Search

In Finland, older persons are entitled to needs-tested public home care services. Home care mainly assists with personal care, activities of daily living and medical needs. It is complemented with auxiliary services that offer help with instrumental activities of daily living. In Finland, municipalities are responsible for organising public home care services. These services are mainly tax-funded, but user fees are also charged. In this article, we examine the levels of user fees of home care and auxiliary services in Finnish municipalities in 2018. The data analysis consists of descriptive statistics and exemplary cases of costs to the service users. The results show that user fees may represent a significant share of older persons’ monthly incomes. Consequently, home care users, especially those with low incomes, are at risk of economic deprivation and non-take-up of the services. We also found substantial variation in user fees across municipalities, causing regional inequality.

Muistisairautta sairastavien ikääntyneiden kotona asuminen onnistuu usein omaishoitajien avulla, mutta tukea tarvitaan myös sosiaali- ja terveyspalveluista. Aina kaikki eivät kuitenkaan saa riittävää apua ja tukea. Niin muistisairautta sairastavat ihmiset kuin omaishoitajatkin voivat kärsiä avun riittämättömyydestä. Tässä artikkelissa tutkimme, millaista tukea muistisairaat ja heidän puolisonsa kaipaavat ja millaisia kokemuksia heillä on avun riittämättömyydestä. Tutkimuksemme mukaan muistisairautta sairastavien ikääntyneiden ja omaishoitajien kohtaama avun riittämättömyys liittyy sekä palvelujärjestelmään ja erilaisiin tukimuotoihin että henkisen tuen tarpeisiin. Muistisairautta sairastavat ja heidän omaishoitajansa eivät niinkään kohtaa tilanteita, joissa he eivät saisi lainkaan tarvitsemaansa apua, mutta saatu apu ei aina vastaa tarpeita tai se on liian vähäistä. Omaishoitajat myös paikkaavat palvelujärjestelmän puutteita ottamalla vastuun puolisonsa hoivasta tilan-teissa, joissa julkiset palvelut ovat riittämättömiä tai niitä ei ole saatavilla. Kotona asumisen tueksi tarvittava apu on riittämätöntä useammin omaishoitajien kuin heidän muistisairautta sairastavien puolisoidensa kannalta. Usein tämä tarkoittaa sitä, että omaishoitajat kantavat vastuuta hoivasta oman jaksamisensa kustannuksella. peerReviewed

Läheisten rooli muistisairaiden hoivaajina on jo nyt merkittävä, ja se tulee kasvamaan. Muistisairaudet yleistyvät pitkäikäisyyden lisääntyessä, ja vanhushoivapolitiikassa painotetaan kotona asumista. Tässä tutkimuksessa selvitetään muistisairaan puolisoille ja aikuisille lapsille tarjottua tiedollista tukea, palveluohjausta ja palveluja. Lisäksi tarkastellaan, millainen yhteys eri taustatekijöillä on palvelujen tarjontaan, ja miten saatu tieto ja palveluohjaus vaikuttavat tarjottuihin palveluihin. Tutkimuksen aineisto kerättiin muistisairaiden puolisoilta ja aikuisilta lapsilta sähköisellä Carer’s survey -kyselyllä. Aineiston analyysi osoittaa, että tietoa oli saatu rajallisesti ja puolisot olivat saaneet sitä enemmän kuin aikuiset lapset. Palveluohjauksen saaminen oli sattumanvaraista, vaikka palvelujen saaminen edellyttää joko tietoa palveluista ja/tai palveluohjausta. Jatkossa muistisairaan läheisten tasapuoliseen tukeen tulee kiinnittää enemmän huomiota. Erityisesti riittävään tiedon saamiseen ja palveluohjaukseen on panostettava, jotta muistisairasta läheistään hoitavat pääsevät tarvitsemansa tuen piiriin.

Twenty-five years ago, robotics guru Joseph Engelberger had a mission to motivate research teams all over the world to design the ‘Elderly Care Giver’, a multitasking personal robot assistant for everyday care needs in old age. In this article, we discuss how this vision of omnipotent care robots has influenced the design strategies of care robotics, the development of R&D initiatives and ethics research on use of care robots. Despite the expectations of robots revolutionizing care of older people, the role of robots in human care has remained marginal. The value of world trade in service robots, including care robots, is rather small. We argue that the implementation of robots in care is not primarily due to negative user attitudes or ethical problems, but to problems in R&D and manufacturing. The care robots currently available on the market are capable of simple, repetitive tasks or colloquial interaction. Thus far, also research on care robots is mostly conducted using imaginary scenarios or small-scale tests built up for research purposes. To develop useful and affordable robot solutions that are ethically, socially and ecologically sustainable, we suggest that robot initiatives should be evaluated within the framework of care ecosystems. This implies that attention has to be paid to the social, emotional and practical contexts in which care is given and received. Also, the political, economic and ecological realities of organizing care and producing technological commodities have to be acknowledged. It is time to openly discuss the drivers behind care robot initiatives to outline the bigger picture of organizing care under conditions of limited resources.

Background: Unmet care needs are usually defined in terms of receiving sufficient help in instrumental activities and activities of daily living. Research on unmet needs is mostly based on quantitative data. Older persons’ and informal carers’ views and experiences have received less attention. Methods: In this paper, we rely on a definition of unmet needs which includes both unmet needs due to insufficient care and those situations where informal carers experience undue strain. Using theory-driven content analysis, we examine community-dwelling older adults’ and their informal carers’ experiences of unmet needs: what kind of unmet needs they have, why and in which ways these needs are left unmet and what would they want to do to improve the situation. The data consists of interviews gathered in Austria, Finland and Slovenia. Results: Results of the analysis reveal that unmet needs are largely psychosocial in nature. The predominating task-oriented care systems often do not consider these as care needs. Using methods of qualitative content analysis, we conclude that care users’ unmet psychosocial needs are related to lacking a personal relationship with care workers; means to maintain or develop social contacts and pursue activities and interests; and adequate home care services or respite care. Excessive responsibilities are put on informal carers as they top up and fill in the insufficient care. Conclusions: This study contributes to a broader understanding of unmet care needs: the relational aspects of care and the universal nature of psychosocial care needs should be addressed in care services. publishedVersion

Muistisairauksiin usein liittyvät kognitiiviset ja persoonallisuuden muutokset sekä itseilmaisun vaikeudet saattavat ilmetä käyttäytymisen muutoksina. Puoliso ja muut läheiset kohtaavat nämä muutokset ensimmäisinä. Laadullisessa tutkimuksessamme selvitimme, millaisissa tilanteissa muistisairauden aiheuttamia ongelmallisina ja kielteisinä koettuja käyttäytymisen muutoksia ilmaantuu, ja miten ne vaikuttavat parisuhteen vastavuoroisuuteen. Käyttäytymisen muutoksista käytetään termiä ’käytösoireet’. Aineiston analyysissä hyödynsimme sosiaalisen vaihdon teoriaa. Käyttäytymisen muutokset tulivat puheeksi vain niissä haastatteluissa, joissa muistisairautta sairastava puoliso oli aviomies. Vaikka puoliso-omaishoitajat osasivat odottaa puolison käyttäytymisen muuttuvan sairauden myötä, muutokset tulivat yllätyksenä. Käytösoireet liittyivät tilanteisiin, joissa puoliso-omaishoitaja neuvoi, ohjasi tai rajoitti muistisairaan puolisonsa arkirutiineissa toimimista, sekä tilanteissa, joissa muistisairautta sairastava joutui kohtaamaan sairautensa. Sosiaalisen vaihdon teorian mukainen vastavuoroisuus ei toteudu parisuhteessa, jossa toisella puolisoista on etenevään muistisairauteen liittyviä ongelmalliseksi koettuja käytösoireita. Puoliso-omaishoitaja joutuu taiteilemaan arjessa välttyäkseen konfliktitilanteilta, eikä muistisairas puoliso välttämättä tunnista näitä tilanteita. Usein pitkään parisuhteeseen liittyvät vahvat tunnesiteet saavat jatkamaan yhteistä elämää. Behavioural changes caused by dementia and the reciprocity of a couplehood Usually, the spouse is the first to face the cognitive and personality changes associated with their partner´s dementia, which may manifest as behavioural changes. In this qualitative study, we examined in which situations disruptive behavioural symptoms caused by dementia appear and how they affect the reciprocity of spouses. The theory of social exchange was used to interpret the data. Disruptive symptoms were mentioned only in interviews of couples in which the spouse with dementia was the husband. Although the spousal carers expected that their partner’s behaviour might change with the illness, the behavioural symptoms came as a surprise. Behavioural symptoms appeared in situations where the partner with dementia tried to control the activities of their spousal carer, when the spousal carer had to advise and guide the partner´s daily routines, or limit what the partner with dementia was doing. Behavioural changes also appeared when the partner with dementia had to face his own illness. The theory of social exchange emphasizes reciprocity as the basis of an intimate relationship. When one of the spouses had dementia that causes disruptive behavioural changes, reciprocity was not possible. The spousal carer has to come up with various strategies to cope with daily life and avoid conflicts. These situations and efforts may not be recognized at all by the person with dementia. The strong emotional ties associated with a long-term intimate relationship make the spousal carers stay in the relationship.

Long-term care of older adults is currently suffering from a shortage of trained personnel and high turnover rates. Care work is poorly paid, demanding, increasingly time-bound and both mentally and physically burdensome. In this study, we examined the individual, organisational and economic factors that predict professional care workers’ intentions to leave their current employment, using the NORDCARE survey data (2015, N = 3801) collected in Denmark, Finland, Norway and Sweden. The respondents were mainly practical and assistant nurses. The analysis showed that the predictors of intentions to leave were similar in the four countries. The most consistent organisational predictors of leaving intentions were related to psychophysical burden and a lack of supervisor support. Younger age also predicted intentions to leave. To break the vicious circle of burdensome work and high turnover, care workers need sufficient resources and support to conduct their work properly. peerReviewed

Robotic telepresence is a potential technology to help alleviating the loneliness of elderly people. The impacts of long-term use of telepresence robots in residential care are not well known. We were interested in how using a telepresence robot influences the resident, family members and care workers at a facility, and what challenges and solutions there are for wider adoption of such robots in residential care. With a telepresence robot Double, we arranged a series of three trials in two separate residential care facilities: one 12-week trial in a private facility and two successive 6-week trials in a public facility. In each trial, we installed the telepresence robot in a room of a long-term care home resident for communicating with her/his family members. Based on the results, telepresence robots do increase presence and possibly engagement of family members in residential care, but privacy is a central concern. The mobility of a telepresence robot is hard to utilize in residential care, and to be able to do so, ethical consideration and guidelines are needed. We provide a draft of such ethical guidelines.

The aim of this chapter is to systematize the discussion regarding robotization of mobile communication. The chapter begins by clarifying the fundamental role of both robot hardware and robot software in this process. This is followed by a critical overview of existing research, which is classified into three categories. First, robotization is understood as the hybridization of the human body with existing ordinary mobile devices. Second, the incorporation of new robotic software, such as algorithms, artificial intelligence, and virtual assistants, into mobile devices is seen to robotize them from inside. Third, the convergence of smart communication devices, typically as user interfaces with robot hardware, is seen to contribute to the robotization of mobile communication. The chapter is concluded by clarification of the boundary between quasi-robot and robot and outlining the ways in which the robotization of smart mobile communication will proceed in the future.

Aim To answer the question: ‘How prepared healthcare professionals are to take robots as their assistants in terms of experience and acceptance?’ Background The ageing population, increasing care needs and shortage of healthcare professionals pose major challenges in Western societies. Special service robots designed for care tasks have been introduced as one solution to these problems. Design A correlative design Methods Eurobarometer data (N = 969) and survey data of nurses and other healthcare professionals (N = 3800) were used to assess the relationship between robot acceptance and experiences with robots while controlling for the respondents’ age, gender, occupational status and managerial experience. Results Healthcare professionals had less experience with robots and more negative attitudes towards them than the general population. However, in healthcare, robot assistance was welcomed for certain tasks. These regarded, for example, heavy lifting and logistics. Previous experiences with robots were consistently correlated with robot acceptance.

This article introduces the concept of care poverty, defined as inadequate coverage of care needs resulting from an interplay between individual and societal factors, and examines its level and predictors among the 75+ population in Finland. The data come from a survey conducted in 2010 and 2015. Despite the universalistic goals of the Finnish care system, 26 percent of respondents with limitations in daily activities faced care poverty with regard to instrumental activities of daily living; the activities of daily living care poverty rate was 17 percent. Concerning instrumental activities of daily living, care poverty was associated with income level, health status and living arrangements, while such connections were not found for personal care (activities of daily living).

Touching in care work is inevitable, particularly in cases where clients depend on nurses for many activities of daily living, such as bathing, dressing, lifting and assisting. When new technologies are involved in nurse–client relationships, the significance of human touch needs special attention. Stressing the importance of practitioners’ opinions on the usage of robots in care environments, we analyze care workers’ attitudes toward robot assistance in the care of older people and reflect on their ideas of the embodied relationship that caregivers and care receivers have with technology. To examine nurses’ attitudes toward care robots, we use survey data on professional care workers (n = 3800), including random samples of registered and practical nurses working primarily in elderly care. As the theoretical framework for analyzing the empirical data, we apply two different conceptual approaches regarding human touch: nursing ethics and the phenomenological theory of embodiment. The empirical results suggest that the care workers are significantly more approving of robot assistance for lifting heavy materials compared to the moving patients. Generally, the care workers have reservations about the idea of utilizing autonomous robots in tasks that typically involve human touch, such as assisting the elderly in the bathroom.

Care robots are often seen to introduce a risk to human, touch based care. In this study, we analyze care workers’ opinions on robot assistance in elderly services and reflect them to the idea of embodied relationship between a caregiver, care receiver and technology. Our empirical data consists of a survey for professional care workers (n = 3800), including registered and practical nurses working in elderly care. The questionnaire consisted scenarios of robot assistance in care work and in elderly services and the respondents were asked to evaluate whether they see them as desirable. The care workers were significantly more approving of robot assistance in lifting heavy materials compared to moving patients. Generally, the care workers were reserved towards the idea of utilizing autonomous robots in tasks that typically involve human touch, such as assisting the elderly in the bathroom. Stressing the importance of presence and touch in human care, we apply the ideas of phenomenology of the body to understand the envisioned robot-human constellations in care work.

Arvostelu teoksesta Antti Jauhiainen & JoonaHermanni Mäkinen Hyvinvointivaltion vastaisku Like-kustannus, 2017 nonPeerReviewed

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross‐tabulation, chi‐square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two‐tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services. peerReviewed

Palveluseteli on yksi vanhuspalveluiden markkinoistamisen väline. Kunnat saavat päättää sen käyttöönotosta ja käytön ehdoista lain sallimissa rajoissa melko vapaasti. Tämä on johtanut siihen, että kunnissa on hyvin erilaisia ratkaisuja ja lähestymistapoja palvelusetelin käyttöön. Palveluseteli voidaan ottaa käyttöön vain yhdessä tai lukuisissa palveluissa, sitä voidaan tarjota kaikille tiettyyn palveluun oikeutetuille tai erilaisin perustein vain joillekin heistä. Tässä artikkelissa tarkastellaan paikallisten johtavien viranomaisten haastattelujen perusteella, millaiseksi vanhuspalvelujen järjestämisen välineeksi palveluseteli kunnissa ymmärretään sekä minkälaisin perusteluin ja tavoittein palveluseteleitä on otettu käyttöön. Tutkimuksemme perusteella kunnissa käytetään palveluseteliä asiakkaiden ja palveluntuotannon ohjailun sekä kustannussäästöjen välineenä. Paikalliset markkinat ovat olennainen tekijä, sillä ilman toimivia markkinoita palveluseteli ei tarjoa todellisia valinnan mahdollisuuksia. Palvelusetelin mahdollistamaa valinnanvapautta pohditaan asiakkaan kannalta eri tavoin. Joissakin kunnissa huonokuntoisimpien vanhusten ei ajatella kykenevän valintoihin. Asiakkaan toimintakyvyn ja kunnon lisäksi palveluseteleitä voidaan kohdentaa maksukyvyn perusteella vain hyvätuloisille. Vaihtoehtoisesti palvelusetelistä voidaan tehdä tulosidonnainen, jolloin yksityisten palvelujen käyttö on aidosti mahdollista myös pienituloisille. Eldercare services and free choice – The public officials’ perspective to service voucher Service voucher is one of the tools that can be used to marketize public social and health services. In Finland, the municipalities may introduce vouchers to chosen services rather freely. The legislation determines the principles and frames but leaves plenty of room for local variation. In this article, we examine in which ways the vouchers are used. Based on expert interviews of municipal officers, we study the arguments and aims that are related to the use of service vouchers in care services for older people. Accordingly, the vouchers are used to channel customers between public and private services and to save costs. The local service markets need to be large enough for vouchers to be a functioning tool, but the authorities may also use vouchers to create demand for private services. Vouchers may be allocated for all older people, only those who are not too frail, or the better off.

The digital divide affects low socio-economic status groups in particular. According to previous research and survey results of the ELOST project (e-Government for Low Socio-Economic Groups), socio-economic factors – especially age and level of education – play a role in determining whether a person is an Internet user or non-user. This article presents the findings of the survey, as well as those of focus group discussions organized within the framework of the project, and contemplates possible solutions for tackling e-exclusion.

Nuorten elämä kiinnittyy usein voimakkaasti asuinalueeseen ja lähiympäristöön. Viime vuosina sekä nuorten sosioekonominen eriarvoisuus että lähiöiden sosiaalinen eriytyminen ovat lisääntyneet. Joistakin ongelmista huolimatta huonomaineisetkin lähiöt tarjoavat nuorille positiivisia samaistumisen kohteita, tukiverkostoja, kaveriporukoita, identiteetin rakentamisen välineitä – ja sosiaalista pääomaa. Tässä artikkelissa tarkastellaan, miten lähiössä asuvat ja kasvaneet nuoret kuvaavat asuinpaikkaansa ja sinne kiinnittyviä sosiaalisia suhteita. Aineistona on Tampereella Tesoman lähiössä asuvien nuorten yksilö- ja ryhmähaastatteluja, joita analysoidaan sekä aineisto- että teorialähtöisesti. Artikkelissa sovelletaan Robert D. Putnamin sosiaalisen pääoman käsitettä ja esitetään, että kiinnittyminen asuinympäristöön sosiaalisten verkostojen ja yhteisen tekemisen kautta on nuorten sosiaalista pääomaa. Nuoret myös luovat sosiaalista pääomaa ja hyödyntävät sen erilaisia muotoja suhteessa vanhempiinsa ja erilaisten instituutioiden edustajiin. peerReviewed

Suomi on pohjoismainen hyvinvointivaltio, joka lupaa tarpeenmukaiset sosiaali- ja terveyspalvelut kaikille. Palvelujen lisäksi tai niiden sijasta monet ikääntyneet ihmiset saavat apua ja hoivaa läheisiltään. Mutta saavatko he riittävästi apua? Tässä artikkelissa avun riittämättömyydestä käytetään käsitettä hoivaköyhyys. Sen yleisyyttä sekä siihen yhteydessä olevia tekijöitä tutkitaan 75 vuotta täyttäneiden suomalaisten joukossa. peerReviewed