Sweden's Servicehouse concept

28 World Health • 47th Yem, No.4, July-August 1994 Sweden's Servicehouse concept Britto Asplund & Ruth Bonita Personal autonomy is important for the elderly and deserves to be encouraged by every means available. p to 40% of people over the age of 80 in Sweden either have some sort of home care or are cared for in facilities provided by each local council. The municipal councils also have responsibility for group homes, which in tum are based on a social model where personal autonomy is regarded as an important ingredient. Usually 6-8 single apartments or single rooms are grouped around a living room and kitchen, and the residents have their own furniture and keys. In 1992 there were around 6000 demented or confused elderly people living in group homes, although it is estimated that by the year 2000 places will be needed for 25 000. Currently there are between 45 000 and 50 000 nursing-home beds and 40 000 sheltered homes. Most of the sheltered homes try to develop a familiar home-like atmos- phere with routine activities and household tasks where the staff are seen as positive role models. Since hospital care is expensive and the communities have their own medical It is token for granted in Sweden that older people hove mode on important contribution to society and now deserve a good life and the best that con be offered. The Servicehouse is regarded as a more pleasant alternative to hospital. It is also regarded as a right. staff, sheltered homes are regarded not only as an inexpensive form of care, but also as a humane one. It is taken for granted in Sweden that older people have made an important contribution to society and now deserve a good life and the best that can be offered. A model centre has recently been developed in Sweden for the care of older people. This "Servicehouse" comprises specially built self- contained apartments, provided by the local council and catering to people needing rest-home care, those needing considerable help and supervision, confused elderly people, and short-stay residents requiring respite from caring for elderly relatives in the community. The Servicehouse is an attractive building with 48 apartments, nine of which are for patients clinically diagnosed as having dementia. Before 1991 it was an "old people's home" where each person had just a single room and a toilet, with only two bathrooms in the whole build- ing. Home health services help elderly people who live alone to stay where they feel most comfort- able- in their homes. Help in the home We visited one woman who was on the waiting list for one of the Service- house apartments. Although needing a walking aid she lives alone on the second floor of a building with no lift and where the washing machine is in the basement. She cannot manage the stairs by herself and has a home help every day, besides help from her relatives. When she had just come home from hospital after a hip frac- ture, she felt insecure and very afraid of another fall but managed quite well. Home service was provided three times a day and evening "patrols" dropped in and helped her prepare for bed. Food service was provided three times a week, with two days' supply of meals at a time. She has a safety alarm linked with the Servicehouse, and could use a com- munity-subsidized taxi service. Monthly rental for a Servicehouse apartment with a fully equipped kitchen and bathroom is around US$ World Health • 47th Year, No.4, July-August 1994 350-400, or $700 includ- ing full service (cleaning and full personal care) and all meals. Residents have their own furniture and furnishings to their own taste. A restaurant is also available which provides three meals a day. 29 for staff and relatives to read. It is also a way of documenting changes over time. Electronic surveil- lance ensures that staff members know at any stage where an individual patient is . The Servicehouse plays an integral part in the community because it also provides respite care (alternative day care). There is no limit to the amount of relief that carers can provide; it depends The "seNicehouse" concept is satisfying both for the elderly who need care and for the students to whom it gives employment. The whole complex provides employment for students during the sum- mer months. Up to ten students, mainly women, help in keeping the old people active and inter- ested. By being paired entirely on the person's needs. Care in the Servicehouse is regarded as a less expensive alternative and a more pleasant one than hospitalization. It is also regarded as a right. For the confused elderly The special unit for the confused . elderly consists of two separate sections, one containing four apart- ments and the other, five. It was opened only 18 months ago and all residents (and staff) have been care- fully chosen. The staff furnished the place, planned all the activities, made schedules and received one week's in-service training and education from a doctor and advice from the psychogeriatric clinic. Each staff member is assigned to one or two residents and takes a special interest in those persons by checking doctor's appointments and arrangements, providing a focal point for continuing care, and in general acting as an advocate and contact person for relatives. The contact staff member also prepares the box of medicines to be taken each night and keeps a log book for each resident. This becomes an important document and is available with a full-time staff mem- ber, they are trained and eventually assigned their own special charges. The students are then able to take sufficient responsibility to allow staff members to go on annual leave. • Mrs Britto Asplund's address is c/o Department of Internal Medicine, University of Umea, Umea, S-901-85 Sweden, with acknowledgement to Mrs Dorothy Olofsson of the same department for her contribution to the article. Dr Ruth Bonito is Masonic Senior Fellow at the University Geriatric Unit, Department of Medicine, P.B. 93-503, Auckland, New Zealand. Older people having mode their contribution to society, in their later years they deseNe a good life and the best care that con be offered. Loving care. the recipe that makes everyone feel at home.