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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

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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.

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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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