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From: TT
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Photo: Janerik Henriksson / TT
You meet with very different staff. Stock Photography.
Elderly care and nursing are lacking on more levels than Ivo pointed out earlier this week. In some cases, development is going in the wrong direction.
– Caregivers seek minutes rather than pursuing patient safety, says Thomas Lindén, unit manager for the National Board of Health and Wellness.
Many older people in nursing homes have not received care and treatment based on their individual needs during the pandemic, the Swedish Health and Care Inspectorate (Ivo) claimed in a critical report on Tuesday.
The review covered the regions, while the responsibilities of municipalities and private actors will be reported in December.
But now, the National Board of Health and Welfare is pointing at several things that are looking in the wrong direction.
A clear example is the continuity of staff in the home care service, which has deteriorated. The number of different employees that a person with home care encounters on average has gone from 12 in 2007 to 16 last year.
– It’s going in the wrong direction. If you meet different people each time, care will be worse, even without a pandemic. But if you also have a pandemic, it can be very bad from an infection control point of view, says Thomas Lindén, unit manager for the National Board of Health and Welfare.
“Run a lot”
The lack of continuity of staff is a consequence of municipalities reducing the number of nursing homes, which has made it difficult for the elderly to access a place there, according to senior researcher Marta Szebehely.
– This means that those who have home care today have great needs. They often get help several times a day, and then it’s more difficult to organize it so that there are not so many people you know, says Marta Szebehely, a professor of social work at Stockholm University.
The National Board of Health and Welfare also notes poor coordination around recipients of care who have interventions from several different sources.
– For example, a palliative care patient may receive input from the home care service, home care, a palliative care team, and someone from the surgeon’s clinic, who leaves. If you don’t coordinate it, it will run a lot, says Thomas Lindén.
The fact that certain elderly care personnel lack training in hygiene routines became apparent during the pandemic, but it was something the National Board of Health and Welfare was aware of before.
– It was bad last year. But when we have a pandemic, this system is put to the test, and suddenly it has greater consequences.
Few nurses
In this context, it is probably also important that Sweden has relatively few nurses in nursing homes compared to, for example, Norway, according to Marta Szebehely.
– Since everyone who works in the care of the elderly does not have the basic skills on how to manage infections, it is very important that there is a nurse and an administrator on site, he says.
Marta Szebehely also notes that one in five people who work in municipal care for the elderly is employed by the hour.
– That figure is very high and not only means that there are more people involved, but it can also be the case that the hourly employee works in several different units to earn enough together, which also increases the risk of spreading the infection, he says.
She and Thomas Lindén both believe that shortcomings are often due to economic austerity.
– Unfortunately, it often comes down to a question of who should pay for what, what is best for patients, says Lindén.
“I can’t starve”
Those that were important quality factors before the pandemic are still important quality factors, but the consequences of deficiencies have become more severe, says Thomas Lindén.
– Whether it has gone well or badly during the pandemic has more to do with what it has done before the pandemic than with the decisions it has made during the pandemic, he says.
TT: Whose responsibility is it that the deficiencies are not fixed and, in some cases, even go in the wrong direction?
– In part, it’s from the caretaker. It is clear that it is a difficult task to maintain finances in a municipality, but patient safety must always come first, says Thomas Lindén.
Marta Szebehely emphasizes that caring for the elderly has had a low status and received fewer resources for many years.
– It cannot be expected that if a company dies of hunger, it will cope with a crisis in an excellent way.
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