From Public Service to Fragmented Care: The Roots of the Assistant Business
In the Nordic countries, citizen welfare services make up a significant portion of national income. Previously, the organization of these services was entirely the responsibility of the public sector. Service provision was regulated, and employees were required to meet minimum standards in terms of skills and language proficiency. Traditionally, services provided by the public sector were not considered actual business operations, since they merely “recycled the taxes paid by citizens.”
Private companies loudly proclaim the added value they bring to society, while the immediate value produced by public services is often ignored. Companies that fail to recognize the benefits of publicly organized services have aggressively applied business models to welfare provision. Dozens (even hundreds) of companies now dominate the assistant and home care market.
The field is flooded with solo operators who define for themselves what kind of service they offer to their clients — that is, to those receiving assistance. Some don’t even have a shared facility where they store, for example, the keys of their clients.
The Practice of the Home Care and Assistant Business
Private companies have turned the organization of welfare services into a multimillion-euro business. At the same time, they’ve managed to thoroughly mess up the entire assistant system. This is evident in concrete ways. For example, ten years ago, when I searched for an assistant through the employment office, I had access to the entire labor market and received multiple responses. But last spring, when I posted a notice through the employment office’s online service, my ad was buried beneath dozens of listings from companies also seeking assistants. Finding a permanent assistant has become practically impossible for me.
Wages
I don’t understand how the added value of public funds increases when tax money is funneled through private companies. The companies that provide assistants pay their employees better wages than I could if I were the employer myself. How is that possible, when the actual payer is the same — the city (i.e., the taxpayers)?
One possible explanation is that the city pays more to companies in order to avoid payroll-related costs. These costs are then transferred to the companies, and they disappear. Companies see their mission as producing profit for their owners.
Employee Orientation
Profit is generated by employees who accept poor working conditions — or who are simply untrained and lack language skills. Often, they have no situational awareness or initiative. They don’t do anything unless explicitly asked. They seem unable to think or act independently, and they have no clear understanding of the work they’re doing, let alone the tools they’re using.
The city pays for the service regardless of how well the company performs — or whether the assistant actually serves the client at all. New caregivers often receive no orientation whatsoever. The baseline seems to be: “The client will explain what needs to be done and what kind of help is required.” That’s a poor guideline when the client is someone like me, who often needs to boost adrenaline just to speak clearly. Or when the caregiver and client don’t understand each other at all.
In such cases, a Finnish caregiver visiting me has sometimes had to act as a phone interpreter for another caregiver who didn’t speak Finnish. Home care workers are always in a rush — but who considers how much faster things would go if the caregiver could think independently, and the client didn’t have to instruct every single step?
Put on the grip socks … lower the footrests of the wheelchair … lift both feet onto the footrests so the toes don’t hang over the edge … place the knee support … lift the leg…
Who among us wants robots nearby — beings with no emotional intelligence, no intuitive mind, and no capacity for independent thought?
Oversight
When an assistant works for a company, they serve the company—not necessarily the client. In some cases, all communication goes through the company, and the client doesn’t even have the assistant’s phone number. One of my assistants had a private number. Once, I had arranged with the company’s scheduling coordinator that the assistant would come to me on Sunday at 9:00. But the coordinator forgot to confirm the shift with the assistant. The assistant didn’t show up, and I had no way to contact them. There was no point trying to sort it out in that moment.
Who monitors whether the company charges the city only for hours actually worked? Who ensures that the client receives the amount of help they’ve been officially assessed to need? Or is outsourcing assistant and home care services simply the city’s way of avoiding legal obligations and costs?
My Perspective
I have interacted with dozens of assistants from intermediary companies, and it often feels like the managers have lost touch with the core concepts. They don’t seem to have a clear understanding of what kind of service their caregivers or assistants are supposed to provide — or who their target group even is.
On their websites, companies promise the moon and stars. Assistants are said to work as a team, but when things get difficult, management implies they can’t expect their employees to actually collaborate. For example, when one assistant found it impossible to coordinate the handover of a key with the colleague who had visited me the day before.
An untrained assistant hired by a company can help only as long as the client is mobile and relatively independent. In November, the lifting motor of my standing wheelchair broke, and I was completely dependent on others for a month. At best, I can move between the kitchen table and my computer using a manual wheelchair — if I can grab onto furniture along the way. Due to a surgery a few years ago, my abdominal wall is still partially numb, and I can’t use my core muscles the way I used to.
Home care helped me get out of bed in the mornings and back in at night. During that month, I saw firsthand what kind of service these “wellness companies” actually provide. I was almost ashamed of how quickly all my social filters and polite façades dropped in the face of real need. I had to boost my system with so much adrenaline that I was swearing like a storm. My days began in a surge of fight-or-flight energy.
This article shares my personal experience with home care and assistant services. At times, I describe things in ridiculous detail — but it’s precisely those “ridiculous details” that have allowed me to keep my house of cards standing.
Sharing my perspective is not a complaint. I know I create my own reality. I’m aware of my privileges — especially the fact that I can make my voice heard. I know thousands of people live in similar or worse conditions. Many likely live alone without any care at all.
I have the freedom to stay in bed, refuse company-provided services, and figure out how to manage on my own. But my task is to rise above time and space and act where I can make a difference.
This writing is not against anyone or anything. Its sole purpose is to offer a grassroots perspective—and the best way to do that is to share firsthand experience.
I hope this piece — which stretched to 11 A4 pages — will help improve assistant and home care services. For easier reading and sharing, I’ve also created a printable PDF version.
The Purpose of Assistant Services and Home Care
In principle, anyone can act as a caregiver or assistant as long as the goal is simply to get through the day. But companies that provide wellness services are supposed to have a clear objective. That objective isn’t just to generate added value for society — or more precisely, profit for their owners. The true purpose is to assist those in need so that their functional capacity is preserved, and so that they — despite their limitations — can continue to contribute to society, even if only by radiating positive energy.
When I moved into my first apartment in the early 1980s, I was considered too “able-bodied” for home care, even though I couldn’t speak and one side of my body was paralyzed. Still, I had no acute weaknesses: I could get out of bed in the morning and manage on my own at night. I went shopping, cooked, did laundry, cleaned the floors — everything. Home care had a clear mandate: to assist those who couldn’t manage basic tasks. They couldn’t help me with things I actually needed, like buying typewriter paper or cleaning the windows. So I did everything myself.
Back then, I wasn’t yet studying. I could devote all my time to daily survival — shopping, cooking, cleaning. But now, having completed my education, I face many other challenges. The assistant’s role is to compensate for the slowness caused by my condition and help me maintain overall functionality. That means the assistant must, in a way, see the world through my eyes.
The assistant system for people with disabilities was developed to meet different needs than home care. The assistant compensates for a permanent limitation that is the person’s normal state. Home care clients often have temporary needs. The assistant’s purpose is to help fully capable and independent individuals become the best version of themselves.
It’s not just about basic tasks like shopping, cooking, eating, cleaning, hygiene, or laundry. The assistant is meant to support everything the client does. At best, they’re a multi-talented all-rounder — a nurse, housekeeper, cleaner, cook, IT support, seamstress, carpenter, gardener — all in one.
They ensure the client has the necessary tools for study, work, and hobbies, and that those tools are functional. One of the assistant’s most important tasks is to make sure that, at the end of their shift, the client’s home is in a state that allows them to function independently when alone.
The Assistant’s Intuition Must Be Intact
During my studies, I once asked a Chinese classmate to be my assistant for the summer. “I’d love to,” she said, “but I already work for a company. I don’t do anything there — I just sit all day — but I need the certificate.”
Over the past 20 years, I’ve come to understand what that situation really meant. It wasn’t that she had nothing to do — it was that she couldn’t see what needed doing. She lacked the ability to perceive the whole and recognize where she could be of help.
Companies often don’t hire trainees because they must fulfill their tasks regardless. Their employees don’t have time to teach someone who can’t act independently.
Back in school, a friend once told me about a wheelchair user who constantly barked orders at their assistant: Get the paper. Get the pen. Do this. Do that. I’ve spent over 20 years trying to help my assistants work in a way that doesn’t require me to say what I want. I suspect that “bossy wheelchair user” was in the same situation. The assistant hadn’t noticed the whole picture — like what the person intended to do with the paper. If they had realized it was for writing, common sense would’ve said: You’ll need a pen too.
When I was in China for rehabilitation nearly 20 years ago, I hired a 55-year-old woman who had never worked outside her home. She had spent her life caring for her family, her parents, her husband’s parents, and other relatives. She was one of the best assistants I’ve ever had. When my mirror broke, she brought me a new one without being asked. When we talked about the cold nights, she got me a hot water bottle. She always seemed to know what I needed — just by observing and using common sense.
This applies to physical assistance too. Does the caregiver understand what they’re doing when I ask them to support my paralyzed elbow so I can stand and transfer to my wheelchair? Or do they think they just need to hold my arm and offer moral support?
Proper support lightens the load on my pelvis, making it easier to move my legs. And then the assistant must know to step aside so I have space to move.
Valitettavasti edes sairaalassa toimivat hoitajat eivät aina osaa käyttää tervettä järkeä, vaikka luulisi, että heillä on kaikki tiedot hoidettaviensa terveydentilasta ja fyysisestä suorituskyvystä. Kun hoitajat leikkauksen jälkeen ensimmäisen kerran yrittivät siirtää minua pyörätuoliin he olivat jostakin saaneet päähänsä, että heidän piti nostaa minut. He yrittivät saada minut sängyllä siirtymään pyörätuolin viereen ja siitä edelleen tuoliin. Tämä ei näyttänyt onnistuvan edes kolmen hoitajan voimin.
Sadly, even hospital staff don’t always use common sense, despite having access to full medical records. After surgery, when nurses first tried to transfer me to a wheelchair, they somehow decided they needed to lift me. They tried to move me from the bed to the chair with three people—and still couldn’t manage.
My assistant at the time — a petite Chinese woman with a firm grip — was visiting me. She watched for a moment, then stepped in. She put on my grip socks, placed my feet firmly on the floor, helped me stand up holding the surgical drains, supported my elbow, and I spun around and sat in the chair.
Caught in the Chaos
Because I speak English and don’t take medication, the company coordinating my assistant and home care services seems to operate under a default assumption: “We can send anyone to her—even someone with no language skills.”
After the first few days in the manual wheelchair, I realized that some caregivers were encountering a push wheelchair for the very first time. Not long after I had expressed my concern to a senior assistant — about how outrageous it was that they were learning on the job — those very trainees managed to drop me from the chair.
Even though there were two caregivers present, neither noticed I was falling, despite my attempts to alert them. Their full attention was on adjusting the footrests. They only realized what had happened when I collapsed onto the floor.
One of them dragged me like a rag doll to the side of the bed and suggested they lift me back up. The other responded firmly: “I won’t lift! My employer has strictly forbidden us from lifting anyone. Let’s leave that to the professionals.” She then called an ambulance.
I watched the scene in stunned silence. I understand the caution around lifting in case of fractures or injury — but in this situation?
What kind of company instructs its employees to call emergency services in a real-time care scenario?
I sat on the floor for nearly two hours, my backside numb, waiting for the ambulance. I overheard one caregiver say to the other, as if I weren’t there: “You know her better. Can you explain to the paramedics what her problem is?”
“I can speak for myself,” I said.
When the ambulance arrived, all they had to do was lift me by the forearms and help me sit on the bed. Then came their routine checks — blood pressure, pulse, and so on — which were entirely unnecessary in that moment.
The whole episode made me feel like I was being handled by a random youth gang, not professional caregivers.
Everything Under Control — Except the Gloves Are Missing
After I fell from the wheelchair, swelling began to rise in my paralyzed leg. Normally, it’s limited to the foot and ankle, but this time it spread to the thigh and groin. The skin was taut, and the veins in my thigh were hard and painful. I couldn’t move the leg consciously — not even a centimeter — and I couldn’t stand on it at all.
For the next week, I was essentially confined to bed.
Cooperation with the caregivers became impossible when their language skills seemed limited to phrases like: “I don’t understand … what do you want?”
After explaining a simple thing multiple times and always receiving the same response — “don’t know … don’t understand” — I decided it was best not to expect anything from them.
When I was hungry, I simply said: “Find me something to eat from the kitchen.”
I had spent the weekend in bed and had a pounding headache. When the caregiver arrived on Sunday evening, she asked me to hand over my apartment key. The key had gone missing, and they’d had to call the building manager to open the door.
“I’ve already given you two keys. If you’ve managed to lose both, I’m certainly not giving you a third,” I said bluntly.
The caregiver tried, along with the on-call office worker, to persuade me to hand over my only remaining key. I refused to even consider it.
She asked: “Why are you making this so difficult?”
“Well, it’s clearly my fault that you can’t keep track of the keys and ensure they’re available when needed,” I replied.
“How am I supposed to get to you in the morning if there’s no key?” she asked.
By then, I was so fed up with the situation that I said directly: “If there’s no key, don’t come at all!”
What Is the Higher Purpose of All This?
Earlier, I wrote that everyone has the right to expect others to act with common sense. Of course, we all have the right to expect anything—but for the sake of our own peace of mind, it’s often better not to expect anything at all.
Everyone has the right to be led by their ego and behave as irrationally as their soul can tolerate.
For the past year, I’ve listened daily to video messages from the Galactic Federation. They’ve been like honey for my soul. But in the past month, those messages haven’t resonated with me at all. They’ve felt like mixed, emotionally manipulative outbursts:
“We have this attitude called unconditional love. No matter how loudly you scream, kick, cry, curse, or grind your teeth — we are always here and we love you. Now go ahead and stew in the mess you’ve made.”
“Goddamn sadists,” I muttered inwardly, thinking of our so-called 5D assistants.
I recalled a documentary I once saw in China, about a married couple who were both doctors. The husband had been paralyzed in a car accident and suffered injuries similar to mine. His wife cared for him day and night in the hospital, and his condition improved enough for rehabilitation to begin.
The documentary was in Chinese, and I may have misunderstood some parts. But I got the impression that the wife had, at some point, decided not to help her husband anymore. She remained in the background, like a shadow. She didn’t assist him when he needed to stand up with crutches — he had to find the strength within himself.
Over the years, he recovered and eventually learned to walk again.
One can only imagine how much faster his recovery might have been if his wife had helped him find the right positions and weight shifts to activate his muscles optimally.
If there are truly methods to heal all diseases and erase human suffering, why must I — or anyone — keep going through the same crap year after year?
Haven’t I already completed my soul lessons many times over?
In my situation, spirit guides were of no help. In my mind’s eye, I stood at a dead end. Before me loomed an insurmountable wall. Memories surfaced — spontaneous reactions to random events where I had felt strong, even though I’d rather forget those moments.
Primal Force
In the early days of my time in China, my ex-husband once acted as my interpreter at a hair salon. I couldn’t yet speak Chinese fluently enough to explain what I wanted. After the haircut, he asked how it turned out. “It’s a bit short, but it’ll grow back,” I said lightly.
For some reason, he took this as criticism. He began accusing me of being unclear, blaming me for the haircut and for his supposed mistranslation. I tried to interrupt, saying it didn’t matter — but he wouldn’t stop. His rant grew more intense, and I realized there was no point trying to reason with him.
I was standing in a doorway, leaning on my walking stick. As his tirade continued, I felt a surge of anger rise within me. I slammed the stick against the floor with all my strength. It snapped in half like a matchstick.
His rant stopped instantly. He stared at me, stunned. Then, as if waking from a trance, he lunged forward, kicked the broken pieces across the room, and shouted: “Goddamn it! Now I have to buy you a new walking stick!”
Another time, I had asked a Chinese classmate to help me with grammar exercises. I had worked late into the night preparing them. The next morning, he found a couple of mistakes and began berating me: “You’re lazy, vain, unserious…”
I listened, bewildered. What had triggered this outburst? My frustration built until I slammed my fist on the table, sending pens flying. “Out!” I shouted, pointing to the door.
He looked at me, stunned, then stood up and walked toward the exit. At the door, he turned and said: “You can’t treat me like a dog — invite me in and then throw me out.”
“And you can’t treat me like one either,” I replied. “I worked through the night, and you find two errors and decide I’m worthless? Think again.”
He sat back down, and we continued the exercises as if nothing had happened.
Once, my ex slapped me so hard my glasses flew across the room. We were sitting face to face on the floor, arguing. He hurled insults, saying I hadn’t given him the life he expected when he married me. When nothing else worked, he shouted: “You don’t belong in my family!”
“Okay. I don’t belong. So what?”
“I’ll kill you!”
“Go ahead,” I said calmly. “Help me stand up so I can find you a knife.”
He helped me up. And in that moment, I thought I saw a flicker of a smile on his face.
Light in Sight
What do these past events have to do with today’s assistant crisis? I asked myself.
The previous weeks had tangled into a chaotic knot in my mind. To make sense of it all, I began drafting this article while lying in bed, typing into my phone’s notepad app. As the structure began to take shape, I found myself laughing so hard — tears streaming, stomach aching — that I felt something shift.
A sense of knowing arose: I’ll get my electric wheelchair back before Christmas.
I had no idea how I’d managed to weave my scattered thoughts into something coherent, but I trusted the process. That trust began to dissolve the anxiety.
My senior assistant, the one who somehow managed to keep things in order, was with me the entire next day. The wheelchair service called to say they’d return my chair by 4 p.m. — while she was still present.
Once I could move independently again, everything became easier. Christmas and New Year’s were gentler than I had expected.
On New Year’s Day, I woke with a vivid image in my mind: the ape-man I had used in a previous article titled Time to Remove the Masks and Costumes (June 2022). Until now, I had interpreted the image as a call to break free from Darwinist conditioning — the idea that humans evolved from apes. I saw it as a reminder to reconnect with our higher selves and recognize our spiritual essence..
But that morning, a new interpretation emerged: We must be authentic—with ourselves and with each other. Life is not a game of appearances, where our energy “vibrates at a higher frequency” while others use us as doormats or tools for selfish gain.
It’s grotesque to speak of soul lessons in such contexts.
If we truly want to reach the core of things, we must drop all filters of politeness and shame. Most of the time, those filters are nothing more than cultural illusions implanted in our minds.
When I opened my phone that morning, the time was 5:55. I felt that I was in the same energies as before.
What Do We Learn from This?
People often lament the erosion of social cohesion. But perhaps it’s not a structural failure—it’s an attitudinal one. Cohesion isn’t something we wait for; it’s something we choose to embody.
It could be restored, even quietly, if more people sought work that invites deep human connection. Work that doesn’t just serve, but transforms. One caregiver once wondered aloud why assistant work isn’t more popular, given how close it brings you to the pulse of life.
I read somewhere that in the Philippines, nursing is one of the most respected professions. Some surveys suggest the same is true in Finland. But respect alone doesn’t pay the rent. People need income to survive — and that may be the root of the crisis.
Skilled caregivers exist. They’re out there. But they won’t step forward until respect is reflected not just in words, but in wages.