Services for elderly people and the North lake

Today I was visiting two departments who deal with elderly Finnish people in Tampere. The first was Kotitoidon - the home care service. Margit explained this service to me. It is funded by the municipalities and provides home care. There are 3 teams of nurses who cover the city dividing it between them geographically. Margit's team has 3 registered nurses and 15 practical nurses. They cover 3 shifts - 7-3, 1-9 and through the night. They visit up to three times a day. The "Customers" are referred by families, friends, other health professionals and self-referral. They initially are assessed by another centre (I think often this is the centre I visited in the afternoon) and they decide if the person meets the criteria to receive home care. This initially assessment includes BMI, activities of daily living, cognitive ability, depression scores, diagnoses and living environment. If the person is suitable they are then referred to one of the home care teams depending on where they live. The nurses will carry out personal care, continence care, organising shopping - this is then delivered by the shop, dispensing medications and filling dosette boxes and getting customers ready to go to daycare. They do some basic nursing care such as removing sutures, dressings, blood pressure and blood glucose monitoring and occasionally catheter care but Margit said they do not get sufficient patients with these to maintain their competencies. They will do some palliative care but are supported by the hospice home care doctor and nurses. They no longer prepare food as this is done by a separate service.

The management used to be much more like the English system. Finland had untrained staff who would go in and do basic care and the nurses would do nursing work. However, then the government decided it wanted one person going in to do all of this so now they have the current system. The main reason that this is done by practical nurses is that they dispense medications to many patients. They too have to do their 5 yearly updates to remain competent to do this. I asked about them filling the dosette boxes and obtaining prescriptions. The Finnish pharmacists had offered to do this but charge about 20 euros to do this per week so no one uses this service and relies on the nurses to do it!

With regard to record keeping they have a central system Pegosos. When I asked if this was shared with the Doctors I was told no! The regular doctor who works once a week at the home care service office does access the system. However, he is now on holiday for the summer and the doctor who is covering him does not access the system and relies on the registered nurses to inform her of any problems. The doctor is paid for 4 hours a week to check lab results, write prescriptions and carry out planned home visits. If there is a concern raised by the practical nurses one of the registered nurses would go and visit and try to sort the problem and then discuss this with one of the doctors or complete a template referral letter and admit them to the Acuta. The patients have a paper record if they wish in their home and then the nurses come back to the office and write up their visits. It was suggested that they had their own laptops but they refused saying that it would take more time, they would not get a signal and did not want to carry the laptops. Back in the office they only have 2 computers for entering the information. There are also two toughbooks but they do not like using these so wait to enter their data! None of the nurses are prescribers but the doctors will prescribe medications on the advice of the registered nurses for simple conditions.

I asked Margit about policies for safeguarding, vulnerable patients but they do not have any. When I gave her a scenario that they may visit a customer who had suspicious bruising she simply said this would not happen. The nurses came back from their visits whilst I was there so I asked what sort of things they had been doing. It was really personal care. These were the practical nurses and it transpired that they are paid a lot less than the hospital nurses, although so are the registered nurses!

Margit then kindly offered to take me to my afternoon visit and suggested we stopped for lunch nearby, We went to the Finlayson area to a restaurant called Plevna named after the old textile mill. I asked her what would be typical Finnish food and she suggested meatballs, fish or Tampere sausages. As I had had the former I thought I would try the latter. I had heard about the black sausage that Tampere is particularly renowned for. When it arrived I really wasn't sure but it tasted really nice, especially with the ligonberry sauce.

My lunch!

After this Margit walked me to my afternoon visit - "Kotitori". This is a private organisation, Mawell Care, that is funded by the municipalities to co-ordinate elderly care services.

Kotitori 

The team talked me through the work they did and also showed me round. Later I received a presentation from the main office in Helsinki which really clarified the work that they did. Kotitori is described as an "innovative homecare service integration solution for elderly". It is a Nordic e-health solution covering healthcare and welfare of elderly people. It's strap line is "more time to care". It describes itself as a solution provider for healthcare professionals, citizens and patients and healthcare IT experts. Their values are agility and continuous learning; customer satisfaction; balance of life; growth and profitability. Their main role is to co-ordinate service provision combining finances from the municipalities and public and private providers. Their goals are to enable the elderly to stay at home, meet the increasing needs of the growing elderly population, and provide a one-stop shop through the centre and the phone call service. They aim to support elderly people in their own homes by offering support through a needs assessment and advice service, care and service planning and monitoring, arranging for home care, cleaning, shopping and social support and co-ordinating feedback and audit of the services provided. All service delivery is outsourced to private service providers. Their data shows that their clients are 29% less likely to be transferred from their homes to   elderly residential homes than compared to the city average. They have 30% lower costs for secondary care, 15% less use of ward beds in that health centres and a 14% reduction in visits to the emergency care centre. 

The centre offers a drop-in for elderly people to come and discuss their concerns and needs. They also have a phone line which is always busy and then there are the members of the team who go out to patients' homes to assess them and help them decide what services they need and would like to purchase in addition to the standard state care and ensure they are receiving any benefits they are entitled to. The staff see the service they provide as client-led and client-focused. There are 10 staff based there 2 of whom cover the telephones, 1 the main entrance reception and 6 who carry out the home visits to assess the elderly person. This is certainly a radical concept and does work well with the current funding of health and social care.

After this I decided that as I was in town I would do some more exploring as there was a small part I had not been to - up by the North lake Nasijarvi. I walked towards the lake passing the Talliphia Stable yards. This now is a centre for arts and crafts.

A converted stable

Some Finnish chickens!

I then walked down to the lake. This is the starting point of the rapids.

I saw a lady swimming in the lake. I spoke to her later and found out that she retired last week as chief physician of the local psychiatric unit at the hospital. She has been winter lake swimming for over 20 years!

The rapids looking out to the lake

Lake Nasijarvi

I walked along the side of the lake and then looked across to the Nasinneula tower and Sarkanniemi - the amusement park.

I carried on walking into the Nasinpuisto park and discovered the Nasilinna Palace.This was built in 1898, and the memorial to the shipwreck of a steamboat, Kuru in 1929.

You may see from the photos that the weather was quite dull and there were brief short showers of rain. However, then the sun  came out and it was really warm. I walked through the park and came out by the Tirkkonen fountain.

I walked back towards the town centre down the avenue known as Hameenpuisto. It had many of the factory workers buildings but I think this one was not one of those:

I ended up in one of the small squares by the library building and sat in the sun eating an ice-cream! I then decided I would try one final time to see the upstairs stained glass in the cathedral. I walked back over the padlock bridge and across to the Satakunnansilta bridge which is a famous Finnish landmark as it was on the last 20 mark bank note before the Finnish mark was replaced by the euro.

I arrived at the cathedral to be informed that the gallery was closed as there was a concert there later so all the instruments were up there so it was not going to be a case of "third time lucky"! So I walked back to the railway station and caught the bus back.