1. Project for Early Support of Elderly People in their Daily Lives (VAMU) Centre for Social and Health Services, City of Kuopio,Finland Anne Tuovinen, MHS, Project Coordinator Mari Antikainen, PhD, Project Director Tarja Hoffrén, MHS, Project Manager

2. Determination and aspects of Early support The Early Support model provides tools for the early identification of risks, assessment of service needs and follow-up planning. Including the services provided by other actors makes it possible to target the statutory services those elderly people who need them the most. By improving practices cross-administratively and multi-professionally in cooperation between the management and staff and other actors, and by coordinating activities, the available resources are better able to meet the service needs of the elderly population. Early Support includes –Early observation is part of every employees everyday work, but also client's own role and relatives role for early observation – Client-oriented and appropriate counselling, assessments if necessary and guidance at the right time and at the right level of service –Special expertise are targeted at situations where it is of particular importance

3. 3 Social functional capacity Physical functional capacity Cognitive functional capacity Psychological functional capacity The Model of the Early Support An individual plan Evaluation of the plan Exercise Medication Nutrition Environment Community The plan in practice Pre-assessment AssessmentExecutionEvaluation Organisations, associations, peer support, church, clubs Early observations of possible welfare problems Counselling Planning Assessment of geriatric needs Assessment of early observation Early observations of possible welfare problems Counselling Assessment of early observation

4. 4 Pilot area in City of Kuopio Other service areas Eastern Finland Model of multidisciplinary management and implementation created Multi-professional Early Support specialists (physiotherapist, occupational therapist, dietician, psychiatric nurse, geriatric outpatient clinic nurses) Systematic training improved the geriatric and gerontological knowledge, early support processes and agreed practices (over 1000) Proactive functional capacity survey questionnaire and e-questionnaires were developed Consultative procedures for employers to support clients in their daily lives Health and Social services Other actors Number of clients The need for targeted expertise Innovative character: management and implementation

5. Impact of The Early Support model 2008 – 2011 Before 2008 After 2011 National recommendation Number of elderly living at home91 % 91 - 92 % Home care10 %14 % Number of elderly in sheltered accommodations 3 % 4 % 5 - 6 % Long-term care 6 % 5 % 3 % The model to manage the age structure changes and costs in the Eastern Finland Early support specialist were found inside of Kuopio Health and Social services The tool to identify organisational risks was developed (e-questionnaires) The tool of proactive functional capacity survey questionnaire for employers and clients was developed The whole staff (n=1100) and other actors (n=50) in the Eastern Finland region were trained in the Early Support proactive approach Clients receive consistent-quality and individual support at the right time according to their needs, regardless of where they live and who gives the service

6. Sustainability Multidisciplinary management clear responsibilities, tasks and monitoring active communication and participation Implementation, monitoring and follow-up a series of questionnaires => opinions and ideas of staff are realised training is a part of the employee training for all new employers lectures are designed and extend also for public Client view elderly peoples own active involvement client representatives and Council of the Elderly involved Continuous development principle Early Support clinic (expertise in health, memory, nutrition, exercise, culture) new: culture nurse, green care expert extension of regional development in Eastern Finland the tool of proactive functional capacity survey questionnaire is widely in use by social and health service and it is also available for all via the national health portal Partnership the University of Eastern Finland, Hospital District of Northern Savo, four provinces in Eastern and Central Finland the Savonia University of Applied Sciences, Savo Vocational College and other actors at Eastern Finland region

7. Clearly, your dreams have turned into reality - Client representatives comment