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
Maarit Rautio, Area Manager
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
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
2. How did we develop it?
Maarit Rautio, Area Manager
City of Helsinki, Department of Social
Services and National Institute for Health
and Welfare (Special Thanks to MD Harriet FinneSoveri) 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
3. How did we make Stepwise Maarit Rautio, Area Manager
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
Social evaluation
Clinical evaluation
Screener
Contact:
Identification information
The categories of social work
Maarit Rautio, Area Manager
• 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
The nine categories of social workMaarit Rautio, Area Manager
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.
7.
8.
9.
Medication and substance abuse
Life crisis
Other social factors
Relatives and significant others
Maarit Rautio, Area Manager
RESULTS
What kind of living the elderly (n=502) have in
the city of Helsinki from social standpoint of
view?
Contact to social workerMaarit Rautio, Area Manager
• 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
Clinical evaluation
Maarit Rautio, Area Manager
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
Social Evaluation
What Social Categories told about
the Elderly in the City of Helsinki?
Maarit Rautio, Area Manager
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
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
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
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
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
Main Results
Maarit Rautio, Area Manager
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
Conclusions
• 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
Maarit Rautio, Area Manager
• 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
Thank You for your attention!
maarit.rautio@hel.fi