Systemic shortcomings in Sweden's elderly care coupled with inadequate measures from the government and agencies contributed to the country's high death toll in nursing homes, an initial report by an official commission said on Tuesday.

Sweden's pandemic strategy, shunning lockdowns and masks, has stood out internationally. It left schools, restaurants and businesses largely open while appealing to people to socially distance and maintain good hygiene.

When announced during the spring, the strategy was twinned with a goal to "ring-fence" the elderly from COVID-19. But as deaths mounted, especially at nursing homes, the commission was appointed to assess the response.

The commission said previously known structural problems within the elderly care system, for which authorities, regions, private care givers and municipalities share responsibility, were to blame for the many deaths.

"But we want to say that it is the government that rules the country and has the ultimate responsibility," Mats Melin, the commission chairman, told a news conference.

"The government should have taken measures to ensure the elderly care was better equipped to deal with the pandemic."

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The commission pointed to poorly educated staff and low levels of nurses and doctors in elderly care, and emphasised that past governments had also contributed to the shortcomings.

Sweden's pandemic strategy has been called reckless and cruel but also earned praise for being more sustainable and business-friendly. Just under half of Sweden's almost 7,700 coronavirus deaths have been nursing home residents.

The commission report said government measures to protect the elderly during the spring had come too late and were inadequate.

"The aspect of it (the pandemic strategy) which centered on protecting the elderly failed. There is no other way to view the fact that so many died in COVID-19," Melin said.

"The government should have taken steps to ensure the elderly care was better prepared for the pandemic."

Prime Minister Stefan Lofven has defended the overall strategy but admitted Sweden failed to shield the elderly, though stressing health and elderly care are the responsibility of regional authorities and not the central government.

In November, Sweden's Health and Social Care Inspectorate said it had found "serious shortcomings" in elderly care - in only 6 percent of cases reviewed were nursing home COVID-19 patients given a physical examination by a doctor.

Social Affairs Minister Lena Hallengren said the Social Democrat and Green government was preparing new legislation to regulate elderly care.

Sweden has suffered many times more deaths per capita than its Nordic neighbours, although fewer than some European countries that opted for lockdowns.