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Personal assistance (PA) is stated in Article 19 of the UNCRPD as an internationally recognised disability right and is operationalised as a measure in the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS Act). The Act’s overall policy goal is to promote good living conditions for the eligible persons by enabling participation in society on equal terms with others. The governance of PA is a divided responsibility between the municipality and the Swedish Social Insurance Agency (SSIA), which assesses and grants PA-allowance if the PA applicant exceed 20 hours of certain needs per week. The overall aim of the thesis was to explore how the governance of PA-allowance enables to fulfil the LSS Act policy goals. The main findings of the thesis demonstrate a tilt in PA towards a medical model of disability, marked by a domination and an increase of healthcare activities over time. Less activities representing participation in society were found and unequal access to PA activities across age, gender and groups of persons with disabilities. The findings imply an increased risk to social and financial exclusion of PA users. Further, the LSS Act’s rationale and policy goals were shown to have a weakened impact on the SSIA instruction, the refined policy tool which outlines the PA-allowance granting process. A development towards a medicalised application of PA-allowance was found, characterised by healthcare measures to support medical conditions and a shift towards PA users with less ability to partake in the PA-allowance granting process. Factors shown to have influenced the governance of PA-allowance include: case law, changed policy priorities, weakened PA collaboration structures, inadequate monitoring of PA outcomes, strained working conditions at the SSIA and extensive complexities of the PA-allowance application. This thesis illustrates that the SSIA regime logic has thoroughly influenced the LSS policy outcome with time and emphasises the need for social reform policy tools to be continuously calibrated towards the original policy goals to uphold policy compliance. The regression of PA, by gradually resigning to a medical model of disability, demonstrates weakened conditions for Swedish disability policy through the LSS Act to fulfil Article 19 of the UNCRPD.

Background The Swedish Act regarding Support and Service for Persons with Certain Functional Impairments (LSS), in effect since 1994, guarantees good living conditions for the users and covers a wide range of user groups with regard to age, disability and severity of needs. The aim of the study was to examine the content of the intervention, to get an understanding how of the core concept, “good living conditions” has been interpreted and to gain an insight on how users perceive quality of their personal assistance. Method A literature survey of perceived quality in personal assistance was undertaken. The review was based on qualitative studies conducted during the past 20 year’s implementation of the act. Results The review emerge joint themes that perceives quality of personal assistance by the user. Overall outcomes shows that an efficient personal assistance is characterized by being in control in relation to the environment, trust of feeling safe and secure in relation to the assistant and performed assistance, and that actions through personal assistance as a whole provides well-being for both the user as well as for the family members. Prerequisites for the ability to exercise control by the user, in the management of personal assistance, are emerging as a key condition for the experience of quality. A dilemma for policy intervention is, however, how the principle of user control should be practiced when groups with weak user control require personal assistance. Conclusions The result shows that perceived quality of personal assistance are in line with general health care and social indictors, rather than performing the core concept of the LSS legislation. There is a need to further investigate how perceived quality of personal assistance falls out for users with different degrees of user control. Avhandlingsprojekt rättsäkerhet inom personlig assistans