The elderly will be left without care places, other services will decrease – the rationing of caregivers has worsened the crisis

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Binding nursing staffing and a nursing shortage have led to the fact that fewer and fewer elderly people get round-the-clock care. At the same time, healthcare services are more congested than before.

Elderly people are left without care places, other services are declining – caregiver rationing worsened the crisisä

The number of people needing round-the-clock care has increased with the aging of the population, but there are fewer and fewer places available. Illustration picture. Photo: Mostphotos [email protected] Today at 7:03

The shortage of nurses in Finland has worsened, which has driven elderly care into deeper and deeper problems. The curtailment of care for the elderly has, in turn, accelerated a chain reaction, which can be seen as worsening congestion in health care services.

Sanna Marini's (sd) government enacted a legally binding and gradually tightening ratio of nurses for round-the-clock care, which the primary purpose was to improve the quality of elderly care.

Now, however, it has happened that fewer and fewer elderly people get round-the-clock care, even if they need it.

Hundreds of customer places are currently empty in Attendo's care homes alone, because the care homes have not been able to hire enough staff to the statutory dimensioning would be met. Group homes have also had to be closed due to a shortage of nurses.

Based on Iltalehti's investigation, both public and private operators have had to keep the 24-hour customer places for the elderly empty due to a shortage of caregivers. It's not just about the congestion caused by the summer holidays, but the situation has been difficult in many places already in the spring.

For example, in the enhanced service housing of the city of Jyväskylä, around 50 client places have not been filled due to a shortage of nurses since the spring. There is no relief in sight for autumn.

– The nurse redundancies had a good purpose, but it has made the situation difficult, says service manager Eeva-Liisa Tammi.

Reductions in beds too

Attendo CEO Virpi Holmqvist says that the situation is now more challenging than last year, as the government's binding ratio of nurses has tightened, i.e. it is 0.6 nursing workers per elderly person. Next spring, the sizing should be 0.7.

– There would be enough residents, but with the current interpretations of the law, the implementation of sizing means that the places have to be reduced, says Holmqvist.

Thus, elderly people in poor health persist in home care or hospital wards, which also suffer from a shortage of nurses. In wards, the functional ability of the elderly often only decreases even more.

Not everyone who needs a service is covered by any service, because the queues for home care have also gotten longer.

The cessation of care for the elderly appears to be one of the factors behind the congestion in emergency rooms. Elderly people stand out among the clientele of emergency rooms.

– When there is not enough resourcing in the area of ​​care, it shows up in the congestion of hospital care, says Lapland's hospital district chief physician Jukka Mattila.

The situation is critical in many places. Beds in health centers and hospitals have also had to be drastically reduced due to a shortage of nurses. This increases the use of specialized medical care and emergency services.

Attendo CEO Virpi Holmqvist says that the shortage of nurses has worsened since last year. Photo: Outi Järvinen

Congestion in different parts of the country

According to IL's report, there are more inconvenient congestions and staff shortages in emergency rooms all over the country, and not only in the hospital district of Helsinki and Uusimaa ( Hus), whose emergency room problems have been widely reported recently.

There has been more congestion and staffing shortages in emergency rooms than before in the hospital districts of Varsinais Finland, North Ostrobothnia, Lapland, North Karelia, Pirkanmaa, Kymenlaakso and Central Finland, among others. . Consequently, patients have to wait longer in the emergency room, even days, even though the emergency room is only intended for acute treatment.

For example, in Finland proper, continuing care places, i.e. care places in primary care and regional hospitals, have been reduced by about a third in recent years.

– There is reason to question the appropriateness of allocating scarce nursing resources so strongly to round-the-clock care, when at the same time there is a crying shortage of personnel in both health care and home care, says service regional director Sari Ahonen from the city of Turku, referring to the nurse assessment.

“With well-intentioned regulation, due to insufficient availability of personnel, a situation is created where those who have access to the services will probably receive safer care, but it becomes even more difficult to access the services. This results in insecurity at home or treatment in the wrong place, in which case the ability to function may be impaired, when there is no opportunity to maintain or develop one's own activity at the place of treatment,” says Jukka Mattila, head physician of Lapland's hospital district. Illustration picture. Photo: Mostphotos

The problem has expanded

Mehiläinen currently has hundreds of empty places in enhanced service housing, which have not been able to be filled due to a shortage of caregivers.

– In the past, the worst shortage has been in the capital region , but now the situation is challenging all over Finland, says Niklas Härus, Business Director of Mehiläinen care services.

According to Härus, the situation has worsened this year due to the tightening of nursing staffing and the general labor shortage.

At Esperi Care, the situation regarding keeping nursing positions empty varies considerably from region to region. Santtu Karppinen, head of the northern region of Esper's age services, says that in his area of ​​responsibility alone, an average of 30 nursing places have had to be kept empty due to a shortage of nurses.

What is new is that we have had to act this way throughout the current year, and not just in the summer. According to Karppinen, the reason behind the difficulty of the situation is the tightening of nurse staffing.

Esperi Care business director Jussi Lehtonen says that the general situation is still good in Esperi care homes, and the recruitment of substitutes has been more successful this year than last year.

Lehtonen estimates that when the number of nurses increases to 0.7, more and more client places may have to be kept empty.

Queues in home care too< /h3>

The city of Helsinki has had to close some of its round-the-clock care places this summer. In North Karelia, the reduction of places in residential services for the elderly in the area of ​​Siun Sote has led to queues for home care and health center hospitals.

– The care dimensioning of round-the-clock housing also affects this, it is a legal requirement and cannot go below that, says the service director Hannele Komu from Siun Sote.

Although the shortage of caregivers is tormenting both private and public operators nationwide, places for round-the-clock care have not had to be reduced everywhere.

For example, the city of Turku has not had to reduce places for the long-term housing service, although the number of places for temporary care has had to be reduced during the summer months.

The city of Tampere has survived the summer by using temporary staff. However, it does not mean that the elderly will receive services corresponding to their needs, because with the aging of the population, there are more and more people who need round-the-clock care.

In Tampere, it has not been possible to open new places for round-the-clock living due to a lack of staff, and the queue is grown during the summer. When people on the waiting list are at home in home care and in hospitals, it has contributed to congestion in hospitals.

“Qualification requirements gone too far”

The municipal association's expert doctor Tuula Kock is worried about what will happen to the availability of services for the elderly when the nursing staffing becomes even tighter in April 2023.

– Legislation alone will not solve the problems, but we must get people to do that work, he reminds.

Kocki thinks that the qualification requirements in the care sector should be eased to ease the shortage of nurses.

– Qualification requirements have gone too far. In the past, for example, medical students could act as substitutes for nursing staff in the summer. Caregiver training should not necessarily be in everything, Kock says.

The situation was eased a bit by the new guidelines issued by Valvira in June, which enable a wider use of care assistants. According to it, there may be no more than one care assistant per ten customers instead of the previous fifteen.

Starting from April next year, when the sizing will be tightened to 0.7, according to Valvira's instructions, there may be no more than twenty care assistants per ten customers.

Nowadays, municipalities have set stricter requirements for personnel in their contracts than the law. Even in the future, despite Valvira's instruction, the requirements may be stricter.

From Attendon Holmqvist, Valvira's instruction is a good start, but it is not enough to ease the situation. He hopes for more opportunities to utilize technology, especially for support tasks, and to facilitate work-related immigration.

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The risk was known

The negotiating official of the Ministry of Social Affairs and Health Anne-Mari Raassina says that the ministry identified the risk that access to round-the-clock care services for the elderly may become more difficult during the preparation of the law reform on binding staffing .

It was estimated that this could happen if services are available to a smaller proportion of those who need services due to changes in staffing requirements and service structures.

Raassina points out that the risk was also mentioned in the government's presentation.

< p class="paragraph">– At the same time, it was emphasized that instead of enhanced serviced housing, new forms of service can also be developed, especially intermediate services that combine housing and service, he states.

In these intermediate services, the need for personnel is not necessarily as great as in round-the-clock care, and the use of personnel can be made more efficient with, among other things, technological solutions.

– It was estimated that over time this could lead to a diversification of the service selection, making it possible to meet the increasingly better to the individual needs of people in need of services, says Raassina.

He reminds that the law reform concerning the second phase of the reform of services for the elderly will enter into force next year. The reform is intended to strengthen home care, and with it, communal living will be entered into the law as a new form of service.

IL Analysis: These facts reveal the harsh reality behind the government's speeches 20.9.2021 8:00 More and more nursing homes are breaking the law – see the situation in your municipality 6.9.2021 13:19 Nursing assessment goals in danger of being watered down, the association's emergency call: “We can't make this a debt” 5 February 2021 12:07

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