Care for the elderly Interpretation of the law on the elderly rubs in nursing homes – the demarcation between nursing and other work led to meticulous instructions and measurement on the clock

According to carers ’organizations, carers’ expectations of the law were high, but implementation in the workplace has been disappointing. The supervisor finds the search in the industry surprising, as the separation of jobs is not new.

What is nursing and what is not nursing? In recent months, this issue has been resolved in nursing homes all over Finland.

For example, heating the porridge or drying the sheets may or may not be included in the care according to industry guidelines.

In October 2020, an amendment to the Elderly Services Act came into force, the purpose of which is to guarantee sufficient employees for nursing homes, ie enhanced 24-hour service housing and long-term institutional care. The law tightened further at the turn of the year.

The implementation of the law has given rise to many differences of interpretation, and the social partners in the sector are not satisfied with the situation. Caregivers’ expectations of the law were high, but its implementation has been disappointing. This is what the representatives of both the Finnish Association of Local and Primary Caregivers Super and Tehy in the social, health and education sector say to HS.

The intention was that the nursing homes would have enough trained caregivers whose working hours would be devoted to caring for the elderly and not to the general maintenance of the nursing home. The weak situation of care for the elderly flashed in the eyes of Finns from the beginning of 2019, when Valvira, which supervises the sector, even ordered some nursing homes to suspend their operations.

Grievances the root cause had often been that there were too few workers. Some employers hid the deficit and giggled to fit the situation, for example, with “ghost nurses” on shifts who were not actually at work.

The calculated minimum staff size is now 0.55. The chapter describes how many caregivers ’work input per elderly person needs to be provided with care and treatment.

The aim is that by 1 April 2023, all nursing homes offering enhanced, ie 24-hour, care for the elderly will increase the dimension to at least 0.7. Thus, if all caregivers were just caring, 0.7 caregivers would be needed per elderly person.

If the elderly are in very poor condition, the sizing may be even higher.

Most importantly the law is that the minimum number of staff specifically applies to the care and nursing of the elderly, in the terms of the legislature “direct client work”.

But there is a lot more work to be done in nursing homes: putting food in, washing laundry and cleaning. They are support work or “indirect customer work”. The work and factors of this work may no longer be included in the caregiver sizing.

So the work has to be separated, and there has been a lot of ambiguity about this.

Near- and according to a survey conducted by the Association of Nurses in November-December, a significant proportion of nurses’ working time continued to be spent on support work, such as laundry, and was still included in staffing in 70% of jobs. 125 surveyors responded to the survey.

“Members, for example, have said that on weekends, a caregiver’s time is spent entirely in the kitchen. It doesn’t make any sense, ”says the expert Leena Kaasinen Superista says.

Pipsa Lehtimäki answers a relative’s call at a nursing home in Jaspiks in Vantaa.­

Inspector general Elina Uusitalo The Social and Health Care Licensing and Supervision Agency in Valvira says that when legislating, the greatest attention was paid to the level of caregiver sizing. Less attention was paid to the fact that last October the law also included the allocation of human resources separately for direct customer work and indirect tasks. It had to be followed in nursing homes immediately, with no transition period.

Uusitalo finds the industry’s search for job segregation surprising. He recalls that the distinction is not new, but has been included for years in the previous staffing recommendation.

The recommendation specified that tasks that are not performed with the customer should not be included in the sizing. The minimum number of direct and indirect staff has also long been assessed and marked in the licensing decisions of private care companies.

“At some point, it has apparently happened that indirect tasks have increasingly become the responsibility of those involved in direct customer work, and they have not been excluded from personnel sizing,” says Uusitalo.

According to Uusitalo, the situation on the ground varies: in some care places, tasks have been separated for years and there are no problems in applying the law. In some places, the matter was only taken up with a change in the law.

Valvira and the regional government authorities organized training events towards the end of the year, and in December Valvira sent a strict message to municipalities and service providers. instruction letter, requiring immediate action to implement changes in the law.

In many nursing homes have separate support workers such as chefs and cleaners. But the boundaries of work are not always clear, and this has been twisted in nursing homes in recent months.

Serving food to the elderly, assisting with food and feeding are caring, but what about exporting an empty plate to the kitchen? According to the current interpretation, it is not caring but indirect work.

Pipsa Lehtimäki assists Eine Wikström in putting on clothes after the sauna at Attendo’s nursing home in Jaspiks in Vantaa.­

CEO of Attendo, a company that provides care for the elderly to municipalities Virpi Holmqvist says that at first there was a misconception about the law that the medical staff would not have to do any indirect work under the law.

“It caused confusion in the fall. The training has made it clear that nursing staff can do indirect work, but it should not be counted in sizing, ”says Holmqvist.

That is, the caregiver can rock the dish back to the kitchen and do other support work, but they are not dimensioned care. According to Holmqvist, a flexible division of labor is important in the daily life of a nursing home in order to preserve the home’s property.

“Having to post jobs for a minute takes the focus away from the client to posting,” Holmqvist says.

Valviran Uusitalo says that the participation of caregivers in indirect tasks must not lead to a situation where the client is deprived of the care and attention they need.

Attendossa has clocked and calculated how much caregivers spend their time on immediate nursing work on the one hand and indirect tasks on the other. Based on the clocking in December, the share of indirect work in carers’ working time varies between 2% and 5%.

“On the other hand, the support staff also do nursing work on a reciprocal basis. They can be there to assist customers in dining and organizing stimulating activities. This is not so black and white, ”says Holmqvist.

To facilitate interpretations, Attendo has provided its nursing homes with instructions on what is immediate and what is indirect work. According to Holmqvist, there is a lot to discuss with the staff.

The new law defines direct client work as, for example, all work done together with the client – that is, care is counted if the elderly person is involved in setting the table or cleaning and tumbling the laundry together with the caregiver. According to Holmqvist, there is a desire to involve the elderly in chores because the nursing home is their home.

If the resident participates in the heating of the morning porridge, then it is an immediate care job. If you do not participate, then it is indirect non-care work. Admittedly, if a caregiver heats only one meal, it is counted as care and not support work.

The instructions of Valvira and the players in the field are quite detailed. Immediate care is, for example, “cleaning up in unexpected situations, such as picking up rubbish or wiping out secretion or dirt from a resident’s room”.

Pipsa Lehtimäki empties the rubbish bins in the nursing home in Jaspis.­

How how much do care companies and municipalities have to hire new employees to make sure staffing is met? The government’s bill estimated that about 4,500 more employees would be needed in the next few years for immediate care alone.

“In some places, employees have been hired for auxiliary tasks, but the number of trained nursing staff has not increased in practice,” Tehy’s labor policy expert Mervi Flinkman says.

According to Super Leena Kaasinen, care homes in municipalities as well as private individuals and organizations are still trying to giggle and do not really want to secure high-quality services, which was the purpose of the change in the law. Super gets the most contacts from corporate employees.

“The number of employees is still going up with a knife,” says Kaasinen.

Attendo has calculated that due to the increase in sizing alone, it will have to hire about a thousand more employees in the next few years from the current 13,000 employees.

Attendo announced in October that it will hire a thousand new nurses from the Philippines over the next four years. They first come to the position of care assistant, but they are encouraged to complete their studies in order to legalize the degree of nurse responsible for general care or nursing in Finland. Attendo now has three hundred employees in the Philippines.

“In order for the law to work, a lot of work needs to be done in Finland to get a skilled workforce. When we move to 0.7 in personnel sizing, there will be a great shortage of experts, ”says Holmqvist.

Personnel sizing as a result, care for the elderly will become even more expensive for municipalities and, after the social reform, for welfare areas. The state promised to cover the additional costs, but it is already visible that the municipalities are looking very closely at who will be directed to the cost-intensive care.

If the condition of the elderly only allows, in addition to home care, various intermediate models will be replaced, such as ordinary service housing. It does not have staff on site 24 hours a day and does not regulate the number of staff by sizing.

Negotiating official Satu Karppanen the ministry of social affairs and health says some clients of home care and some clients of enhanced service housing could benefit from intermediate solutions if they were available. They must not be a means of saving.

“There are clients who need more and more care and attention, and they should have the right to access round-the-clock care that meets their needs.”

Amendments to the Elderly Services Act

The amendments to the Elderly Services Act came into force on October 1, 2020.

The minimum number of staff in enhanced service housing and long-term institutional care for the elderly will be regulated by law in the future, when the farm previously had a recommendation.

Personnel sizing was initially 0.5 employees per customer. From the beginning of 2021, the staff measurement must be at least 0.55.

From the beginning of 2022, the dimensioning will be at least 0.6 employees per customer. The law will enter into force in full on April 1, 2023, when the dimensioning is at least 0.7 employees per customer.


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