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10.11.2010 Erkki Vauramo Aalto University

Problems and possibilities related to Healthy and active living of elderly before death in Finland. 10.11.2010 Erkki Vauramo Aalto University. Ageing in Finland. Where are we in Finland? How big is the change required? How can the problem be solved?

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10.11.2010 Erkki Vauramo Aalto University

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  1. Problems and possibilities related to Healthy and active living of elderlybefore death in Finland 10.11.2010 Erkki Vauramo Aalto University

  2. Ageing in Finland • Where are we in Finland? • How big is the change required? • How can the problem be solved? • What it does mean for the built environment?

  3. Population projection, whole Finland 2010-2040, both sexes Tilastokeskus 9.2009

  4. Life-born, probability of death per mill Death is compressing rapidly – less elderly care services?

  5. Deaths by age in 1980 and 2008 Life expectation isincreasing rapidly 10 years Avoidable cause of death 85%

  6. Long term wards are generally gone (in other countries)!How does the ward cure or help people with dementia?

  7. OECD Health Data 2010

  8. Annual Client inventory in Finland –Results from 31.12.2009 • National Institute for health and welfare undertakes annually (at January 31th) client inventory in all Finnish long term institutions including • Long term hospitals • Elderly care homes • 24-h service homes • service homes with daytime service • The inventory give a useful picture of the elderly care system • Clients’ date of arrival defines the amount of used inpatient days or resources in ongoing and unfinished treatment • It is possible to sort the patient in groups according to the length of stay • By using average price of service/day, an estimation of distribution of resources can be made

  9. Inventory of in-house elderly care 31.12.2009 ,all FinlandFigures are patients or residents Red area, maximum stay at ward 30 day, maximum stay at any institution 2 years covers 24 384 persons or 35 % of all

  10. Inventory of in-house elderly care 31.12.2009 ,all FinlandFigures are total inpatient days in each category

  11. Inventory of in-house elderly care 31.12.2009 ,all FinlandFigures are Euros for one period since arrival

  12. Inventory of in-house elderly care 31.12.2009 ,all FinlandTotal capital invested since clients arrival until 31.12.2009, number are €

  13. Reasons for institutionalization

  14. Oversized service system • In Finland we have some 40 000 death in institutions annually. The capacity of the service system is 70 000 places. Before death 80% of Finns have to stay in the service system for 1.75 years. • Most of EU citizens stay in institutions only an average of a few (7…8) months. • The red (inappropriately allocated) figures of some 5.0 billion € indicate that the service system could be reorganized to meet the needs of the ageing population.

  15. Primary care ward used as home for years

  16. Or is the ward a prison with small cells?

  17. Or is the ward a factory producing bedridden elderly? In Day room there are 6 chairs for 30 patients or two hour for a patient in a day In these condition in 31.12.2009 totally 5362 elderly had lived over a year, each average 3,3 years in these condition. Chair for a friend

  18. The role of Elderly Care in cost management is underestimated Annual resource use/costs in stroke and coronary artery for patients in care 31.12.2005- special vs. primary care from 1st year and life-cycle perspective Coronary artery Stroke Euro Euro 1,5M€ 6M€ Special 0,01 M€ Special 1,4M€ Primary 1,36M€ Special 0,2 M€ Special 0,1M€ 1,0M€ Primary 4,34M€ Primary 4,30M€ 4M€ Primary 0,97M€ 0,5M€ 2M€ Life-cycle (2006-2015) 1st-year-perspective (2005) Life-cycle (2006-2015) 1st-year-perspective (2005) Source: Eklund, Vauramo, 2005

  19. Re-organizing means new buildings • Ministry of Social Affairs and Health recommended the amount of institutions to be as 3 % over 75 years old or 13 000 places • Today we have 35 000 places. • Municipalities are key players but paralyzed • EU-level minimum quality standards or recommendations are severely needed

  20. Investment is needed • Refurbishment requires (22 000 place x 40 m2 x 2000 €/m2 = 1.6 billion €) funding. • The new care facilities have to be located in village or city centres. • Elderly need to use normal services at walking distance. • The public space of care home is also a living room for neighborhood. • The rent will be high, but the self care is possible • Healthy elderly require much less personnel! • Pay-back time of the structural change is 8-10 years

  21. In the future the current number of personnel are able to take care of about double the amount of elderly, if A regional rehabilitation service exist Rehabilitation will be started according to the symptoms without delay Elderly are located to service facilities by neutral body based on individuals need The environment support elderly when they are training and keeping on their physical condition Rehabilitation is a core function

  22. flow patient  specialisation Forming a regional rehabilitation centre REGIONAL SERVICE NETWORK INTERCONNECTED, CUSTOMER-CENTERED Medical specialities are focused on solving problems collaboratively SEGREGATED SILO ORGANISATION ISOLATED, PROFESSION-CENTERED Focused on organisation by medical speciality Regional Centre for rehabilitation Mental rehab Drug abuse Physical therapy Rehabilitation Multidisciplinary Teams Professional devlopment

  23. Common spaces Housing for the elderly Care home Housing Common Services and spaces café school shops services Integrating Care from stand-alone institutions back to Society Integration into multifunctional urban blocks Active environment supporting self-care Home care services based on the needs of the elderly living in the area Stand-alone elderly care institution Passive, work-intensive environment

  24. An ageing society needs more space!

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