This troubling article illustrates what is happening with care of those elderly patients who are not able to care for themselves. This solution, with few positive exceptions, borders on the cruel and nasty, and voters’ demands for improvements are being ignored by the successive governments. It has been going on for too long and the present right-wing government appears to distract attention away from this serious problem to talk about fast trains and the threats of immigration!
Fact: Care of the elderly who require enhanced service housing are normally patients with dementia or who are not able to perform basic care for themselves. This is a basic service from our welfare state and impacts every household – we all get old, and the majority end up in one of these homes.
There has been much political discussion with few concrete results for improving the sufficiency of care for these people who are unable to care for themselves. New legislation was passed in 2020, (the Elderly Services Act), which set a minimum staffing ratio that is currently set to be at least 0.65 employees per patient. It was meant to be increased to 0.7 per patient, but the present government stopped this.
The above ratio sounds like a sensible number given because it gives the impression to voters that there is always a trained caregiver on hand 24/7 for each patient. However, this is not the case which can be seen from the below calculation that is based on current legislation.
The ratio only refers to trained caregivers (TC), and do not distinguish between those who have just started their career and lack work experience, and those who are foreigners who do not speak or understand Finnish.
The diagram below is based on numbers from the Finnish Institute for Health and Welfare and they illustrate the type of calculation used in the 25-bed round-the-clock enhanced housing for trained caregivers (TC) that have 25 patients with dementia or otherwise not able to perform basic care for themselves are living.
The 17 TCs are not attending all the time and only 5 are there on weekdays, and just 3 or 4 at other times. Let’s use an example of taking such a patient to the toilet. This requires 10 to 15 minutes 4 or 6 times a day on average when the TC must undress, undo and refix nappies, clean and dress the patient. That can take up 5 hours each day for each TC. Furthermore, time must also be used by the TC for medical procedures, exercise guidance, and many other small but time-consuming tasks…
This illustrates that this staff ratio is the absolute minimum for acceptable care.
What you do not see in these numbers is something that taxes the time of experienced TCs. The above numbers only refer to trained caregivers (TCs), but they do not distinguish between young TCs who lack experience, and foreigners who do not speak or understand Finnish. Both groups need to be assisted by experienced TCs – another tax on their available time.
The argument that it is too expensive or impossible to secure enough TCs is a fallacy because higher salaries and better training facilities would quickly relieve that pressure of work and make this important work more attractive.
The situation of low and limited resources is mainly due to successive governments having promoted private sector healthcare companies to expand into this sector. The companies are mainly led by owners who want to maximize profits by aggressively expanding their market share. They have employed doctors and experienced TCs from the public sector. Their management and administrative costs are significantly higher because their CEOs and other senior staff get to take large salaries while young TCs and other junior support staff see their salaries squeezed.
The result is a major sector disruption in both the public and private sectors. Almost all the companies operate at, or somewhat below, the above ratios and have no hesitation in employing inexperienced staff along with foreigners who have limited or none language abilities. Why spend money on training when low-cost newcomers and foreigners can be employed to fill the homes! Patients do not complain and few of them receive regular visits from younger family members.
Here is a true story about a colleague’s family member in such a home. (This example was verified by your correspondent with an on-site visit and has been seen to repeated regularly in other similar homes). The patient is an 85-year-old female who suffers from advanced dementia. She is a resident at an Attendo enhanced care home in one smaller city in Finland. Attendo is owned by a fund run by European private equity company called IK Partners. They post a current 0.68 staff ratio, which we were unable to verify. Many TCs working were clearly new to the work and several TCs were foreigners who do not speak or understand Finnish well – even their English was poor. My colleague is paying for a private TC who is employed to use all her time to exercise and spend time providing social support for the patient. Instead, she spends up to half the time sort out small health problems, and taking the patient to the toilet, – something that is the clear duty of Attendo’s staff. Complaints from my colleague are met with sighs that they do not have enough time and staff!
This example illustrates that the care this patient is receiving is not based on optimizing her health, but on Attendo’s profits. Let’s recount her situation – she cannot speak coherently, cannot express basic physical needs, does not have sufficient exercise, and receives poor quality food, which has resulted in increased weight and the swelling of her legs.
Before the advent of private companies, enhanced service housing was owned and run by the public sector. They were quiet rather decent places where the elderly could spend their last days in dignified surroundings with trained caregivers. Today the sector has been allowed to turn into a casino where private capital seeks and receives unearned profits, which right-wing politicians appear to protect.