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From: TT
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Photo: Fredrik Sandberg / TT
The pandemic puts its finger on the errors of the system in the care of the elderly, according to the Swedish District Medical Association. Stock Photography.
Despite the fact that those who live in nursing homes are among the most fragile in society, medical medical competence is undervalued and degraded in municipal elderly care, believes the Swedish Medical Association.
– We are very few with often large assignments, says Dr. Nadja Schuten-Huitink.
A doctor, a couple of hours a week. Approximately 50 patients in the risk group, with an extensive and complicated disease picture. In the middle of a fiery pandemic.
This is how it looks right now in many of the nation’s nursing homes.
– Most district doctors only have four hours a week for the home for which they are solely responsible, says Nadja Schuten-Huitink, a district doctor at a health center responsible for a nursing home in the municipality of Falu.
Extensive assignments and elderly care for physicians is nothing new. This has been the case for a long time, long before unions fought for masks and visors. However, the burden of disease has become heavier in the last decade.
– We have the same number of hours compared to 2000, but a completely different burden of disease. We usually jokingly say that only you manage an entire medical department with just half a day a week, says Nadja Schuten-Huitink, who is also a member of the Swedish District Medical Association.
Extreme test
Just over 2,840 of the nearly 80,000 people who live in special homes have died from covid-19, according to figures from the National Board of Health and Welfare on November 16.
The Swedish Health and Care Inspectorate (Ivo) states in a review that many covid patients in nursing homes have not received an individual medical evaluation.
– Personally, I do not recognize myself in the fact that individual evaluations have not been made. I think my colleagues do their best to keep up, but sometimes there is not enough time and you are forced to set strict priorities. We are very few with often large assignments.
Doctors have had to step in and work both afternoons and evenings during the spring and fall, says Schuten-Huitink.
– We have had to prioritize covid care over other care initiatives. This means a lot of ethical stress between colleagues.
If the infection enters a home, you should put everything else aside, he says.
– And it’s not like I can leave my patients with heart failure and high blood pressure. I am afraid that we will soon see an excessive mortality rate for other diseases as well.
Crucial continuity
She herself has worked with the same resident for almost ten years, with well-developed routines.
– An important prerequisite is continuity. If you know both the patients and the nurses and you already have a good picture of the disease, it is easier to do qualified medical evaluations if the patient becomes seriously ill, he says and continues:
– In cases where you have previously made an individual assessment and spoken with family members, a video call may be sufficient. Otherwise, you will need to put on protective gear for a home visit.
The responsibility of the municipality
The care of the elderly is the main responsibility of the municipality. But the responsibility of caring for a home is shared. Nurses and auxiliary nurses are employed by the municipality. The regions are responsible for medical interventions, which are regulated in collaboration agreements with the municipalities.
But the municipalities are responsible for the safety and quality of the care provided, through the medically responsible nurse of the municipality.
– It has become clear during the pandemic that the competence of the doctor in the care of the elderly was lacking, says Marina Tuutma, president of the Swedish District Medical Association and second vice president of the Medical Association.
The union requires medical experience in managing municipal operations for the care of the elderly.
– A function of chief physician is necessary at the management level in the municipalities, with a mandate to make the necessary decisions about the design of care. In a crisis situation, shared responsibility and cooperation don’t work, so a captain is required to take command, Tuutma says.
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