course material comments REPORTS 155 research reports Marion Karppi, Heidi Tuominen, Anne Eskelinen, Regina Santamäki Fischer & Anneli Rasu (eds.) ACTIVE AGEING ONLINE Interactive Distance Services for the Elderly on Baltic Islands VIRTU Project 2010–2013 reports from turku universitY of applied sciences 155 Turku University of Applied Sciences Turku 2013 The content of the publication reflects the authors’ views and the Managing Authority cannot be held liable for the information published by the project partners. Cover photo by Toni Koskinen. Additional photos by Terhi Hytönen. ISBN 978-952-216-356-1 (printed) ISSN 1457-7925 (printed) Printed by Suomen Yliopistopaino – Juvenes Print Oy, Tampere 2013 ISBN 978-952-216-357-8 (PDF) ISSN 1459-7764 (electronic) Distribution: http://loki.turkuamk.fi 441 729 Print product CONTENTS FOREWORD FROM FINLAND 7 Helena Räsänen FOREWORD FROM ESTONIA 9 Piret Pihel BALTIC SEA COOPERATION AND VIRTU PROJECT 10 Heidi Tuominen PART I VIRTU – A NEW SERVICE MODEL IN ELDERLY CARE DISTANCE SERVICES FOR THE ELDERLY IN THE CHANGING OPERATING ENVIRONMENT IN FINLAND 22 Ari Heikkinen THE COST-EFFECTIVENESS OF THE VIRTU SERVICE 38 Outi Koivumäki & Inger Nygård TELEREHABILITATION – A FUTURE OPPORTUNITY IN THE FIELD OF REHABILITATION 50 Marion Karppi FACING UNCERTAINTY WHILE DEVELOPING VIRTU PROJECT 61 Anneli Rasu COOPERATION ACROSS SECTOR BOUNDARIES – AN OPPORTUNITY FOR MUNICIPALITY RESIDENTS TO MEET EACH OTHER 73 Ida-Lotta Lind SOMETHING OLD, SOMETHING NEW, SOMETHING BORROWED, SOMETHING BLUE – VIDEO CONFERENCES AS distant service 85 Mika Arvola PART II – SUPPORTING ELDERLY COPING AT HOME A HUMAN RIGHTS APPROACH TO DISTANCE SERVICES IN ELDERLY CARE IN ÅBOLAND, FINLAND 102 Bodil Julin & Janina Sjöstrand THE VIRTU CHANNEL – THE ELDERLY USERS, THEIR QUALITY OF LIFE AND EXPERIENCES OF PARTICIPATING 111 Regina Santamäki Fischer, Anette Häggblom, Bodil Julin & Inger Nygård USER EXPERIENCES OF INTERACTIVE TECHNOLOGY ON VIRTU CHANNEL 129 Hannele Lampo PART III – DEVELOPMENT OF NEW WORKING METHODS FOR HOME CARE THE ADOPTION OF SYSTEMIC INNOVATION AS AN EPISTEMIC CHALLENGE 138 Harri Jalonen NEW TOOLS TO SOCIAL CARE IN ESTONIA 160 Inge Lunkova & Helis Roosimaa BEING LIKE AN OCTOPUS – THE PROJECT COORDINATOR’S EXPERIENCES OF STARTING UP AND IMPLEMENTING VIRTU PROJECT 170 Jenny Husell ENGAGEMENT OF THE ELDERLY CARE WORKERS IN DISTANCE SERVICES 183 Kaisa Jokela DEVELOPING HOME CARE INTERVENTIONS IN VIRTU PROJECT 193 Leena Pekkonen & Carita Saarikivi PART IV – STUDENTS LEARNING IN VIRTU PROJECT VIRTU PROJECT AS LEARNING ENVIRONMENT 208 Anne Eskelinen STUDENTS AT THE VIRTU CHANNEL – PLANNING, REALISATION AND ASSESSMENT OF STUDENTS’ ACTIVITIES WITH ELDERLY USERS AT THE NOVIA UNIVERSITY OF APPLIED SCIENCES 221 Bodil Julin, Marina Grunér, Ann-Maj Johansson & Minna Syrjäinen-Lindberg TOUCH THE SCREEN – NURSING STUDENTS’ PARTICIPATION IN VIRTU CHANNEL COMMUNICATION WITH ELDERLY PEOPLE 229 Anette Häggblom & Regina Santamäki Fischer STUDENTS’ EXPERIENCES OF WORKING ON THE VIRTU CHANNEL 239 Pia Suvivuo, Sari Asteljoki, Anu Kuikkaniemi & Sirppa Kinos LIST OF AUTHORS 251 ABSTRACTS IN FINNISH 255 ABSTRACTS IN SWEDISH 275 ABSTRACTS IN ESTONIAN 297 FOREWORD FROM FINLAND By 2030, the number of 75 year-olds will double in Finland. If we were to continue with the current service system, this would mean doubling the nursing staff from the current numbers. This is an impossible equation, because the age groups entering the job market will grow smaller at the same time as increasingly larger age groups will retire and leave the workforce. Even if workers are recruited from abroad, Finland’s tax revenues will be insufficient due to the decreased number of working people. The only remaining options are longer careers (a practice that is being implemented poorly, even today) and investment in welfare technology. It is naturally desirable that the government’s health policy actions succeed in the sense of giving people timely treatment for their illnesses, effectively preventing national diseases and enhancing self-care. However, it is a known fact that, even in the future, the elderly who need treatment and care will have memory disorders and will also be lonely if their relatives live far away, as is often the case, or when their contemporaries have died. The Act on Care Services for the Elderly will come into force on 1 July 2013. Its central message is that long-term care should not take place until the final stages of life, and even then for the shortest time needed. This means developing non-institutional care and home care and adopting new operating models. The use of welfare technology in services for the elderly does not replace human care but supplements it, enabling the adoption of new kinds of operating models in municipalities and greater participation by the elderly in the surrounding society. We all need other people and empathy. However, the physical presence of another person is not always possible. When implemented well, welfare technology enables both. Prejudices about the elderly as technology users and family members’ concern about technology possibly replacing human carers play a part in hindering the wider use of technology. Nursing staff have also had reservations about technology as part of care work. Active Ageing Online 7 The VIRTU project has demonstrated that there is no limit to how technology can be utilised. Group sessions with a physiotherapist at customers’ homes, nurse’s appointments, pharmacy lectures about medication, not to mention the opportunities that the library, cultural services and universities of applied sciences have had as producers of the programme. In the future, it will be important for the elderly themselves to participate more in planning programme contents as experienced experts. The VIRTU project has also provided family caregivers with much-needed variety and content for their days. In the future, welfare technology must be expanded to better cover lonely elderly people in the sense of preventive care. According to studies, loneliness is what brings people to the circle of health and emergency services. The goal must be to have welfare technology as part of the entire municipality’s service selection for those elderly people who have difficulties participating in activities organised by the municipality due to a lack of transport connections or their physical condition. Every person, including the elderly, must have the opportunity to be part of the surrounding events and to have contact with other people. And not just as an observer. Sipoo, February 2013 Helena Räsänen Manager of Elderly Care Services Member of the Steering Group of the VIRTU project 8 Reports from Turku University of Applied Sciences 155 Foreword from Estonia E-services have become an inseparable part of our daily lives. We are used to e-banking, filling electronic income declarations, signing documents digitally, shopping in e-stores, buying e-tickets, using the conveniences of e-parking, etc. The appearance of e-books next to traditional and cherished conventional books creates some agitation or even disputes, but the service has already been introduced and the new solution will surely expand. There is nothing one can do about it – e-life develops with greater speed than in our wildest dreams. Today, we are still slightly doubtful of e-services in the social area, where a human touch, communication and sensitive help form important parts of the services. While the elderly people of today are not always ready for e-services, the later generation used to daily e-services will take their place very soon. They all have reasons to expect the increasing availability of e-solutions also in the areas of social services and health care. Regular medical surveillance, virtual rehabilitation service or social communication network with its extensive opportunities – all that supports the preservation of the quality of life, prevents illnesses and hospitalisation. Today, the financial contribution of the state is mainly aimed at the compensation of costs due to health problems that have already occurred. It is very expensive and the price is increasing. Only 5% of the funds are allocated to prevention. Here, politicians need to contemplate on the best solution. The experience of European colleagues shows that the use of e-solutions in the area of medicine and social relations enables remarkable saving of funds. The present obstacles, including the fact that the financing of medicine and social area is organised through different systems, and that social services are an obligation of local governments, should be easily solved by good will and wise decisions. The population is ageing – this is the demographic trend today, and we are obliged to offer everyone services characteristic of a prosperous society, and not treat those as a privilege of rich people, who can afford to buy expensive services from the private sector. Saaremaa, February 2013 Piret Pihel Director of the Saaremaa Development Centre Member of the Steering Group of the VIRTU project Active Ageing Online 9 BALTIC SEA COOPERATION AND VIRTU PROJECT Heidi Tuominen Abstract In the Baltic region and elsewhere in Europe, demographic changes and the need to ensure the quality and availability of services pose challenges for the social and health care sector. Especially in the periphery such as the archipelago areas, long distances and limited availability of qualified personnel create pressures to reshape services. The increasing scarcity of resources makes it essential to develop new social and health care work methods. Supporting services that are delivered at home and the ability to live at home as long as possible are an essential part of both the national policy and the Europe 2020 strategy. VIRTU – Virtual Elderly Care Services on Baltic Islands is a project that was carried out in Finland, Åland and Estonia in 2010–2013. The aim of the project was to develop a service model to help elderly people living in the archipelago by utilising welfare technology to support their social interaction and ability to live at home, improve their quality of life and increase their feeling of security.