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Towards Active Old AgeEuropean Conference on the Elderly Care

23-24 April 2004Pori

Finland

Lis Wagner, R.N., H.V., Dr. PH.

Associate Professor

Department of Nursing Sciences, Faculty of Health Sciences, Aarhus University

Denmark

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Twenty years experience with an Integrated Health care Model

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Structure for Health- and Social Care for Elderly

• DK: 5.4 mill / 700.000 > 67 years old (13%)

• State- The Ministry of Interior and Health- The Ministry of Social Affairs

• Counties (16)

• Municipalities (275)

Lis Wagner, R.N., H.V., Dr.PH. Denmark

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Some Statements in Elderly Policy 2003

• The health service, hospitals and social care are provided at no cost to the elderly and financed through taxation

• Families have no legal duty to care for elderly

• It has been difficult to meet growing needs in the field of care for elderly people by a similar growth in the use of resources

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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• Of elderly over 67 years old, 24% receive home help

• Among elderly 80-100 years old, 60% receive home help

• Of all hospitalized persons, 1/3 is over 65 years old and use 50% of the total amount of bed-days.

(continued)

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Rules and Regulations

• Waiting days

• Nursing homes Dwellings for elderly

• Preventive home visits

- Home visits from hospital

- Geriatric teams from hospital

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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What were these changes based on?

1. Continuity in the individual’s life

2. Better use of elderly people’s own resources

3. To preserve elderly people’s self-determination and also the Commission raised a fund for research purposes.

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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POCKET MONEY

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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The Skaevinge Project1984 - 1987

A municipality in Frederiksborg County

Time: 1.6.1984 to 31.12.1987 (3.5 years)

Population: 5000 inhabitants (500 > 67 years old)

Health personnel: 130

Method: Action research

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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The Aims

• to offer health and social services to the whole municipality regardless of type of housing, and

• to give priority to preventive efforts to support the individual’s potential for self-care,

preserve and strengthen his or her health and improve the quality of life.

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Definition

In action research we have the chance to try out new models that often have not been worked out in detail beforehand but are generally specified in broad outline and made more concrete and precise in this kind of collective learning process where social scientists, clients and people in the system operate.

Kalleberg (1992)

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Characteristics ofAction ResearchAction Research

- Collaboration between researchers and practitioners

- Solutions of practical problems

- Changes in current practice; and

- Development of local theory as central to all forms of Action Research

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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The Action Research ModelQualityEfficiency

IdeaMeetings

Project team:citizens and staff

Educational programme: the concept of self-care

Agreement

Thawing phase Seeking phase Freezing phaseTime

Project description: intervention plan

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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The Action Research Model

QualityEfficiency

IdeaMeetings

Agreement

Thawing phase

• What do we, the health care staff, do wrong in an institution?

• Why is the nursing home an outmoded institution?

• Maidservant syndrome

• ”Helping” and ”Taking Care of”

• “Service package solution”

Lis Wagner, R.N., H.V., Dr.PH. Denmark

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The Action Research Model

Project team:citizens and staff

Educational programme: the concept of self-care

AgreementSeeking phase

• Project Team Tasks

• Criticism and creative thinking

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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The Action Research Model

Educational programme: the concept of self-care

Freezing phaseTime

Project description: intervention plan

• Time

• Self-criticism and sense of humour

• Organizational structure

Lis Wagner, R.N., H.V., Dr.PH. , Denmark

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• Health Centre – autonomous groups

• Common budget - common training

• Common understanding of man

• 24 hour care service

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Political Statement in 1987

”We have selected this structure because we believe that responsibility, quality and creativity are more prevalent in those persons who are given the required competencies and responsibilities for their own work area, and as a result, can have a true influence on how the work should be structured.”

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Frederiksvaerk Weekly Magazine/Halsnaes Post (Wednesday, 17 October 1993)

Skaevinge saves the county 175 million DKK.

Prevention and care result in fewer hospital admissions and fewer doctor visits.

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Frederiksborg County News (31.10.1995)

Skaevinge shows the way

Political interest in a new health model

Impressed by Elderly Project

Lone Moeller ( a minister) wants to use Skaevinge for economic considerations in counties and municipalities

Lis Wagner, R.N., H.V., Dr.PH., Denmark

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Evaluation -10 years onward (1997)

(Study of an integrated health care model)

Lis Wagner, R.N., H.V., Dr.PH., Denmark