The security alarms suddenly could not be trusted.
Elderly and sick people had to wait for hours without help - in some cases lying on the floor after a fall, in other cases in their own feces.
The chaos around the security alarms came to affect over 100 municipalities, of which several later lex Sarah-reported themselves to IVO.
But IVO has not found any errors in the municipalities' actions, and has therefore in several cases, including Munkedal, Vimmerby, Motala and Lidingö, already chosen to close the cases without action.
The company Tunstall cannot be inspected by IVO because it does not count as a care provider.
In one case in Luleå, a woman died after she had sounded the alarm several times in vain.
SVT has shown that the alarms were received by Tunstall - but did not reach the municipality.
Starts new supervision
IVO is now concluding the two cases prompted by lex Sarah reports from Luleå, without action.
At the same time, a completely new review is being started, with a focus on Luleå municipality's information security management.
The supervision takes place in accordance with the so-called NIS regulation, which since 2018 will ensure a high level of security in information security systems, measures and incident reporting within the EU.
According to Stefan Lilius, inspector at IVO, the purpose is to "investigate the background to incidents that have occurred regarding security alarms, including division of responsibilities" with a focus on the municipality's information security work.
Lacks explanation from the company
The municipality has in turn asked Tunstall for an explanation for the events in October and says that they still have not received any.
"The social administration has not received any explanation from Tunstall," the municipality wrote in February in an email to the company, asking for a written report or a meeting.
The answer from Tunstall is short.
"As we announced earlier, we have provided the information we have in the case.
If IVO should have any specific question about any particular detail that is addressed to us, IVO is happy to contact us directly and we will see what we can do. ”
Were you or someone you know affected by the problems? Do you know more about the events? Get in touch with SVT's reporter.
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In the clip above, you can follow the timeline from the home care service's visit at 6 pm until she was found dead almost eight hours later.
Photo: SVT Grafik