The Elderly Living at Home Social Standpoint of the View How did we develop Stepwise Assessment...

The Elderly Living at Home Social Standpoint of the View

How did we develop Stepwise Assessment System for Social work in Helsinki?

ENSA, Madrid, June 2010Maarit RautioArea manager, Elderly ServicesSocial Services DepartmentCity of Helsinki2.6.10

Outlines of the presentation

1. Why did we develop Assessment for the elderly and for the social work?

2. How did we develop it?3. How did we make Stepwise Assessment

System for Social work? • The categories of social work

4. Results: What kind of life the elderly people have in the city of Helsinki from social standpoint of view?

5. Conclusions

Maarit Rautio, Area Manager

1. Why did we develop Assessment for the elderly and for the social work? • The number of elderly people is growing

very fast in the city of Helsinki in Finland– 90 % should live at home– The number of social problems is raising, when a

greater number of elderly live at home

• We must use resources more efficiently– Lack of personnel and need for more qualified

personnel– Co-operation – assessment suitable for social work

and also compatible with health care

• We need more impressive, comparable and successful work with elderly people– Documentation varies from worker to worker and from

place to place– Need for systematic assessment and follow-up

2. How did we develop it?

City of Helsinki, Department of Social Services and National Institute for Health and Welfare (Special Thanks to MD Harriet Finne-Soveri) conducted a study during 2007 to 2009.

The Principal goals were:1. How to develop an assessment instrument

suitable for social work and also compatible with health care

2. To test the international algorithms for stepwise assessment and decision making in the social work, in Finland


3. How did we make Stepwise Assessment System for Social work?

• We used interRAI Home care and Contact Assessment Forms as basis for stepwise assessment

• We wanted to develop an Assessment Instrument in which the worker who is evaluating elderly can proceed step by step

Contact:Identification information

Screener

Social evaluationClinical evaluation


The categories of social work

• The new aspect in our study was that we developed questions for social evaluation: the categories of social work

• How did we create them?– Using theory and practical knowledge– Thinking that social ability is multidimensional– Remembering that measurement and meeting

the client face to face are not opposite things


The nine categories of social work

1. Home environment 2. Environment outside own home3. Participation

Hobbies at home and outside home, other social interaction4. Loneliness, feelings of unsafety / Being abused5. Economical situation

Strengths and weaknesses6. Medication and substance abuse7. Life crisis8. Other social factors9. Relatives and significant others


RESULTS

What kind of living the elderly (n=502) have in the city of Helsinki from social standpoint of

view?


Contact to social worker

• When somebody contacts a social worker there is normally more than one problem and the problems are in contact with each other

• 75 % needs help to cope weekly because of physical and cognitive reasons

• The contacting person is normally near relative or other authorities and not the elderly themselves

• Memory problems explain about 2/3 of those difficulties or problems which elderly persons have

• Almost 40 % estimate that their health condition is week


Clinical evaluationInstrumental Activities of Daily Living (IADL)

• Memory problems were typical– Every 2nd have difficulties to understand others– Every 5th cognition were getting badly

• Every 3rd eyesight or hearing is degradation• Pain, melancholic, feeling dizzy and falling

down were typical problems• Most common sicknesses were memory

illnesses and stroke• Every 5th have been in hospital and/or in

emergency policlinic within last three months


Social Evaluation

What Social Categories told about the Elderly in the City of Helsinki?


1. Home environment • 50 % have problems in their home environment

– getting out of the house – have difficulties to use toilet or bathroom

2. Environment outside own home• Only 25 % could use the services independently

and 50% having help outside own home

• There are a lot of problems which can be repaired quite easily:– To take off paving's, make more resting places…


3. Participation (Hobbies at home and outside home, other social interaction)

• 2/3 have a hobby outside home– clubs, culture, outdoor exercise…

• At home almost all elderly– listen to the radio or watch television.

• It´s typical that many have to incline hobbies because of sicknesses and especially because of memory illnesses


4. Loneliness, feelings of unsafety/ Being abused

• 30 % feel lonely because the number of friendships or their own initiative have diminished

• 25 % feel unsafety• 7 % suffer from violence within families

– The abuser is most often own grown-up child and there is a relationship of trust of the older person toward their abuser.


5. Economical situation (Strengths and weaknesses)– 20 % have financial troubles – 16 % were poor– 44 % managed to care their own finance

6. Medication and substance abuse– Almost everybody have medicines – 1/3 could take medicines by themselves– 20 % used alcohol, but usually they didn't know what

kind of interference alcohol have with their medicines– Probably the elderly drink alcohol more than they admit


7. Life crisis50 % have had significant life crisis in near past

– Illness or death of a close relative…

8. Other social factors– 25 % felt often that it's hard to get services – 15% suffered from the lack of services

9. Relatives and significant others– Most of caregivers were aged spouses– Every 6th caregiver were exhausted– Every 3rd of the caregivers living in the same

household were exhausted


Main Results


1. The Elderly who need social services need also health services

2. In Finland we don't give attention quickly enough when elderly person is depressed, have difficulties with own hygiene or when the caregiver is exhausted

3. Memory illnesses are very common. They affect a lot in managing the every day life and increases the need of family caregivers


Conclusions


• Social and health services should cooperate perfectly

• We need more immediate assessment• Assessment must be done efficiently and urgently

• We need more practical home help: cleaning the home, doing the housework and making the meals.

• There is a dilemma in our society: We think that it is very important to make independent decisions, but many elderly suffer of memory difficulties and to make decisions is very difficult to them

• We need to listen the voice of elderly more carefully

• We can do this with better assessment, which includes the importance of reducing social problems and understanding social needs for the good life of the elderly.

• But still: 90 % of the Elderly in Helsinki feel that they have a lot of positive strengths


Thank You for your attention!

[email protected]


The Elderly Living at Home Social Standpoint of the View How did we develop Stepwise Assessment...

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