Basket | Login | Register

 
 
 
 

Finland

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions.

Place of residence

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

Estimated 25-40% (incl. non-diagnosed cases)

At home (with relatives or close friends)

Yes

Estimated 20-30% (incl. the non-diagnosed cases)

At home (with other people with dementia)

Possibly

Not known but undoubtedly very rare

In general/non-specialised residential homes

Yes

8.7% based on health care statistics(*)

In specialised residential homes for people with dementia

Yes

Included in the above statistics

In general/non-specialised nursing homes

 Yes

6.1% based on health care statistics(*)

In specialised nursing homes for people with dementia

 Yes

Included in the above statistics

In hospitals, special wards or medical units

 Yes

6.4% based on health care statistics(*)

In psychiatric establishments

 No

People with a memory illness do not live in psychiatric establishments but there may be rare and usually temporary exceptions.

* Data from National Institute for Health and Welfare 2009. The statistics show living arrangements of the 36,000 people with a memory illness diagnoses in hospitals, residential care and home care.

Thus majority of the estimated 130,000 people with memory illnesses are not included in this data either because they live at home or because their memory illnesses is not the primary reason for residency or care.

According to statistics from theNational Institute for Health and Welfare (2009), 12.5% of residents in general/non-specialised residential homes (i.e. where staff are only available during the day) have dementia compared to 39.6 % of residents in residential homes with staff available throughout the day and night.

Of all the people living in long-term care (residential homes and nursing homes combined), 80-85% have a memory illness. In nursing homes, this may be even 90% (source not known). As people with mild cognitive impairment might be included in these figures, a more cautious figure would be 46.3% (National Institute for Health and Welfare, 2009).

The National Framework for High-Quality Services for Older People (Ministry of Social Affairs and Health, 2008) requires that the ratio of staff to residents should be at least between 1: 2 and 1:1.67 and preferably between 1:1.43 and 1:1.25 – depending on the residents and their (medical) needs.

It is not mandatory to follow the framework. During the preparation of the new “Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons” (from 1 July 2013), there was debate about whether or not to include regulations for a sufficient staff-ratio and it was eventually left out. The law states that every establishment must have an adequate staff-ratio that correlates with the number of residents and their ability to function, and ensures the quality of services provided. If these requirements are not fulfilled by the end of 2014, adjustments to the law will be made.

The organisation of care and support for people with dementia

The overall organisation of care and support

Informal carers provide a great deal of care for people with dementia but society holds the biggest and ultimate responsibility for caregiving and rehabilitation. Living at home as long as possible is an aim, but often people with a memory illness move to a long-term care establishment in the moderate or severe stages of the disease at the latest. This is commonly preceded by periods of short-term care, often in “intervals” (for example in two-week periods). The aim is to provide care facilities that are “homely”, but the reality is that still too many people end up in a hospital bed in the late stages of the disease.

The need to move into assisted living or institutional care is determined by municipal social services based on their own, the doctor’s and the person’s own / closed-one’s assessments. The wellbeing of the informal caregiver is usually the main focus and often defines the point at which the person with a memory illness moves into long-term care.

The need for broad range of rehabilitation services is stated in professional guidelines and national development programmes, but resources are still too scarce.

Every person’s right to an evaluation of their need for services is specified in the Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons (from 1 July 2013). Expert recommendations and guidelines (for example the Current Care Guidelines) state that every person with a memory illness is entitled to an up-to-date care and rehabilitation plan.

The care and rehabilitation of people with memory illnesses is organised by various service providers, including municipalities and federations of municipalities (public social and health care including home care, care homes and rehabilitation) implemented with government support, hospital districts (information and guidance about rehabilitation) and Kela (an independent social security institution offering rehabilitation). In addition, Finland has a wide range of social welfare and healthcare organisations, providing services both free of charge and for a fee.

The cost of the services varies depending on the need for attendance, but society supports care and rehabilitation and only a fraction of the cost is borne by the person with a memory illness or his/her family. There are municipal and privately owned care homes but both are financially supported by the municipality. The variety of services is even wider if purchased directly from private service providers and/or using service vouchers, which many municipalities grant for social and health services.

The cost of long-term care depends on the facilities and the services provided. The cost of assisted living consists of the rent and every additional service the resident uses/needs. Institutional care is more expensive but usually includes every possible service including food, medicine and round-the-clock care.

How specific aspects of care and support are addressed

Care and support of people with dementia are addressed in national policies as follows:

Standards of care and support

The National Framework for High-Quality Services for Older People (2008) defines the values and ethical principles guiding the provision of services for older people. It also outlines strategies for boosting quality and effectiveness in three dimensions: (1) promoting health and welfare and developing the service structure, (2) staffing levels and staff skills and management, and (3) old-age living and care environments. Following the framework is not mandatory.

The Finnish Medical Association, Duodecim, develops and updates Current Care Guidelines which are national, evidence-based clinical practice guidelines in support of health care decision making and for the benefit of the patient. The Guideline for Memory diseases was published in 2006 and updated in 2010. It covers the standards of diagnostics and care for people with memory diseases.

Controlling and monitoring care and support

According to the National Memory Programme the local authorities and joint authorities will be responsible for procuring 24-hour care for the patients in a manner that ensures that the rights of people with dementia are guaranteed and that the chosen service providers have sufficient know-how for the treatment of people with dementia.

The National Framework for High-Quality Services for Older People instructs that The National Institute for Health and Welfare provides indicators for monitoring and comparing promotion of health and welfare, service needs, service structures and finances.

Continuity of care and support

The service system in Finland is based on units offering different levels of care and support. In this model the patient has to change location when her/his needs of care and support change. These problems in the continuity of care have been identified in the National Memory Programme and the local authorities are urged to avoid unnecessarily moving residents.

One of the objectives in The National Memory Programme is to reduce the amount of residential care and to increase the availability of treatment alternatives based on housing and personalised services.

Interdisciplinary cooperation and coordination

The efficient clinical pathways, which combine social welfare, primary health care, specialist medical care and rehabilitation services in a seamless bundle, are one target in the Memory Programme and the local authorities are urged to create them.

Needs assessments (e.g. ensuring that it is timely, fair and appropriate)

The case worker coordinating care and support is mentioned in The National Memory Programme as a key factor of cost-effective support that meets the needs of the person with a memory illness and his/her family.

The recently approved Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons” (from 1 July 2013) states that local authorities are responsible for assessing the need for services to support wellbeing, health, functioning and autonomy of each older citizen when s/he demands it.

Facilitating access to care and support

The National Memory Programme states primary health care providers responsible for both treatment and follow-up of the people with cognitive disorders. It highlights the importance of the case management as a means of ensuring that patients and their families have access to as much information as possible about the services available from the public sector, the private sector and the third sector.

In addition to the primary health care providers, the occupational health care providers (which provide services to the working population) are responsible to detecting memory illnesses and referring patients to further examinations and care.

Staffing levels

The National Framework for High-Quality Services for Older People gives recommendations about staffing levels in home care and in 24-hour care. It states that the strategic guidelines of the staff should be incorporated into the local old-age strategies and integrated into the personnel strategies.

Research into care and support

The National Memory Programme identifies The National Institute for Health and Welfare, universities and other research organisations as responsible for producing information about services used by people with memory illness, the quality of those services, the effectiveness and quality of clinical pathways as well as costs. Information about best practices and the current situation is also needed to support the development work carried out by local authorities and joint authorities.

Funding and control bodies

The following table provides details of the responsibilities of the social welfare and health care system in Finland(gathered and published by Ministry of Social Affairs and Health)

In addition to the above, the work of the third sector (the Memory Society and its 43 associations) is mainly funded byFinland’s Slot Machine Association (RAY).

Communication skills with patients

One of the four main targets of the National Memory Programme is to make the public and professionals’ attitudes towards memory disorders and people with the disorders more positive. It is hoped that this change in attitudes will improve interaction and communication with the people with memory disorders.

Complaint procedures

The Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons” (from 1 July 2013) instructs each residential care unit and home care unit to monitor its’ own work in relation to the quality of services, safety and overall functioning. The older people and their relatives have the right to appeal to patients’ and social ombudsmen if they have complaints about the services (based on the Act on the Status and Rights of Patients and The Act on the Status and Rights of Social Welfare Clients). When the complaints cannot be solved within the unit, it is possible to appeal to a supervisory body.

Promoting well-being and autonomy

Rehabilitation services are mentioned in the Memory Programme as tools to increase the quality of life and optimise the functional capacity of the people with dementia living in home or in residential care. Rehabilitation needs to be seen as a goal-oriented form of care and a specialist branch of medicine in its own right.

The National Memory Programme recognises the high-quality living aids and information technology as means to promote the safe, full and active life of people with dementia.

Respecting individuality and cultural diversity

The National Memory Programme identifies the need for personalised palliative care plans and clear documentation to support them.

Finland has two national languages (Finnish and Swedish), and citizens are entitled to use both of them.

The laws and frameworks highlight the importance of offering adequate services of a high quality. The issues of individuality and cultural diversity arise from this idea, but are not clearly stated in the documents.

Involving people with dementia in decisions about care and support

At local level municipalities are required to maintain council of the elderly which keep track of the services for elderly citizen in general level.

The National Memory Programme emphasizes the rights of people with dementia. Involvement to their own care and support is not mentioned as itself but should be incorporated to the set of rights.

Other

Attitudes towards people with memory disorders are given a significant importance in the Finnish National Memory Programme. What is needed is an attitude check to allow people with cognitive problems and dementia to be included in society on equal terms with others, to lead a full and active life and to have timely access to the support, treatment and care that they need to enable rehabilitation.

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

Social or healthcare professional

Involved in the provision of care and support to people with dementia in residential care or at home

Nursing staff

Yes

Auxiliary staff

Yes

Allied health professionals

Yes

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

No

General practitioners*

No

* Only if they are linked to the provision and organisation of care and support (i.e. not with regard to their role to provide medical treatment).

Nurses (with a Bachelor’s degree) and licenced practical nurses (auxiliary nurses) (with a vocational degree) work in both residential and home care. They work independently but medical care is under the authority of doctors. Nurses may administer medical treatment and procedures, whereas practical nurses help with daily living, like hygiene and monitoring clients’ condition. Practical nurses may also have a licence to administer medicine. These professions and their rights are regulated by law and supervised by Valvira, the National Supervisory Authority for Welfare and Health (which operates under the Ministry of Social Affairs and Health).

Auxiliary staff work in both residential care and in home care, preparing and delivering meals, cleaning, helping with simple acts of daily living etc. They usually have no medical or care training.

Physiotherapists (with a Bachelor’s degree) and occupational therapists (with a Bachelor’s degree) work both in the residential and home care setting, but not in every establishment. The people in home care can be referred to see speech and language therapists (with a Master’s degree), dieticians (with a Master’s degree) and podiatrists (with a vocational degree). Majority of the people in the home care does not use these services

Professionals who have a Bachelor of Social Services or a Bachelor of Elderly Care work irregularly in residential care. They may have a licence to administer medicine, if properly trained.

The type of training that social and healthcare professionals receive

Basic information about dementia is a small or moderate part of the training of nurses and part of elderly care studies. Auxiliary staffs’ theoretical and practical training includes modules in dementia and dementia care. For social sector professionals and for allied health professionals (e.g. language therapists, physiotherapists, dieticians, podiatrists), basic information about dementia might be a small or moderate part of their training, if they specialise in the care of older people. There is a range of courses in the context of continuing education for memory nurses.

How the training of social and healthcare professionals is addressed

The National Memory Programme sets goals with regard to the training of social and healthcare professionals. It states that education authorities and organisations should pay particular attention to ensuring that basic, further and supplementary social welfare and health care training includes enough elements aimed at promoting brain health, detecting memory disorders in their early stages, treating and rehabilitating patients, providing palliative and end-of-life care and supporting people with dementia and their families.

We do not currently have systematic criteria for the training of professionals in all levels of education in dementia care in Finland. According to the National Memory Programme, national targets should be agreed for the skills that professionals (such as nurses and coordinators) working with individuals with memory disorders and dementia must have.

Support for informal carers

Support for informal carers is addressed in national policies.

Respite

The Act on Support for Informal Care has been in effect since 2006 In Finland. Based on the Act, carers, who have made an agreement on support for informal care with municipalities, are entitled to at least three days of leave during the months, in which the carer is bound to providing around-the-clock care.

Training

Based on the Act on Support for Informal Care, when a carer and municipality make an signed agreement on support for informal care, a care and service plan must be attached to this contract. Necessary services for the care receiver, care allowance and leave for the carer, and services that support informal care such as training should always be defined in a care and service plan.

Consultation/involvement in care decisions

Based on the Act on the Status and Rights of Patients if a patient because of mental disturbance or mental retardation or for other reason cannot decide on the treatment given to him/her, the legal representative or a family member or other close person of the patient has to be heard before making an important decision concerning treatment to assess what kind of treatment would be in accordance with the patient's will.

Counselling/support

Based on the Social Welfare Act and the new Act on Care Services for the Elderly, municipalities are obligated to organize guidance and counselling on social welfare benefits and other forms of social security and their use.

Case management (insofar as this relates to care)

Based on the Social Welfare Act and the new Act on Care Services for the Elderly, municipalities are obligated to organize guidance and counselling on social welfare benefits and other forms of social security and their use.

Other

There is a working group preparing a national developmental plan for informal care, which was set up by the Ministry of Social Affairs and Health and will run until the end of 2013.

Information could be added here about what the Finnish Association does, in addition to national policies, to support carers and people with dementia.

National Alzheimer Association

The Alzheimer Society of Finland (Muistiliitto) provides the following services and support.

Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

x

Care coordination/Case management

 

Home help (cleaning, cooking, shopping)

 

Home care (personal hygiene, medication)

 

Incontinence help

 

Assistive technologies / ICT solutions

 

Tele Alarm

 

Adaptations to the home

 

Meals on wheels

 

Counselling

x

Support groups for people with dementia

x

Alzheimer cafes

x

Respite care at home (Sitting service etc)

x

Holidays for carers

x

Training for carers

x

Support groups for carers

x

Day care

x

Residential/Nursing home care

x

Palliative care

 

References

Ministry of Social Affairs and Health (2008).The National Framework for High-Quality Services for Older People, Ministry of Social Affairs and Health

Ministry of Social Affairs and Health – Social welfare and health care system in Finland (2013), Responsibilities 27.6.2013, Website of the Ministry of Social Affairs and Health, http://www.stm.fi/en/social_and_health_services/responsible_agencies

Statistics Finland (2013).Population and Cause of Death Statistics, Preliminary PopulationStatistics March 2013.

Acknowledgements

Eila Okkonen, Executive Director, The Alzheimer Society of Finland

Heidi Härmä, Specialist, The Alzheimer Society of Finland

Kirsti Kuusterä, Specialist, The Alzheimer Society of Finland

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

Options