The Development of Elderly Care

Before 1992, when the Ädel reform was implemented, many elderly people lived for several years in long-term care departments. Not infrequently, these individuals lived in four-bed rooms. In dementia care, which was run by psychiatry, things often looked even worse. At Ulleråker's Hospital, more than 20 people could live in the same room, separated only by screen walls. Often, it did not take many months before the person admitted with dementia was completely bedridden with contractures (misalignments) in the joints. Not infrequently, routines ruled more than the individual's needs. There were shower days and enema days. Times for going to bed were more dictated by staff routines than the individual's needs.

Old age homes had their roots in the old poorhouses and often had better housing standards, but access to medical expertise was limited. With the Ädel reform, municipalities became responsible for ensuring that no elderly person would have to live in a hospital. Everyone was to be offered a full-fledged home and have the right to their own room. The help and efforts were more based on the needs of each individual. The elderly person was no longer a patient who had to comply with hospital routines. With the support of the Social Services Act, the person in need of support was given rights. At that time, this was a completely new way of looking at the aging individual.

Many municipalities also municipalized home healthcare then. Today, most municipalities are responsible for home healthcare. It is only in Stockholm County where home healthcare is still managed by the region. A fundamental idea was that both social and medical needs should be met in a coherent way. The needs of the elderly have changed over time. Life expectancy is increasing and it is healthy years that are added to life. The medical-technical development means that it is possible to live an independent life despite diseases. The need for care and service has moved up in age. Many municipalities also have safe housing where good 24-hour support can be obtained without having to move into a special accommodation.

Elderly care is also affected by digitalization. Security alarms have existed for many years. Now there are digital lock solutions that allow home care services to unlock the door with their mobile phone. Instead of making a disturbing supervision visit, many municipalities offer the security of checking in via webcam. There are also medication robots and machines that can feed a person. These have not yet gained much spread in care. Regarding documentation, it has been improved and secured with data journals and digital signing. There is also the possibility to share essential information between healthcare providers in NPÖ (National Patient Overview). GPS alarms for people with dementia are another aid that is being used to an increasing extent.

By making more and more homes accessible for people with disabilities, the elderly can continue to live in their homes. The availability of aids has also increased. Instead of the elderly moving, home care and home healthcare provide equivalent efforts at home. For many, it is a great advantage to be able to stay in their familiar environment.

Development Trends in Elderly Care

One trend has been to give the individual more power over care and treatment. The opportunity to choose a care home has been introduced in large parts of the country, and in many municipalities there are also private providers of care. This has also spurred care, both municipal and private, to improve. Different providers learn from each other. Relatives have been given increased opportunities for insight and influence. What is now coming with Nära vård is an ambition to move competence and resources out of the hospitals so that even more care can be taken care of at home.

Gradually, care has improved. Pressure sores and catheter use have decreased significantly. The work to prevent fall injuries is becoming more effective. Work for better oral health has begun and is starting to have effects. Measures against malnutrition are implemented earlier. The time for wound healing has more than halved in ten years due to improved knowledge about wound care and better materials. Better wound care also means fewer amputations and increased opportunities for a continued active life for the individual.

More and more resources are being devoted to health-promoting work with physical activity, better diet, and stimulation for the residents to remain socially and culturally active. At the same time, the number of places in elderly homes is decreasing while more and more people are getting older. Many feel that those who move into elderly homes are sicker and more in need of care than before. End-of-life care has also improved and more and more people get to die where they wish and with well-balanced medication that relieves pain and other suffering in the last time of life.

The opportunity to live a safe and independent life in case of disability has improved thanks to better opportunities for compensation. An example is GPS alarms that enable outdoor stay for people with dementia. The development of a knowledge-based care and service for the elderly, partly through registration and use of data from national quality registers such as Senior Alert and "Swedish Palliative Register", are today self-evident, compared to 25 years ago. This way of working drives for increased quality in elderly care.

There are ongoing challenges for elderly care. If more and more advanced care is moved out into the home and in elderly homes, doctors need to be available around the clock. This is to avoid unnecessary hospital admissions. Many of the admissions that occur today are due to fall injuries. The work to reduce fall accidents and fractures must continue. Here, the statistics speak their clear language. At the municipal level, the differences are large and the number varies between 33 and 83 fall injuries per 1,000 inhabitants 80 years and older.

Likewise, the investigation of and preventive measures against urinary incontinence need to be strengthened. Preventive work regarding alcohol abuse and violence in close relationships is also important. Loneliness is another major problem for many.

Many visits to our emergency departments are related to elderly people being malnourished. This can also be prevented with more active efforts. The more advanced care also means that there are more actors supporting the elderly. The need for coordinated individual planning therefore increases. These needs are most clearly seen in home healthcare.

Leadership and Competence in Elderly Care

Today, managers in elderly care often have many subordinates. They also have an important task to have close contact with residents and relatives. With such an organization, it becomes difficult to see and be there for all employees. In leadership lies the support for its employees to increase competence and develop in their professional role. Leadership needs to be strengthened in many organizations.

The availability of dietitians, speech therapists, and pharmacists needs to be strengthened. The care staff's competence in rehabilitation, dementia care, quality development, and mental illness needs to be strengthened. Likewise, elderly homes would need more nurses with specialist education. Specialist education for physiotherapists and occupational therapists is also likely needed.

Nursing assistant has become a protected professional title and may only be used by those who have undergone an approved education.

Reflection Questions - The Development of Elderly Care
Care Personnel:
- What are your thoughts on how elderly care has developed?
- How do you think your work will develop over the coming decades?

Manager, Nurse, Occupational Therapist, and Physiotherapist:
- How do you work to ensure that the residence meets the future in the best possible way?
- Can you see that the development described also applies to your unit?
- Where are your strengths and weaknesses?

Resident and Relative:
- Do you see any strengths or weaknesses that distinguish your particular elderly home?

Erland Olsson
Specialist Nurse
Sofrosyne - Better care every day