0.8 1.1
D. Industrial
municipalities
27 5.2 9.9 1.4 0.2 1.6
E. Rural and
sparsely
populated area
municipalities
30 4.5 16.6 0.9 0.1 0.2
F. Other
municipalities
36 7.4 12.3 1.2 1.0 0.6
Total 147 9.9 14.3 1.7 1.2 1.4
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Table 5. Average level of care and normality in the municipality’s provision of individual housing
services in five intervention groups. The means are weighted by the number of individual services
provided in each municipality
Categories of
municipality
Subletting
through
social
services in
normal
housing
Staff
support
and care
in normal
housing
Residence
and care
institutions
Re-entry
housing at
the end of
continuum
of care
Low
threshold
housing
outside the
continuum
of care
Total
individual
provision
�10,6851
Level of care, mean
A. Metropolitan
city
0.37 (a) 0.38 (g) 0.50 (m) 0.52 (s) 0.25 (z) 0.40 (ff)
B. Suburban
municipalities
0.24 (b) 0.53 (h) 0.59 (n) 0.29 (t) 0.29 (aa) 0.39 (gg)
C. Large and
medium size
municipalities
0.21 (c) 0.50 (i) 0.59 (o) 0.36 (u) 0.37 (bb) 0.41 (hh)
D. Industrial
municipalities
0.23 (d) 0.49 (j) 0.60 (p) 0.45 (v) 0.49 (cc) 0.45 (ii)
E. Rural and
sparsely-
populated area
municipalities
0.13 (e) 0.49 (k) 0.36 (q) 0.33 (x) 0.37 (dd) 0.34 (jj)
F. Other large
and small
municipalities
0.14 (f) 0.50 (l) 0.55 (r) 0.18 (y) 0.31 (ee) 0.34 (kk)
All municipalities 0.22 0.48 0.53 0.36 0.35
Level of normality, mean
A. Metropolitan
city
0.79 (a) 0.85 (g) 0.68 (m) 0.70 (s) 0.33 (z) 0.67 (ff)
B. Suburban
municipalities
0.77 (b) 0.86 (h) 0.58 (n) 0.67 (t) 0.52 (aa) 0.68 (gg)
C. Large and
medium size
municipalities
0.81 (c) 0.85 (i) 0.59 (o) 0.67 (u) 0.52 (bb) 0.67 (hh)
D. Industrial
municipalities
0.80 (d) 0.85 (j) 0.63 (p) 0.68 (v) 0.54 (cc) 0.70 (ii)
E. Rural and
sparsely
populated area
municipalities
0.79 (e) 0.85 (k) 0.64 (q) 0.51 (x) 0.82 (dd) 0.72 (jj)
F. Other large
and small
municipalities
0.79 (f) 0.86 (l) 0.66 (r) 0.70 (y) 0.52 (ee) 0.71 (kk)
All municipalities 0.79 0.85 0.63 0.66 0.54
Notes: 1 Imputation was not possible for all interventions, which reduced the total number of individual servicesprovided.(a) n�611; (b) n�376; (c) n�1891; (d) n�168; (e) n�114; (f) n�383; (g) n�245; (h) n�753; (i) n�3009;(j) n�281; (k) n�404; (l) n�685; (m) n�35; (n) n�149; (o) n�444; (p) n�48; (q) n�22; (r) n�61; (s) n�168;(t) n�88; (u) n�144; (v) n�4; (x) n�2; (y) n�52; (z) n�187; (aa) n�52; (bb) n�194; (cc) n�53; (dd) n�4; (ee)n�30; (ff) n�1245; (gg) n�1418; (hh) n�5682; (ii) n�554; (jj) n�546; (kk) n�1239.
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The use of explicit housing policies in the municipalities
Housing policies would ideally be a way to establish some kind of preventive strategies in
order to prevent or promote a certain development. From this perspective housing policies
can be seen as crucial for the municipalities to develop functional strategies to prevent and
handle acute homelessness. Functional policies could be manifested in written documents,
in practical routine collaboration and in the adoption of ‘a model’ to handle cases of
homeless persons. Thus, the index ‘degree of housing policy tools’ (see above) was used to
assess this factor. The criterion items as well as the index value for all municipal groups are
shown in Table 6.
On average, the municipalities apply only one of the three policy tools. When
comparing the types of municipality on a group level, they differ significantly. The more
populated municipalities use more housing policy tools. But 52% of all the municipalities
apply no housing policy tools at all. This is especially uncommon in the smaller and
sparsely-populated municipalities. Policies are meant to guide the provision of housing
services. A relevant question is therefore in what direction these policies influence the kind
of housing interventions chosen by the municipalities?
A comparison between level of explicit housing policies and the kind of housing services
provided
A correlation analysis was conducted in order to test the relationship between the degree of
specific housing policies and the two content indexes. For 132 municipalities with complete
data sets (of 357 interventions) the degree of housing policy tools is negatively correlated
with normality in the housing interventions (Rho��0.39; pB0.001) and non-related to
the level of care (Rho��0.08; p�0.37).
Thus, we may conclude that more housing policy tools do not seem to be helpful in
providing care, and rather than supporting normality in housing, they seem related to the
opposite, i.e. less integration, less autonomy, less permanence of housing and more
restrictions on the residents.
Discussion
The total amount of housing interventions provided for homeless people appears to be
close to the estimated need, at least based on the official statistics. Nevertheless the
problem of homelessness persists. Therefore one may argue that the services provided may
not be suited to the needs and preferences of the users. Need-based provision is the main
social priority in social services (Payne 2006). Although assessing needs is complex there
are approaches for mapping and meeting need (Ellis et al. 1999). The importance of such a
match has been demonstrated in a number of studies and the preference expressed by most
homeless individuals is for normal independent housing with flexible support (see Lipton
et al. 2000, Busch-Geertsema 2002). Explanatory factors may include the social stigma of
exclusion and in other cases a lack of need for care. People who are homeless for economic
reasons may benefit more from accommodation which is as normal as possible. Persons
with severe misuse and psychiatric problems may on the other hand need solutions that
include care. In order to ensure that the most vulnerable receive substantial services,
policies in social work should guide the provision of services and strive to obtain effective
targeting.
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Table 6. The prevalence of different housing policy activities in six categories of municipality (n�147)
Total Metropolitan
city
Suburban
municipalities
Large and medium
size municipalities
Industrial
municipalities
Rural and
sparsely-populated
area municipalities
Other large and small
municipalities
N 147 1 18 35 27 30 36
Housing policy,%a 18 100 33 34 7 7 11
Collaboration group,%b 31 100 39 57 19 7 25
Applies the stair-case
model of housing,%c34 100 33 69 15 7 36
Index: degree of housing
policy tools, mean rankd147 141 81 104 57 50 72
Notes: a chi-2�15.9, df�4, pB0.05; b chi-2�25.8, df�4, pB0.05; c chi-2�35.0, df�4, pB0.05; d Kruskal Wallis Test pB0.001.
41
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This study focuses primarily on municipalities’ provision of housing interventions.
Without individual data on the homeless persons who are the target of the interventions,
the match between individual needs and services provided cannot be studied. Previous
studies, however, point out the lack of support available to homeless people regarding
additional problems assessed by the social service agencies. This was reported in a case
study of two special category houses (Blid and Gerdner 2006) and in a study of all the
homeless people and the services provided in one Swedish city (Lundstrom 2004).
The present study examines the care and normality features of the housing
interventions provided. Two types of housing intervention dominate the field: daily life
support and sublet contracts through the social services. Both these have a relatively high
normality factor since the setting is in normal housing but the level of normality is
somewhat lower in sublet contracts due to restrictions in the sublet contract provided by
the social service agencies who act as landlords.
Daily life support includes care and is usually implemented before the person is evicted
and it can therefore be viewed as a preventive intervention, e.g. helping people to keep
order, to avoid nuisance and to plan their economy so that rents are paid. The mostfrequent accommodation intervention � sublet contracts � comprises a relatively low level
of care, implying a low degree of rehabilitation, access to staff, and staff qualifications.
These components may be needed to support the re-integration of persons with severe
misuse and psychiatric problems, but on the other hand they are not needed by many
whose homelessness is primarily the result of economic constraints, rather than misuse or
psychiatric problems.
Residence and care institutions, re-entry housing at the end of the continuum of care
and temporary low-threshold housings outside the continuum of care are all relatively
unusual compared to the two prevailing intervention types. All of these strike low on the
normality index.
Housing interventions including care and rehabilitation are almost equally unusual in
all categories of municipality, but interventions with a high degree of normality are more
common in smaller and sparsely-populated municipalities. The lack of normality could
therefore be associated with the structure of the housing market, e.g. the stock of
apartments. The most excluding housing interventions are more frequent in the larger
cities. A striking example is the higher level of normality even in low-threshold housing insmaller and sparsely-populated municipalities compared to in other municipalities. A
probable explanation may be that these municipalities have empty flats available in normal
housing due to migration.
Furthermore, the degree of normality and care in the different interventions can be
associated, to varying degrees, with the different models of intervention programmes
discussed earlier. One model often referred to in the most densely-populated munici-
palities, the staircase model, means that the homeless individual is temporarily offered the
least normal setting, such as shelter. Eventually he or she will move up to accommodation
that offers a higher level of normality, as in the most frequent accommodation
intervention, apartments sublet through social services. This particular intervention service
could in turn be compared with the model housing as housing which is based on the belief
that simply living in a normal setting in the community will integrate a person back into
normal living. When sublet contracts are used as the first option, i.e. without previous
steps, this might be seen as a form of housing-as-housing programme. The daily life
support often found here has more resemblance with another model, the housing support
model, since it includes care and daily life support provided to persons living in regular
flats.
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It seems that the use of housing policy and tools to implement it does not support an
increase of normality of housing provisions to the homeless, but rather it is related to the
opposite. The policies seem to increase the degree of socially excluding housing
interventions without increasing the content of care and rehabilitation. Rather than
improving the care and/or normality features of the housing service interventions, these
policies seem to result in more social exclusion, i.e. increased social stigma. Sahlin (2005)
has criticised the frequent use of the staircase model in Swedish municipalities, and claims
that it does not work as a route to inclusion in the regular housing market, therebyreducing the homelessness problem. Rather it contributes to keeping people excluded.
Hence, social work is facing a challenge to develop new policies based on research, better
suited to promote inclusion when working with homeless people.
One may question to what extent policies are formulated primarily to assist homeless
individuals in securing adequate housing and to provide support for them to be re-
integrated into the community, or if the policies are primarily formulated in order to
protect the community from homeless individuals. In a forthcoming article the
municipalities’ choice of housing interventions will be analysed based on independentcontextual variables, such as the local authority’s economy, the housing market, the
population structure, the health level and similar factors that may influence the problems
and the prerequisites for dealing with them.
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