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The group made a case visit to a centre for the elderly.
After this interviews were debriefed and the case was discussed.


 
 

   

Case visit. We visited the Riistavuori centre. We got a presentation of the centre, we asked ͞Kirsti͟
questions on innovation in the centre, we saw the facilities of the centre, we interviewed some
customer͛s of the centre in thee groups.

 

    
   Semi-transcript. 

 
  
  

    
We saw the practicalities of the centre and learnt about the practicalities of elderly care.



 
 

   

@ebriefing of the case study visit including experiences, interviews. In addition random, open
discussion.

 

    
   Semi-transcript.


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Presentation of Riistavuori centre for multiple services to the elderly by ³Kirsti´

En elderly costs 35/40k ¼ a year


One year salary for a nurse, 50¼/year

Q: What are the criterias for 24 -hour care?


We use RAVA - a Finnish questionare with 10 questions for giving points for what the elderly is capable of.
There are around 30 similar types of questionares in Finland.

Most clients of the centre are women.


- Husbands have usually passed away.
- Women live longer, but also get married earlier.
åsually the clients coming here have been taken care by their spouse.

Husbands are taken very well care of at home by the wife. åsually the husband needs to move around a lot more at
the centre, and thus gets better.

Q: You are in charge of services?


Yes, I take care of services in this areas - not at the centre

Q: What are the internat capabilities of the people here?


This area has highly educated people - in general they are capable of using the internet.

There are centre with ethnic people in Eastern Helsinki - somalies, etc. In this area the minority is swedish
speaking.

Q: Are there any internet groups? No.


The elderly here are in bad condition.
The current elderly have not been using internet in their work life, but future generations of elderly will have more
experience.
Enter ry is a group concerning elderly and internet.

The people coming here are in quite bad shape already. The average age of people coming to the rehabilitation unit
was 86 years.

How are your processes planed, etc. The council recommends processes and plans.

Q: Where do you pick up the learnings of innovative elderly services?


The services are created for the clients. We (rehabilitatio unit) make the services according to the needs of the
clients.

Q: Where is the best service?


Different countries are doing it in different ways, in the context of their culture.

Q: What countries attended the conference?


Only Eå countries.

Q: Where can we find solutions outside of the box?


I think work should be planed bottom-up, not top-down. The nurses understanding the day to day problems and
gaps should develop the service.

Q: Do you have a development budget?


New ideas dont necessaryly need new money, but instead just trying out new ideas.
I may see a client with a problem, try to figure out how the problem can be solved, if there are no solutions we
develop one, then we may realize other people need the same solution.

Q: Do you need a critical amount of certain type of customers to be able to innovate new services for them?
No, we dont need data on large amounts.
We try new ideas. There are no stupid ideas. We try them for six months. If they succeed, great, otherwise we kill
them.

A practical example of an idea was shown. "Thursday group" in which home care clients visit the centre and
design/customize an activety day with other participants. Excerise + some activety.

Q: How do the council and people "on the field", the workers interact?
They do have meetings.

The work going on here seems to need very professional workers.


How much of the work being done here could be done by non-professionals?
A lot of the service needs professional workers.

Going on with the presentation


Personell structure
- practical nurses 43%
- general nurses 21%
- responsible nurses 6,2%
- social advidors and advisors 7,4%
- therapy unit 6,1%
- others 16% (receptionists, back office, etc)

Salary difference between the first two groups? About 300¼. Around 2100/month + bonus for experience

Q: What kind of reward system do you have?


The boss can give a personal allowance.

There is a career development plan. Nurses can show what they can do, and get new experiences and jobs. There
is a possible to advance - we are trying to make it possible to advance through expertise, not just advancement to
boss.

Q: How crazy can you go?


I can change things here in the service centre in Riistavuori. I can have ideas on what kind of services we provide
and what we do together with other services like home care. If those ideas are good, they are implemented in other
places too.

Q: Looking 10 years down the road, what will your work look like?
Very many things are changing. You need to be flexible.
Helena: We are looking to lower the amount of 24 hour care.

Continuing with the presentation

- Multiprofessional team makes the assessments and the service is decided (home care, sheltered housing, etc).
(slide)
- Multidiciplinary work (slide) - we tend to go outside our own zone and interact between the professionals. This
makes it possible to share information between the professionals.

Q: How often are outsiders are invited in to asses the services?


Not frequently. Occasionaly engineering students from the school close by visit.

LåNCH BREAK

INTERVIEWS WITH CLIENTS OF CENTRE (debriefed later)

COFFEE AND TEAM BåILDING EXCERSISE (observer made intervention)

Another 25 minutes with Kirsti

Q: How can you use us?


We need help from outsiders to get us into new ideas. I can't say a practical idea now.
Maybe on Friday?

Q: If you could freely share ideas with colleges in Denmark, Norway, would you use them?
It would take time. It would be more easy to visit them and see differen ways of doing things.

Q: If you were given the task of designing a new institute, what would you change?
A lot things. Technology is one. There is technology available, like door security, but clients themselves pay for
them. We dont use enough technology even though it is available.
Helsinki is a big city. We have a lot to learn in home care, elderly centres, voluntiers, social work that operates in
the area. In smaller cities and places it's easier. It's difficult in Helsinki. Customers get lost in the network.

Q: What do your clients dream of?


Some of them would like to get more service. They are old and they have different kinds of illnesses. Here the y
have to walk themselves, dress themselves, etc. In some cases they feel they are too old, they need help in doing
them. Thinking of Finnish culture and their children live somewhere far away, there is probably never enough social
activities in a place li ke this.

Q: In Helsinki we have seperate social and health services, does this create issues?
Yes, it creates information gaps. Some services are created by social services and some by health services. Our
information systems don't discuss. An elderly person doesnt care which depertment gives her service, but the
depertments will push responsibility around. In some cases the client suffers.

In one case in the interview somebody told she had a problem with a leg.

Social services and health services have different goals.

You have clients, patients and guests - there is a difference?


Being old is not an illness. Being old gives you some illnesses.

In Finnish we use the word vierailija for the rehabilitation "strangers", främlingar. Instead of guest. Guest sounds
like it is free of charge.

Quality of life?
They themselves define what is quality of life for themselves.
...
No matter who is asked, it is that nurse's problem.
...

Good life? To be able to participate?


Yes, to be able to make your own decisions.

BåS TRIP BACK

At dipoli

Erkki telling is own experiences on Riistavuori. He shared some views on the centre

Lars observation is that the visit was suprisingly unsuprising. It looks like a very professionally driven,
institutional, efficiently driven solution.
Erkki: yes, and a yesterday's model, like a model

This whole case is a very complex model. Let's try to make a catalogue of ideas. We can then help Helena how to
pursue them.

We could come up with a totally new concept, but you would not be able to perform it, because we dont know
enough, and you know too much.

What if we only have 50% of the budget?

The aging problem is a city planning problem. Elderly should be living on t hird floor and down, with a restaurant on
the first floor. The way that dinners are delivered today are more expensive than 8 euroes.

Elderly must have a meaning in their life.

What's new with that?


I saw today several people in the institution that co uld be leaving at home.

What is the goal for today?


There has been no goal for today. There has been no fasciliator for today.

DEBRIEFING OF THE INTERVIEWS

Rehab group
(Three ladies)
Living at home. Meeting once a week. Their personal backgrounds were pretty different.
Not interested in books, not interested in internet, not able to read. They think they could not learn anymore.
They enjoyed the social interactions of a meeting happening once a week. They reflect on personal experiences
from the week. Their main wish was that the meeting would continue.
Two of the ladies were very enthusiastic about voluntary work. It gives meaning.

One seems to be some sort of engine. She had started a group of widows. She had become an organizer of a
support group. She created a weekly schedule.
Another had a schedule being taken care of others.
For the third voluntarism was important. Gave a reason to grow.

The room was not planned for rollators, but the ladies were using rollators.

The person that was working as a social amplifier. Although she was an amplifier, she was not too outgoing.

They were happy with the institutions. The worker at the Riistavuori centre was the node organi zing the meetings.
A new person could be introduced into the circle of ladies.

The challenge is what will the centre be like in twenty years when i'm there?
What made it uncomfortable? How people were dressed, interior, etc.
There are more workers in prisons than in elderly homes.

The air was extremely dry and very little oxygen in the elderly home.

Talking with this generation there are some steps to overcome.


But we are not focusing on the current generations. How should the service look 10 years down the road?

Permanent residents
Aarno, did not remember his age. Lyyli, has been there for eight years

We had an informal chat. They were enthuasiastic to talk.


They need another generation to talk to.
Lyyli mentioned that the air conditioning wa s not good. She had done customer survey experience for 80 people.
Nobody apprecieted the work she had done.
Aarno is very educated. "kyllä täällä elelee" - It's bearable to live here. He has epilepsy and is afraid to be alone in
his room. His wife is ali ve and at another epilepsy.
Several in the staff talk foreign languages - Aarno and Lyyli want to learn languages!
Concerning the quality of life. Lyyli wants air!

I get sad when i visit these institutions. I called my 82 year old father today. He told me he never wants to be in an
elderly's home.
We need young people to create new pictures on how elderly should be taken care of. Give young people a video
camera and let them make news story about the whole story.

Elderly taking initiatives are not apprecietated.


Children are apprecietated a lot more for their efforts compared to elderly.

People can adapt to all kind of situations. What can we demand people to adapt to.

This generation has been through harship, but the next will be spoilt.

Comments on ethnic minorities. Are gypsies using this service?

2000 people are working in this service, getting low salary. You will never get good salary unless you pay well!

The Finnish problem is that we have doubled the capacity in eldery care. The number of institutions, care homes
and hospitals.... we need 13k beds, but we have 30k.
In Sweden they have done it - but it is not working. People are not happy with it. Not custom ers and not staff and
people trying to develop it.

Example of a mental hospital in Italy. The staff had left. Very sick people had taken initiativ to run the restaurant,
etc.
Another example of home where

Kirsti had some symbols on her, typical for se rvice people.


Keys.
It conveys the image that she is a guard.

Suggestion to break.

Talks on what we are doing.


Group 5 will be presenting their results soon.
What will we be presenting?

It is suggested that one smaller group of people should prepare the next day.