ESN at Peer Review in Sweden
On 25-27 September 2013 delegates from Sweden, Belgium, Bulgaria, Croatia, the Czech Republic, Germany, Lithuania, Romania, Slovenia, the Netherlands and Cyprus took part in a peer review Dignity first – priorities in reform of care services, hosted by the Swedish Ministry of Health and Welfare. Alan Braid, Chief Social Work Adviser at the Scottish Government, and Lisa Schönenberg, Policy Officer, represented ESN delivering a paper and presentation based on the experiences and good practice examples of several ESN members.
In order to balance quality of care and financial sustainability, the Swedish government has implemented several reforms, including legislation promoting free choice, dignity in care, support for carers, training for care workers, coordinated and integrated care, quality registers and national guidelines on care of people with dementia. The participants discussed how their national care systems can balance formal and family care, and how to promote innovation and rehabilitation. In addition, they discussed how to use modern technology in elderly care and how to measure quality care services.
In all of the represented countries, national long term care systems rely on the provision of care by family carers. However, Lennarth Johansson from the National Board of Health and Welfare outlined that in 30 years the population over the age of 80 is going to double or triple in some countries, and the intergenerational contract needs to be renegotiated. Moreover, family care also raises questions about labour market participation and financial support for female care givers. Delegates agreed that supportive measures for family members are crucial for people who want to stay at home. Alan Braid explained that a stress test for family carers run by the local Scottish authorities can prevent harm or burnout.
Many delegates also stressed the importance of possibilities in an ageing society, such as longer life expectancy, developing technology, and civic engagement. “We need to change our care system from an intervention-based system to an enabling approach, and assess what skills older people and communities can offer”, noted Lisa Schönenberg from ESN at the end of the session. Lena Borell from the Swedish Karolinska Institute gave more examples of redesigning services, such as health control by patients via technology, or the Danish everyday rehabilitation home care services that enable older people to perform everyday tasks themselves. This paradigm change resulted in a 40% reduction of home care.
The following session focused on the implementation of technology in older peoples’ lives. “Our homes are not built for advanced care”, noted Stefan Lundberg, “however, home is the future place of care.” Care technology, medical technology, Ambient Assisted Living technology and social technology should be implemented in a person-centred way. “Older people know how to use technology, we just have to use existing technology and not invent something new that doesn’t cater the service users’ habits”, concluded Stefan Lundberg his presentation. Lisa Schönenberg from ESN pointed out that, although technology has an increasing potential to improve future care, it is unaffordable for many service users today. As one of the few areas in Europe, Scotland has implemented a nation-wide programme for technology in elderly care, the National Telehealth and Telecare Delivery Plan for Scotland, which was briefly presented by Alain Baird. Around 80% of Scottish people already receive telecare support at home, and this is showing positive outcomes, such as fewer hospital and care home admissions.
In Sweden, professionals can use data from over 78 national quality registries in health care in order to monitor the quality of social and health care services. Several of the Swedish registries are focused on long-term care, such as the Senior Alert registry that gathers individual data on falls, pressure sores and malnutrition; the palliative registry and the dementia registry. “The registers are a learning and quality improvement tool for social care and health services and do not supervise services”, explained Bodil Klintberg, Head of the Swedish National Quality Registry Office. Eva Nilsson Bågenholm, the National co-ordinator for elderly care, explained how the dementia register helped to improve care for people with dementia: “The BPSD register collects behavioural and psychological symptoms in dementia which affects 90% of all patients with dementia. With the register we are now able to record personal preferences that have a much better impact on symptoms including aggression or hallucination, and we are able to provide person-centred care in a team rather than medication.” The Swedish registers are also successful because legislation promotes data collection and service users are actively involved in data collection. At the end of the event, delegates underlined that knowledge exchange on quality measurements and the redesign of care service would help to provide quality care with financial sustainability.