1. 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 2010 Maarit Rautio Area manager, Elderly Services Social Services Department City of Helsinki 2.6.10

2. 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

3. 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

4. 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 Maarit Rautio, Area Manager

5. 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 evaluation Clinical evaluation Maarit Rautio, Area Manager

6. 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 Maarit Rautio, Area Manager

7. The nine categories of social work 1. Home environment 2. Environment outside own home 3. Participation Hobbies at home and outside home, other social interaction 4. Loneliness, feelings of unsafety / Being abused 5. Economical situation Strengths and weaknesses 6. Medication and substance abuse 7. Life crisis 8. Other social factors 9. Relatives and significant others Maarit Rautio, Area Manager

8. RESULTS What kind of living the elderly (n=502) have in the city of Helsinki from social standpoint of view? Maarit Rautio, Area Manager

9. 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 Maarit Rautio, Area Manager

10. Clinical evaluation Instrumental 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 Maarit Rautio, Area Manager

11. Social Evaluation What Social Categories told about the Elderly in the City of Helsinki? Maarit Rautio, Area Manager

12. 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… Maarit Rautio, Area Manager

13. 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 Maarit Rautio, Area Manager

14. 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. Maarit Rautio, Area Manager

15. 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 Maarit Rautio, Area Manager

16. 7. Life crisis 50 % 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 Maarit Rautio, Area Manager

17. Main Results Maarit Rautio, Area Manager

18. 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 Maarit Rautio, Area Manager

19. Conclusions Maarit Rautio, Area Manager

20. 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

21. 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 Maarit Rautio, Area Manager

22. T hank You for your attention! maarit.rautio@hel.fi Maarit Rautio, Area Manager