Commenting on the full year and quarterly numbers as usual. After that, I'll present Attendo's updated strategic direction and new financial targets that we just published in connection with the quarterly report. Before jumping into the presentation, I'd like to share a few comments on the coronavirus pandemic and the status right now. We've seen increasing levels of transmission in society in the entire Nordic region during the second wave of the pandemic. While number of infected have been increasing also in Denmark and somewhat in Finland, the general level of transmission in society has been the highest in Sweden, comparable to or even surpassing the first wave. In Attendo, we've had very few cases of infection in Denmark and Finland, while the situation in Sweden has been more challenging.
At this time, we have almost concluded the vaccination program for nursing home clients in Sweden, and the result is a 75% reduction of infected clients in only two weeks. We hope that this marks the start of a gradual normalization for both customers and our operations. I will now turn to the presentation, and then Fredrik will take you through the numbers in more detail. Next slide, please. On group level, we delivered progress in both sales and results. With more sold beds and higher prices in all markets, we achieved a healthy organic growth of 5% on group level. Executing on our turnaround in Finland is dependent on succeeding with both increasing occupancy to healthy levels and to recoup the cost of change regulation over the next few years. During the quarter, we nearly finalized negotiation of prices for 2021 in Finland.
For framework contracts, we achieved an average of above 10% increase. This translates to slightly more than 3% increase on total revenues in Finland. Bear in mind that for 2021, cost inflation and cost for the new law is likely to largely offset the margin expansion from the price hike. Prices in Finland are still structurally too low, and we will continue to push for higher prices. As we enter the quarter, the new elderly care law in Finland became valid. While the first increase in staffing density requirements to 0.55 is valid from January 1st this year, other changes in staffing regulation led to increased cost of around SEK 10 million in the quarter. Apart from that, we're largely in line with our turnaround plan. Our Scandinavian operations stabilized somewhat during the quarter after a very challenging period with hampered demand due to the pandemic.
Adjusted for corona impact, the result was in line with Q4 last year. Net customer inflow was positive in the quarter, while still lower than normal. Because of the pandemic, we will enter 2021 with a lower average occupancy compared to a year ago. During 2020, employee engagement has increased sharply in all markets. The result of our annual employee net promoter score survey reached all-time high, indicating a dramatic improvement of staff engagement. We've also seen people attrition has been steadily decreasing during 2020. We believe that our forceful response to the pandemic, in combination with our efforts in digitalization, values, and internal communications, has been seen very positive among employees. The net financial impact on the COVID situation was very low in the quarter and significantly lower versus what we earlier indicated, as we've been granted government reimbursement in Q4 derived from costs that occurred throughout 2020.
Next slide. Overall, the effects of our turnaround plan starts to become visible in the numbers. Occupancy is increasing, profits and margins are improving, and we are moving towards a more balanced expansion phase with lower open beds and a more balanced pipeline of new projects. We reported a top-line growth in the quarter of 2% year-on-year in local currency, translating to an organic growth of 5%, related to the progress we're seeing. Putting a lot of effort into developing the next generation of quality system and quality work methods. The ambition is to monitor and work more proactively with health, quality of life, and preventive care compared to how the industry have been working in the past. Next slide, please. This chart shows the rolling 12 months opening pace and openings per quarter.
We're now seeing clear effects of the strategic shift we decided on two years ago to decrease establishment of new units in Finland and return to a more balanced expansion pace. In Q1, we plan to open 200 beds in Scandinavia and 140 in Finland. For 2021, we expect gross opening pace to roughly 800 beds, with the majority is in the Scandinavian business. Next. We increased the number of own beds in operation by 6% from the corresponding period last year. During Q4, we opened 198 beds, and at the same time, we closed down 20. In Q4, we only started construction of one new group home with six beds. As you can see, we have reduced the total number of beds under construction by 48% since the same period last year. By the end of Q4, we had roughly 1,000 beds under construction, the majority in Scandinavia.
In Finland, our focus is to fill the units that we have established in recent years and continue to deliver the improved occupancy coming quarters. Turning to occupancy by vintage. We continue to increase total occupancy for the second consecutive quarter, although the effects of the pandemic is still visible in the mature units. We continue to see a slight downward trend in the fourth quarter. This chart explains group margins in mature and startup units and sales. We can finally observe an uptick in mature margins driven by the turnaround program in Finland. The key drivers for continued margin recovery in Finland are higher occupancy and higher prices reflecting our new cost base. We expect to continue gradual increase in occupancy during 2021.
In Scandinavia, we gradually expect to normalize inflow on new clients going forward as the effects of the pandemic wear off. As we enter 2021 with lower occupancy, combined with a higher number of new openings, we will continue to see pressure on margins in the short-term. With that, we move into the financials for the quarter, and please go ahead, Fredrik. Next slide, please.
Thank you, Martin. Let's turn to page eight. Net sales increased somewhat to SEK 3.1 billion, up by less than 1% compared to the corresponding quarter last year. The exit from Norway impacted the comparison with about SEK 100 million, and currency also had a negative impact of 1.9%. Organic growth was 5%, despite the negative impact on growth from lost revenue due to the corona situation.
In Finland, there's a growth across all service offerings, while growth in Scandinavia is still negative, driven by exited home care areas. Organic growth for elderly care nursing homes are, however, positive again. Reported EBITDA amounted to SEK 193 million in the quarter. I will come back with details on the underlying EBITDA development. The positive SEK 6 million report as items affecting comparability is only currency effects on the write-down we did in the second quarter of this year. Financial net was negative SEK 164 million, compared to negative SEK 156 million in the fourth quarter of 2019. IFRS 16-related interest expenses increased by SEK 14 million, while interest expenses for our borrowing from banks were flat. Last year, we had a one-time charge of SEK 8 million related to the new financing agreement.
Income tax for the quarter was SEK 0 million, which corresponds to a tax rate of 31% for the full year, adjusted for the goodwill write-down. Profit for the period amounted to SEK 4 million in the quarter, which equals an earnings per share after dilution of SEK 0.02. From this year, we will also report adjusted EPS. This is earnings per share adjusted for effects from IFRS 16, acquisition-related amortizations, items affecting comparability, and the corresponding tax effects. The full table on the calculation for adjusted EPS is available on page 28 of the interim report. The adjusted EPS for the quarter was SEK 0.31, up from SEK 0.04 last year. Next slide, please. The Scandinavia business area is clearly impacted by corona. Net sales for the business area decreased as we have exited Norway and corona has impacted sales. EBITDA decreased from SEK 172 million- SEK 155 million.
Corona impacted negatively with SEK 20 million, lower than expected as some compensation for costs early in the year was received during the quarter. Own care homes opened in 2019 and 2020 had a large negative impact on operating profit for start-up costs, as expected, while underlying profits increased for home care and outsourcing. During the quarter, we have in tendering processes won, but yet not started, contracts with an annualized revenue of SEK 84 million. For all of 2020, tendering processes have resulted in a positive net of estimated SEK 42 million in annualized revenue. Next slide, please. Growth continues to be high for Attendo Finland and amounts to 9% reported and 13% in local currency. The growth primarily comes from more occupied beds in units opened in 2019 and 2020, price increases, and acquisitions. Price increases amounted to around 3%.
EBITDA improved from negative SEK 20 million to positive SEK 48 million. Price increases and improved occupancy among mature units was only partially offset by start-up costs from units opened in 2019 and 2020 and higher costs in operations, largely due to the implementation of the new law. By the end of the quarter, the number of empty beds was lower than one year ago. Attendo received reimbursement for some corona-related costs that had occurred early in 2020, which resulted in the corona-related supportive measures more than offset the cost for the isolated quarter, with a positive net of about SEK 20 million. Compared to the fourth quarter in 2019, calendar effects were positive with about SEK 10 million. Before we turn slide, I just want to give a few comments on the coming quarters for both Finland and Scandinavia.
The corona pandemic will impact the coming quarters, although the magnitude is still somewhat uncertain. Revenue in Scandinavia will continue to be impacted negatively as we enter 2021 with a lower occupancy. We have in Sweden applied for government reimbursement to cover for corona-related extra costs. Those applications are sent to every municipality individually, who takes them forward to the national government. In Finland, we have applied for cost coverage of somewhat increased costs. As mentioned, we have received some reimbursements in 2020. By year-end, we still had about SEK 70 million pending. In January 2021, we have received around SEK 30 million. Timing and to what extent the rest of our applications will be covered is still unclear. When comparing year-on-year, one should also remember that the impact from corona was limited in the first quarter of 2021.
Besides corona, I also want to mention that although we should see positive price effects on revenue in Finland in the new year, not all prices are valid from January 1st. As Martin mentioned earlier, the margin impact will be limited. Compared to previous year, calendar effects in the first quarter are estimated to be negative with about SEK 20 million, as we had a leap year in 2020. Next slide, please. Free cash flow was positive with SEK 132 million in the quarter, somewhat lower than last year. The positive working capital development we have seen during the year is partly due to timing effects. Adjusted net debt amounted to SEK 1.6 billion, which equals an adjusted net debt to adjusted EBITDA ratio of 2.6, a clear improvement to previous quarter. During the quarter, Attendo divested a company with 11 properties and related bank loans amounting to SEK 297 million.
Attendo will continue to run the care operations in the facilities. You can read more about the transaction in the report. With that, I hand back over to you, Martin.
Thank you, Fredrik. Next slide, please. I'd like to make a quick roundup of the quarter development before we enter the next part with our updated financial targets. Turnover and profits developed positive year-over-year with a clear improvement in Finland and a stable development in Scandinavia. We will continue to execute on our turnaround program in Finland in 2021, while Scandinavia will start the year with a tough comparable quarter as Q1 2020 had very limited impact from the COVID situation. Finally, I'm satisfied with the progress of vaccination in all countries. I sincerely hope that we're now see the beginning of a normalization where our customers in the near future can again meet and socialize. This concludes the first part of our presentation today and now turn to the Attendo strategic direction and our updated financial targets. Please turn to page 14, please.
I'd like to start this part of the presentation with a short review of the company history. For more than 35 years, Attendo have been developing care services based on the needs and preferences of the individual. Through the years, Attendo has been pioneers in many areas such as measuring and reporting quality and developing methods and processes to assure health and wellbeing. Attendo is also the private provider that has established the highest number of new nursing homes the last 15 years, helping local authorities to cut queues and save money. Today, we operate more than 700 care units across the Nordics. Next slide, please. As a private provider of welfare services, our purpose is to provide quality care with higher customer satisfaction at equal or lower cost for society.
Quality, health, and satisfaction goes hand in hand, and we're currently developing the next generation of quality system to better monitor and work more proactively with health, quality of life, and preventive care. Our payers, mostly municipalities, must obtain the best care possible for the tax money they spend. We have a long history of successfully delivering quality of care equal to or better than the public sector at lower cost. In essence, this is how we provide value for customers and society. Next slide, please. Since 2008, our core strategy for growth has been to build and establish new own-operated nursing homes for elderly and disabled people. There are several advantages in own operations compared to our outsourcing business. Firstly, we build modern, customized care homes with the best possible conditions for providing good, safe care while ensuring resource-efficient operations.
Secondly, these units are free from heritage, and we can recruit and train all staff from start according to our values and way of working. Finally, our own operated units creates more value over time as we are not limited to a fixed-term outsourcing contract. Over time, Attendo's own operation business has generated the bulk of growth and profitability and now stands for over 80% of revenues. Another tangible contributor to growth is acquisitions. Except for the large Mikeva acquisition in Finland in 2017, the majority of acquisitions in the past has been smaller value-creating bolt-on acquisitions. Our view is that there is still significant in-market M&A opportunities to acquire small and medium-sized companies in existing segments and geographies. Longer term, acquisitions are also potential route to establishing Attendo in new markets.
While outsourcing is the smaller part of our business today with limited growth potential, there are attractive pockets in this market. Next slide, please. Our value creation model is built on three fundamental principles: a scalable platform with common tools, a common operational model called Attendo Way, and finally, a customer-centric and value-based culture. In terms of a shared and scalable platform, we took additional steps in 2020 with the launch of apps for employee communication, information, and e-learning, and the app for relative communication, as well as the rollout of a mobile planning, scheduling, and documentation system in all care for all the people. We see good opportunities to further increase customer satisfaction and quality, thus strengthening the conditions for higher occupancy going forward.
To this aim, we further developed our operational model in 2020, which provides wider support to local operations in the work to ensure high-quality care while encouraging local commitment. By constantly refining the Attendo Care Model, we have consistently been able to deliver strong and stable margins in mature units over time. While our overall margins has been heavily challenged the past years with overexpansion, regulation, and corona, our consistent performance within mature units in Sweden shows the long-term potential in our business. Please turn to slide 18, please. Historically, Attendo has been able to combine high growth with stable margins. During more than 10 years, Attendo's group EBITDA margin in old GAAP was around 9%.
The main factor behind this consistency in performance was a balanced expansion pace where openings and new beds matched growth and market demand, reaching full occupancy and mature margins within 12 months from opening. In 2017, this trend was broken. There are mainly three factors behind the margin erosion past four years. Rapid overexpansion in Finland, 2017-2018, change to regulatory landscape in Finland in 2019, and COVID in 2020. In 2017 and 2018, Attendo tripled opening pace in Finland based on the demographic outlook, anticipated replacements, and the upcoming SOTE reform. This was followed by increased opening pace also from competitors, while the closure of old care homes took longer time than expected. As a result, overall occupancy in the market fell from over 90% to below 80%, diluting profitability. In 2017, Attendo also acquired the Finnish competitor Mikeva, a company with low profitability.
In hindsight, the timing of this acquisition was very poor, adding to the occupancy dilution, and this acquisition have not been able to meet their expectations regarding long-term profitability. In early 2019, there was a national political debate in Finland focused mainly on quality and staffing density in the care sector. The implication was sharper staffing requirements for all providers, with private providers risking to get permits revoked if not fulfilled. Despite high running costs for staff effective immediately, private providers were not automatically compensated. Instead, we have to seek compensation in a multi-year process as public contracts runs out for renegotiations. In 2020, the pandemic had a significant impact on Attendo's operations, particularly in Sweden, resulting in lower inflow of new customers in combination with higher running costs. For 2020, we have estimated SEK 120 million in COVID-related costs that has not been compensated by state support so far.
Next slide, please. During the coming three years, our aim is to execute on our turnaround program to increase profitability while strengthening the Attendo platform and value proposition. In the first half of 2019, following the Finnish care crisis, we initiated a multi-year turnaround program to reverse the profitability trend in Finland by investing more in quality, reduced rate of new openings, renegotiation of old contracts, and optimizing the structure of existing homes. As of today, we have renegotiated approximately 50% of our framework contracts in Finland and have at least two more years of negotiations ahead of us before all contracts are renegotiated. With a more balanced opening pace, fair price, and increased focus on sales and quality, we expect both occupancy and margins in Finland to increase over the coming years.
In Sweden, we expect to see a gradual normalization of customer inflow during the second half of 2021, as the effect from the pandemic is expected to decline. It's important to remember that the pandemic has not changed the fundamental need for care, but short-term, lower occupancy also in public sector units will hamper demand. While restoring profitability, we will also continue to refine our operational model and strengthen our competitive advantage to be ready for a new period of higher growth from 2024 with the coming elderly boom. Let's turn to our revised financial targets. Our previous financial targets were set in connection to the IPO in late 2015. Since then, market conditions have changed, Attendo's expansion strategy laid out in 2016 has led to significant occupancy and profitability problems. The past two years, we have done significant changes in Attendo.
We have launched a comprehensive turnaround program in Finland, recruited a new management team, both on group and business area level, and revised our strategy. With early progress of the Finnish turnaround now visible and COVID vaccination programs ongoing, this is a proper time to launch updated financial targets. Please turn to page 20, please. Our new financial target is achieving adjusted EPS of at least SEK 4 by 2023, calculating according to the earlier accounting standard IAS 17 and excluding amortization of acquisition-related intangible assets and items affecting comparability. This measurement replaces the previous growth and margin targets. As we have described, Attendo is in a phase of a turnaround in which we expect gradual profit recovery over the coming years. To emphasize and give guidance on what we expect for the turnaround, we have chosen a midterm financial target with a three-year horizon.
In terms of dividend policy, the previous target has not changed and remains a distribution of 30% of the company's net profit. Like the profit target, this measurement is based on the earlier accounting standard. Our capital structure target is based on financial stability and the capacity to execute long-term decisions. We maintain the old target to maintain a net debt in relation to EBITDA below 3.75 over the long term. Fredrik will now walk you through the difference between reported and adjusted EPS. Next slide, please.
Thank you. This slide shows the reported and adjusted EPS for 2020 and the adjustments in between. We have chosen to set the target on adjusted EPS as we think it correlates well with value creation and is less impacted by how different companies have implemented IFRS 16.
In the table, you can see the adjustments for acquisition-related amortizations, IFRS 16, and items affecting comparability and their respective tax effects. As you can see, we reported an adjusted EBITDA of SEK 375 million, a financial net of SEK 85 million, and a tax cost of about 20%. With 161 million shares, this translates to SEK 1.43 per share. Assuming no major changes to number of shares, the tax rate, and the financial net. Our target for 2023 of at least SEK 4 per share would translate to roughly SEK 900 million in adjusted EBITDA, that is without effect from IFRS 16. Next slide, please.
Finally, let me just say a few words on our long-term prospects for growth. Beyond 2024, we have a long period ahead of us, where the number of people above eight years will increase and the demand for both home care and nursing home will follow.
Bear in mind that the 1930s generation, that is our main customer group today, is significantly smaller compared to the 1940s generation in most countries. In terms of demographics, there will be a more pronounced acceleration in the number of older people from 2024 onwards. This is the fundamental base for our market assessment long term. The Nordic remains a very attractive market in care, and Attendo has all prerequisites to create value to customers, municipalities, and society, and hence to bring long-term value creation for our shareholders for many years also beyond our 2023 targets. Thank you for your attention. Andreas.
Yes. We're now entering the Q&A session. Please state one question at a time. Operator, please go ahead.
Thank you. If you wish to ask a question, please dial zero one on your telephone keypad. Once your name has been announced, you can ask your question. If you find it's answered before your it's time to speak you can dial zero two to cancel. Our first question comes from the line of Victor Forssell of ABG. Please go ahead, your line is open.
Thank you very much, and good morning, everyone. I'll start with a question on Finland, and I think the net effect here from price increases and the overall wage inflation or cost inflation that you provided us with in Q2, I think. Has anything changed there? Also weighing in all the different moving parts of costs that you, Fredrik, talked about earlier, is this something that has changed over the last six months or so?
The new elderly care law in Finland was implemented in the start of Q4 this year. While the new staffing density requirements moving up to 0.55 from January and then gradually up to 0.7 to 2023 was well known, the law was more detailed in terms of how staffing mix and staffing time were regulated, which drove a bit more extra costs in Q4 and therefore also in 2021 than we foresaw.
Based on the details you provide us now, it's fair to assume that the improvements in Finland now for 2021 will only stem then from occupancy improvements and the levels you expect for the full year?
Mainly from occupancy improvement, yes.
Yeah. Okay, thanks. Moving on to Scandinavia, how do you view the improvements in 2021? I would assume that your 2016 vintage and earlier is dampened in the Stockholm region. But overall, just high level, what is your strategy to strengthen your position in municipalities overall with freedom of choice and mainly in Scandinavia now, let's say from mid Q2 and onwards?
This is a work that is very long-term, and that we're constantly working with our relationship to municipalities. I think during this pandemic, we've also shown the strength of Attendo in terms of being earlier and more forceful in the way we handle the pandemic. I think that's somewhat strengthened our reputation among municipalities as well. We will of course, continue our work to opening up the market in the Stockholm area and the larger freedom of choice areas. We are dependent on the normalization of the business. We believe that given the lower occupancy also in public sector will mean that we will see a gradual normalization of inflow. We expect it more so second half this year.
Just I may follow up on that. Are you somewhat worried about the Stockholm market at the moment given the lower occupancy from public providers as well? Just lastly also, what should we view as your ambition? Obviously a lot of moving parts in the first half of the year. Is it fair to assume that with the openings you have, the opening rates and also what you expect for the second half, is it fair to assume that you would defend these occupancy rates that you have now with you from Q4 at least?
That's our ambition. As you say, we have a lot of openings during 2021. We have around 700 beds opening in Sweden this year. Of course that is a challenging number given the pandemic. We're somewhat optimistic around the vaccination program and the way that we believe that the market will normalize during the second half.
Thanks. Just finally there, have you seen any change in behavior now just during the first month of 2021, please?
No.
Thank you very much. Okay, thanks.
Thank you. Our next question comes from the line of Kristofer Liljeberg of Carnegie. Please go ahead. Your line is open.
Yes. Hi. Two questions. First, just a clarification. I think you stated in the report that on the group there were no, or the effect from the pandemic was zero in the quarter, while you described Scandinavia, it was still a -SEK 20 million effect, while Finland was close to zero. Maybe I'm missing something there. When it comes to this financial target for 2023, do you see this being backend loaded or a gradual improvement from the 2020 level? Thank you.
Thank you. This is Fredrik. Let me start here. You're correct that the total effect is neutral, but in Finland it was actually a positive effect because we had more reimbursement related to cost early in the year than we had cost in the isolated quarter. It was -20 SEK in Scandinavia, +20 SEK in Finland, and for the group, neutral. If you look at the isolated quarter, it's clear negative if you look at the full year effect. Then to your second question on the profit growth profile, so to say. Given where the starting point with the low occupancy situation going into 2021 in Scandinavia, and also what we mentioned that, the margin effect from the price increases in Finland will be limited in 2021. It will be more back heavy profit growth profile.
Okay. The SEK 900 million you mentioned, for the implicit EPS target, implicit meaning, did you say SEK 900 million EBITDA based on the same tax rate? What other assumptions were you making?
Exactly. It's in old GAAP, so excluding IFRS 16, I said it's roughly SEK 900 million, and that's assuming that there's no major changes to tax rate, no big changes to the financial net, and also no major changes in number of shares.
Okay, great. Thank you.
Thank you. We currently have one further question in the queue. Just as a reminder to participants, if you do have a question, please dial zero one on your telephone keypads now. The next question comes from the line of Karl Norén of Danske Bank. Please go ahead. Your line is open.
Yes, good morning. A couple of questions for me. First, in Finland, can you please just say anything about what your current staffing rate show of care workers per resident is as of now, and if it's around 0.55 as the current standard? Just on the financial targets, just a clarification there. Is this pure organic growth that you see including in the kind of development for 2023, or are you including smaller bolts on acquisitions? That is a little bit unclear in the report. Also, on the continued lower occupancy in Scandinavia, is it fair to assume that if we look at, in Scandinavia for Q4, the negative impact of COVID seems to have been -SEK 50 million, if you adjust for the SEK 30 million that you got in subsidiaries?
Is this still a valid kind of assumption to guess that overdemand due to COVID will impact the EBITDA by around SEK 20 million per month, as you said in your Q3 report, going into H1 2021?
Yeah. If we take the first question on staffing levels in Finland, we're currently on average at around 0.57 in our operations. Mind you that we have a mix of contracts. We have some contracts with 0.55 as a baseline, but there are some municipalities with 0.6 as a baseline. It's a mix of staffing density requirements, where the law is a minimum of 0.5, but you can set higher staffing requirements as an individual municipality. Currently 0.57 in our operations. Yeah. The second question was organic growth versus bolt-ons. Our EPS target of minimum SEK 4 in 2023 is based on mainly organic growth, but including also selected bolt-on acquisitions.
Okay. Just to follow up on that, what do you include there? Can you just say anything on around percentage of sales that you think you do there, like percent of sales per year maybe?
We assume that we will maintain a healthy organic growth, and it's mainly organically driven.
On the occupancy in Nordics.
On the occupancy situation in Scandinavia. Timing-wise, we went into 2020 with a positive momentum in Scandinavia, with quite a lot of openings planned for both 2020 and 2021. COVID hit us, which was in that perspective, bad timing. We've been struggling with occupancy during this year as we had many openings combined with COVID at a stifled demand. Of course, that will continue into 2021. We were ending 2021 with a lower than expected occupancy due to COVID, and still with around 700 beds in planned openings for 2021. We don't expect an increase in occupancy in Scandinavia this year.
Okay. Yeah. Got it. If we just say the 700 beds, around how many of those are in Sweden compared to Denmark?
All of them.
Okay. Thank you. That is all for me. Thank you very much.
Thank you.
Thank you. Our next question comes from the line of Victor Forssell of ABG Sundal Collier. Please go ahead. Your line is open.
Thanks for taking the follow-ups. Just firstly, what is your current view regarding people or elderly getting eligible to enter a nursing home, but due to current circumstances, not willing to take the opportunity? Do you have a view on this worth sharing to understand what the pent-up demand, let's say, around summertime could look like in Sweden?
That's a good question. I wish I had a perfect answer to it. We believe that the fundamental demand and the need for care services has not changed. People in a certain age and with certain physical and mental symptoms will be in need for elderly care services. We believe that the main reason for the lower customer inflow during 2020, and expected also to continue a bit into 2021, is based on the fear from or anxiety from actually moving in. As the majority of the deaths and the mortality in Sweden for COVID has been in elderly care homes. We believe that this will normalize. Question is, how long time will it take? We're expecting a gradual normalization during second half, even though that the vaccination programs will be finished during Q1. We expect a slight delay.
Yeah, of course. That's fair enough.
This is local psychology, so it's really hard to exactly predict.
Yeah, sure. Just two technical ones. Just in terms of the 2019 vintage in general, is it fair to assume that you are at least break-even now at these levels of occupancy? Secondly, also the cost you took earlier in 2020 for protective equipment, et cetera. If we exclude the support you receive now and what you foresee for the coming months, is it fair to assume that the levels of protective equipment or the costs associated to it are fairly in line with last year or has anything changed there? Thanks.
If you take the cost for protective equipment, it's going to stay higher for some while. We continue to utilize more protective gear than we normally would, especially mouth protection and face protection. We can also see that prices have gone up for certain types of equipment. We are planning for a higher than historic cost for protective equipment. As you can see, 2019 is now at above 70%, 75%, which means that it's on a normalized level. It is almost at break even level.
Okay. Just on the cost side, did you say that it's in line with last year or slightly above then?
It will be higher going forward.
Yeah. Okay.
The cost for protective equipment.
Yeah. Okay. Thank you very much.
Thank you. Once again, if there are any further questions please dial zero one on your cellphone keypad. We've had a third question from Karl Norén of Danske Bank. Please go ahead. Your line is open.
Hi. Just a follow-up on the M&A side. Looking at your balance sheet right now, which has strengthened quite significantly recently. You have some acquisition firepower given your financial leverage target. Should we expect to see any M&A in 2021, or are you constantly monitoring the market? If you will not give any dividends for this year, I guess your cash flow will be positive, so you will have around SEK 1 billion to acquire for. Could you comment anything on M&A?
Yes, absolutely. I can comment on that. As I said, our view is that there is
Significant in market and opportunities are still in the market to acquire small and midsize companies in existing segments and geographies. Of course, with an improved balance sheet situation, we will continue to look for opportunities.
Okay.
Just bear in mind, it's not that we have not done. We have done some small M&As during 2020, and we continue. Just in the quarter, we acquired some home care customers in the Stockholm and Mälardalen region, and we also did that small acquisition in Finland. There are continuously opportunities, but as our balance sheet becomes stronger, that gives us more and more opportunity to look more actively. That's not our major route to profit growth looking at 2023.
Yeah. Just, of course, you have acquired some smaller, maybe bolt-ons, but are you also considering larger companies which have sales of around, let's say, SEK 500 million or something like that?
It's not our main focus currently.
Thank you. Once again, if there are any further questions, please dial zero one on your cellphone keypads now. Okay, that seems to be the final question. I'll hand back to our speakers for the closing comments.
Okay, we will now conclude this conference call, and please contact us directly if you have any further questions. Thank you for your participation.