Social public services: Municipal home care services in Kotka
Since the 1990s the municipality has had a policy to provide more client orientated services with an emphasis on community based social and medical care and rehabilitation. The development of quality home care services in Kotka was an innovative move to develop city-wide services which could be publicly or privately provided. The home care service is engaged in regular collaboration with other municipal departments, private companies and voluntary organisations in providing a range of services and a 24-hour emergency tele-service. A home care manual sets out the standards for care and each older person is assigned a caregiver. Low staff turnover good client relationships are built up over time.
- Older people living alone
- Public sector
- Coordinated/integrated service
- Locally based quality improvement measures
A policy of developing home services in the city of Kotka was adopted in the 1990s in order to develop more client orientated services. This followed a shift from in the emphasis of care for the elderly from institutional care to open care and the introduction of a more coordinated approach to city service delivery. At the same time, city services were divided into separate areas and a shared responsibility system was begun. The measures were an attempt to provide more client-oriented services and to provide adequate services irrespective of where older people lived. This viewpoint emphasised that quality was important and led to the development and printing of a "Home Care Manual".
The development of the plan was facilitated by the Municipalities Federation's LASSO Project. About 90 people were involved in the LASSO project and their objective was to disseminate the notion of quality among social welfare and health care personnel. Underlying the improvement of the quality of home services was the viewpoint that, if the services were not acceptable, they could be transferred to private-enterprise providers later. Private companies already provide a large share of support services. In addition to the elderly living at home and in full service residences, home service clients include the disabled, the long-term ill and mentally ill and a few families with children.
The city of Kotka employs over 3 000 people and the city is by far the biggest local employer. Over 200 people are employed in Kotka's home service programme and about 30 people are employed in the home nursing programme. These employees provide home care for about one thousand elderly persons annually. Care days total about 160 000 annually. A relative care subsidy was paid to 116 relatives in 1997 and 42 of these carers made use of relative care vouchers. There were almost one hundred elderly using the transport service annually. According to one estimate about 40% of the elderly availing themselves of home services would have had to enter long-term institutional care were it not for the support of home care. The home service workers provide the service single-handedly as this has been found to make for a better relationship between the home carer and the elderly.
The home service collaborates daily with private companies, other municipal departments, voluntary organisations and the regional emergency services centre. The parishes and the local Finnish Red Cross organise, for example, visits to shops, outdoor activities and a friendship service. These services vary greatly from borough to borough depending on whether there are enough and, for instance, what attitude the local parish has towards such activities. Private companies provide meals-on-wheels and cleaning services and more extensive home service and home nursing care. There are also private care homes in the city. About 20 companies provide a support service for the elderly who pay for these services, while the city's social welfare and health service oversees the services provided. Cooperation has worked well and private services can increase the range of services offered in locations where the municipality is not regularly involved. The services complement each other and, in this sense, are not seen as being in competition with each other. Within the city, home services operate through collaboration, for example, between social workers, the city technical department and the police. The technical department is mainly of help in renovating private dwellings. It also requests expert advice from the home service in the planning of public buildings and road layout. The regional emergency services centre receives calls and alarms from emergency telephones and safety bracelets and conveys them to borough workers. Emergency telephones and safety bracelets are supplied by the privately-run local Kotka Telephone Company.
Contact with the organization comes from an elderly person, a relative or a third party. Facts are gathered about their situation and needs by means of one or more home visits. This may not result in a client relationship, as other ways of meeting the client's need are looked at first. Following this a home service representative, social worker, physician or member of the police force visits the home. The home visit plays a key role in identifying the elderly person's needs and their ability to remain at home, using their own resources. Each elderly person is assigned a caregiver. This is possible because the turnover of home service personnel is fairly low. Client relationships can endure a long time, even as long as 20 years or more. Once or twice a year, home service personnel attend training sessions on all aspects of home services and any changes that have occurred. The training is performed mainly in-house, with the city's experts stating their views. Effort is made to standardise the services provided and improve their quality. The theme this year is "Rehabilitation Care".
The key instrument for maintaining quality is the "Home Care Manual", in addition to which there are sector-specific instructions for various services. Quality is upheld by entering all feedback (be it positive or negative) from clients, relatives, etc. Likewise, an effort is made to regularly ask the elderly for their views on the satisfactoriness and availability of care. Employees attend "Kokemi" sessions (the name derives from "Kotka Overall Development Model") at which a review is conducted of current themes or, for example, the implications of the client-centred approach (client empowerment) for work and the significance of home care principles and values, such as individuality, continuity, the security of overall care, self-initiative, confidentiality, responsibility, professionalism, family orientation and the exercise of economy). The supervisor conducts development discussions with personnel once each year. In addition, various work guidance groups operate among personnel. There has also been an effort to improve quality by devolving decision-making to the level of those performing the work. In this way, services can by tailored more flexibly than before so that they meet the changing needs of the elderly better.
There is a recognition of the need to place greater emphasis on client empowerment and client feedback. This can be achieved not only by the means mentioned above, but by setting up elderly group activities (local councils for the disabled) and by maintaining the training level of personnel. Setting up elderly group activities would require a separate initiator at the start of operations but, based on earlier experience, such groups would organise themselves into independent units over time. There have been positive experiments in "Mother/Child Groups". Personnel training gains in importance as a single person will have to take responsibility for satisfying the needs of the elderly more comprehensively in future. The elderly cannot generally choose who will provide the services. Private services are available but the cost restricts freedom of choice. Caregiver relatives have the option of one service voucher annually with which they can purchase private services, when they wish to take a break from the strenuous job of providing care.