A full life - all your life A Quality Reform for Older Persons

Norwegian Ministry of Health and Care Services LIVE YOUR WHOLE LIFE CONTENTS

Preface ...... 5

Summery ...... 7

1 Goals and target group ...... 13

2 Background and history ...... 14

3 Implementation and methods ...... 16

4 National programme for an age-friendly Norway ...... 19

5 Activity and socialisation ...... 22

6 Food and meals ...... 29

7 Healthcare ...... 35

8 Coherence ...... 41

9 Basis for the reform ...... 42

LIVE YOUR WHOLE LIFE 3 4 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE

A Quality Reform for Older Persons

Recommendation by the Ministry of Health and Care Services on 04 May 2018, approved at the cabinet meeting the same day. (Solberg government)

LIVE YOUR WHOLE LIFE 5 6 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE 7 Most older persons in Norway live good ensures security and dignity for the lives . They have an impact on their own senior years? One idea is to offer all daily lives . They are active and older persons at least one hour of participate in the social community . They activity per day based on their own have good health and care services that interests and wishes . Another is for are available when needed . They health and care services to establish a contribute with their own resources at community contact person to mobilise work, and to family and friends in their volunteer efforts. A third is to provide community . older persons with more opportunities to choose what they want to eat and to All older persons should be able to have a good meal in the company of continue enjoying their daily lives, even others . when health issues arise and public services are needed . Government representatives have travelled around the country in search of Local communities have developed good good measures, and have arranged solutions to ensure this . However, not all dialogue meetings to collect advice and of these good solutions are utilised by ideas . Hundreds of examples of good municipalities, and some are used only local services and measures have been randomly . Services are therefore not received and assessed . In addition to always adequate, and the quality of recent research, this input forms the services for older persons may vary . foundation for the reform . The reform promotes opportunities for older The Live Your Whole Life reform consists persons to use their resources and have of 25 specific and tested solutions in their needs met at all stages of their areas where services for older persons later years . This requires a more age- are considered inadequate . friendly society, where older persons can live goods lives and participate in the • An age-friendly Norway social community . • Activity and socialisation • Food and meals The government is promoting a process • Healthcare whereby municipal councils can review • Continuity of services and decide on how to implement the The reform builds on what health and solutions of the reform . Once this is care personnel, older persons, family, done and municipalities have described volunteers, researchers and leaders how they wish to organise these have found to work in practice . What is it solutions, the efforts to implement and that raises the quality of services and execute the reform can begin .

8 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Municipalities that restructure their all older persons . This involves better services to accommodate the reform will services and activities, and a society be prioritised for both relevant existing where older persons are able to use programmes and newer ear-marked their strengths and abilities . programmes . The reform period will begin on 01 January 2019, for a duration Previous reforms have often dealt with of five years in different stages for systems . Live Your Whole Life deals with planning, implementation and people and things that matter the most evaluation . in life . Community, activity, good food and healthcare services . With Live Your The hope is that municipalities will learn Whole Life, older persons will have the from one another and inspire each opportunity to master their own lives other . In order to set things in motion, where they live, throughout their lives . ensure that the solutions are distributed throughout the country, and that they are systematised and utilised by all municipalities, the government will establish a national and regional support network for the reform period . The intent is for this support network to guide and assist municipalities with planning, design and implementation of the reform in the local community . All municipalities will be invited to participate in the learning network, to share experiences and learn from one another .

Through the Live Your Whole Life reform, the government has, for the first time, gathered and systematised new and improved municipal solutions for measures aimed at older persons . Along with currently initiated and implemented efforts and measures, the government is signalising a new and sustainable policy with Live Your Whole Life, meant to ensure good and secure senior years for

LIVE YOUR WHOLE LIFE 9 A reform is created between two health conferences

The Norwegian Health Conference kicked off in May of 2017, under the direction of the Ministry of Health and Care Services and the Directorate of Health . Participants from all over the country attended the conference . Snacks were served in the corridor just outside the conference hall . As many as 750 older persons, professionals, family members, leaders, representatives from volunteer organisations and other key actors gathered in groups and around tables . The corridors were buzzing with interest even before the conference began .

The annual Health Conference is an important meeting place . This year’s conference launched Live Your Whole Life - a quality reform for older persons .

Bent Høie, the Minister of Health and Care Services, opened the conference by introducing the reform, which deals with basic needs that are often not addressed in services for older persons, including Food, activity, socialisation, healthcare and continuity of services .

By ensuring activities and socialisation for elderly people in local communities, we are not only helping to make lives better and more meaningful, but also helping to prevent a number of health problems, both physical and psychological. This is why activity and socialisation are important aspects of the new reform for older persons.

Older persons who eat enough nutritious food are healthier and happier. This is why good food and good meals are an important part of the new reform for older persons.

Early intervention can halt the progression of diseases and prevent complications from health issues, to help older persons manage their daily lives. This is why good healthcare services are an important part of the new reform for older persons.

Reliable services with better continuity are essential for those who need help, and for their families. This is why better coherence and continuity is an important part of the new reform for older persons.

During the conference, participants listened to presentations on topics related to Live Your Whole Life, by professionals, researchers, family members and service users . Kåre Reiten, Chair of the Municipal Board for Social Welfare in Stavanger, presented their Live Your Whole Life project .

“When I saw the work being done on the reform, I knew there was something familiar about it. This is a project we have had running in Stavanger since 2010. It is a restructuring project we initiated many years ago, because we knew we had to deal with the future care of older people in a different way, rather than simply granting resources and spending more money.”

Kåre Reiten believes it is important to begin municipal restructuring efforts early in order to meet upcoming challenges:

“To change the course of a ship, we need some propulsion.”

10 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Erlend Eliassen, kitchen manager at Nygård nursing home in Sandefjord municipality, explained how nursing home food could be good food . In the Nygård model, feedback from service users is key . Meal surveys are carried out each week, and nutritional contact persons in the wards also meet weekly:

“We tend to forget the people - that is the biggest mistake. I always have to convince others that people are actually the most important factor here.”

Maurtuva Vekstgård in Inderøy municipality is service for people with dementia living at home, and their families . The service is run in cooperation with Inderøy municipality and social entrepreneurs, and offers activities and long weekend stays for older persons. Maurtuva Vekstgård offers respite care for family caregivers, and a secure, enjoyable environment for people with dementia . These services were presented by Kjerstin Heggdal Grimstad and Ida Stene Tangstad:

Good respite care is respite care with a good conscience.

Our goals include good food, socialisation, mastery and an enjoyment of life - the golden moments that linger in the mind and body.

It is incredible what can be done with our own efforts and the help and involvement of key actors.

During the breaks, participants had the opportunity to visit stands presenting some excellent tools and solutions .

On day two, Prime Minister Erna Solberg took the podium:

“We have done a great deal to improve services for older people. Nevertheless, we still often fail in the most important areas in the care of the elderly. This makes the final years of life more difficult to manage for many elderly people and their families. This is the reason we have now begun work on a reform for older persons.”

She was followed by the Minister of Finance, Siv Jensen:

“It’s time to change the way we think. We cannot erase the difference between services for older people at a government desk. We have to talk to people who know where the shoe pinches. These differences are most apparent out in the municipalities. And that’s where the good solutions lie.”

Bent Høie, the Minister of Health and Care Services, was the last to speak at the conference. He described the continued process for reform efforts:

“We will present the advice and ideas we receive in the form of a White Paper in spring of 2018. The municipalities will have identified specific focus areas and tools for implementing changes. We will then use the remainder of 2018 to prepare municipalities for the reform. The reform will be initiated in 2019.

LIVE YOUR WHOLE LIFE 11 The work then began on organising dialogue meetings throughout the country, toobtain input for solutions and to hear some good examples . Five dialogue meetings were held on the main topics of the reform:

Food, nutrition, social mealtimes, Stavanger 30 May 2017 Healthcare services for elderly patients, Bergen 20 June 2017 Activity and social community, Bodø 31 August 2017 Coherence, Hamar 26 September 2017 Implementation and distribution, Stjørdal 07 November 2017 Seniors and their families, municipal employees and leaders, volunteers, professionals and researchers were all invited . More than 400 people participated in the dialogue meetings . Feedback from the participants was positive:

“It was great to be involved in the development of a reform, and not one that was already completed.”

All dialogue meetings have been summed up in separate reports at regjeringen .no .

In addition to the dialogue meetings, all participants were encouraged to submit ideas for the reform . Several hundred letters and emails arrived from older persons, family members, employees, municipalities, interest groups, professional environments, and other key actors . All good examples and ideas were summed up and collated with recent knowledge and research results as a basis for the white paper . The Ministry of Health and Care Services obtained seven reports that provided a review of the knowledge and research results .

Food and nutrition for older persons (1)Activity and socialisation for older persons (2) Transitions and interruptions in patient trajectories for older persons (3)

Distribution and implementation of good measures for older persons (4) Families of older persons (5) Competency enhancement and necessary conditions for a good professional work environment in municipal health and care services for older persons (6)Healthcare services for older persons (7)

A year of work on planning the reform will be concluded at the Health Conference in 2018 . The white paper on the new reform will be presented by Åse Michaelsen, the Minister for the Elderly and Public Health . Once the white paper has been processed, work will be under way to implement the quality reform, Live Your Whole Life .

12 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE GOALS AND TARGET GROUP

The reform, Live Your Whole Life, will where they can use their competency contribute toward: and do a professionally good job .

Additional improved years of life for The target group is older persons over older persons, with better health, better the age of 65, living at home or in quality of life, and greater mastery of institutions . This is a target group with life, while also ensuring that older different capacities and significant persons get the health and care they differences in their needs and wishes. need, when they need it . While this reform is especially aimed at Families who are less exhausted, and the health and care sector, all sectors who can provide more stable care for must contribute to create a more their loved ones . age-friendly society, where older persons can remain active and Health and care personnel who feel they independent . have a good working environment,

LIVE YOUR WHOLE LIFE 13 TARGET AREAS

Live Your Whole Life has identified five well-documented that activity, both target areas: physical and social, can improve appetite and well-being . Socialisation leads to 1 . An age-friendly Norway better physical and psychological health . 2 . Activity and socialisation 3 . Food and meals This reform will highlight the five target 4 .Healthcare areas both separately and collectively . 5 . Continuity of services The essence of Live Your Whole Life can For each of these target areas, the be gathered into a few main topics, reform has identified five challenges and which collectively will contribute toward five proposals for solutions, which all greater enjoyment, quality of life and refer to local examples . The solutions security for older persons and their presented in this white paper are families . proposals for changes that municipalities can work with, based on The opportunity to choose local conditions and needs, in Live Your Whole Life is a reform cooperation with other service areas, the intended to provide a greater freedom volunteer sector and other key actors in to choose . It should give each individual the local community . better opportunities to choose service providers (who), be involved in the The target areas of the reform are content of the services provided (what), closely related . There is a strong determine the manner in which services connection between the different topics. are provided (how), and the time and Attention to one area is likely to affect place for the provision of services (where the other areas . For instance, it has been and when) .

14 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Meal enjoyment for older persons Alternative work arrangements Live Your Whole Life is a reform intended Live Your Whole Life is a reform for all to improve meal enjoyment, whether you who work in health and care services . It live at home or in a nursing home or should inspire a reorganisation of work hospital . The goal is to make mealtime an schedules, and utilise new technology, enjoyable event in daily life, and to ensure new methods and new solutions . It several meals a day and good nutrition should promote structures to ensure with good cooks and local kitchens . better continuity of services, with easier transitions and fewer staff rotations for Health and care services those receiving services . for older persons Live Your Whole Life is a reform intended to create health and care services for older persons, where the essential question is: What is important to you? Services should give older persons a sense of security in knowing that help is available when needed . Services should invite activity and participation, and provide assistance for greater mastery, regardless of illness or functional impairment .

Care of family caregivers Live Your Whole Life is a reform for family members . It should provide care for caregivers and help those who are looking after their loved ones, to prevent exhaustion . It should facilitate better cooperation on shared tasks between family caregivers and health and care services .

LIVE YOUR WHOLE LIFE 15 IMPLEMENTATION AND METHODS

In order to ensure the best possible of the reform on the agenda, and to collective progress, the reform period develop tools, methods and materialfor will have a duration of five years, with a local implementation . Municipalities will collective start-up on 01 January 2019, be invited to participate in learning networks, to share experiences and and with different phases for learn from one another . assessment, planning, implementation Phase 2, Assessment and planning and evaluation . (2019-2020)

Figur 1 .2 Time frame From 2019 through 2020, municipalities will assess reform solutions and begin planning how to design and implement these locally . Municipalities and county councils will be expected to assess their own needs and challenges, and make Phase 1, Preparation and initiation (2019) political decisions on the solutions for During the first year, Live Your Whole Live Your Whole Life . Municipalities will Life will be put on the agenda for summarise their measures for following municipalities, county councils, health up the reform in the budget and trusts and the general public . The financial plans for the initiative, prior to government will establish a support their implementation . Specialist network for reform implementation healthcare services will be followed up from 2019 to 2023 . This support network through general management and will initially communicate, inform and reporting systems . inspire municipalities to put the contents

16 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Phase 3, Implementation and execution The government wishes to collaborate on (2021-2023) implementation and execution with the Once municipalities, county councils and municipal sector through the Norwegian health trusts have made decisions on Association of Local and Regional the reform proposals and described how Authorities . The Norwegian Directorate this will be organised, work can begin on of Health will oversee the distribution the implementation and execution of the and implementation of Live Your Whole reform . Municipalities that restructure Life, with a line of management to county their services to accommodate the governors . The Directorate of Health will reform will be prioritised for both also include national professional relevant existing programmes and environments, as needed, in the newer ear-marked programmes . collaboration on the implementation of measures aimed at the health and care Phase 4, Evaluation and sector . The work to achieve an age- improvements (2023) friendly Norway is multi-sectoral, and will The reform will be evaluated through be organised in close cooperation with accompanying research on a the Norwegian Association of Local and representative group of municipalities . Regional Authorities, in conjunction with Halfway through the reform period, a the National Council for Seniors . This research report will be prepared in order support network will help to facilitate to follow the changes made in participation, engagement and activities municipalities, and to adjust the during the reform period . direction and use of methods if needed . Research will be concluded with an evaluation of the results of the entire reform after 2023 .

The basis for the reform is an acknowledgement that good local solutions exist . Many municipalities are making solid, systematic efforts on one or more of the reform areas . At the same time, it is acknowledged that these solutions are less likely to be implemented or transferred to others . The reform will therefore facilitate opportunities for municipalities, health trusts and others to learn from one another and to implement good and innovative solutions for services .

LIVE YOUR WHOLE LIFE 17 The primary efforts by the government Improvement of care services for older will be placed at the regional level, where persons will primarily be covered by county governors will work together with municipal free income . Municipalities the Norwegian Association of Local and that restructure their services to Regional Authorities, the Centre for accommodate the reform will be Development of Institutional and Home prioritised for both relevant existing Care Services, county councils and other programmes and newer ear-marked regional professional environments, as programmes . well as the county councils for older persons and other relevant organisations . The regional support network for the reform period will carry out network measures, provide information, counselling and guidance, and will assist the municipal sector with regard to planning, restructuring and changes .

It is assumed that the municipalities will first make political decisions on the reform proposals and describe how they wish to organise and implement these locally . It would be reasonable to prioritise these in the municipal action plans and financial plans that are revised annually . It would also be reasonable for efforts to become a more age-friendly municipality to be thematised in the municipal planning strategy and other municipal and county measures .

The reform will not impose new demands or tasks on municipalities that entail increased expenses . In fact, several of the proposed solutions may result in better and more efficient services, and in time, less extensive service needs among older persons .

18 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE NATIONAL PROGRAMME FOR AN AGE-FRIENDLY NORWAY

Expanding today’s services in line with programme will encourage the senior the demographic development would population to become engaged in the not in itself be sufficient to meet the planning of their own senior years and needs of future generations of older the structure of their environment . At persons . This white paper therefore the same time, it is essential to ensure invites older persons and the general that health and care services do their public to become involved in creating a share of the work by creating age- more age-friendly Norway . An ageing friendly hospitals, nursing homes, population affects all areas of society, residential accommodations and markets and sectors . services .

One of the primary tasks of Live Your The National programme for an age- Whole Life is to follow up the friendly Norway has five main elements: government strategy, “Several years - several opportunities”, and to assist in its 1 . Planning for senior years implementation in municipalities and When dealing with demographic local communities throughout the changes, it is necessary to encourage the country . This work must be based on a population to take greater responsibility broad partnership between public in planning for their own senior years . authorities at the state and municipality The programme therefore includes an level and private actors, civil society, and informational campaign with focus on: research and education institutions . The

LIVE YOUR WHOLE LIFE 19 Adapting one’s own home municipalities are now working to Investing in friends and social networks determine whether they will join the Maintaining the best possible function network . through an active life 4 . Multi-sectoral partnership 2 . Senior-based planning The government strategy for an age- Municipalities should involve older friendly society will also be achieved at a persons in the planning and organisation national level through planning of local communities . The method processes in all industries and sectors . entitled “Seniortråkk” (“Senior The national network therefore Pathways”), which has been tested in encourages a partnership arrangement three different municipalities, has shown for representatives from institutions, how senior councils can actively organisations, education, research and participate in the assessment and businesses aimed at creating more planning of a secure and age-friendly age-friendly institutions and companies . local community . Organisations for retired and older persons are involved in 5 . Senior resources this work . Results of the assessment One study estimated that total have been summarised and sent to the contributory value to society by older municipality, businesses, local persons through formal and informal organisations and central authorities . volunteer work to be around 45,000 FTEs, or just over NOK 25 billion in 2016 . 3 . National network This study concluded that there is a high Norway participates in the World Health potential for additional contributions by Organization’s Network for Age-friendly older persons and that this total Cities and Communities, and supports contribution could nearly double by and coordinates local efforts with a 2030 . This requires more targeted separate national network for recruitments, organisation and Norwegian municipalities, in cooperation accommodations through different with the government and the Norwegian private and public structural forms . Association of Local and Regional Authorities .

This network now supports around 500 local communities in 40 countries, and offers a five-year package and planning process to create age-friendly cities and local communities . So far, Norwegian participants include the municipalities of Oslo and Trondheim . Several

20 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .1 International and local examples for inspiration, see box 4 .2 Measure What Who The WHO Global Network for age-friendly cities World Health Organization Network and local communities Age-friendly city Participates in the WHO Global Oslo municipality Network City conference of Recommends that its County councils for older persons county councils for municipalities participate in the in Bergen, Drammen, Fredrikstad, older persons WHO Global Network Kristiansand, Oslo, Sandnes, Stavanger, Tromsø and Trondheim municipalities Pop-up flats The Safe Home displayed at Alna district of Oslo municipality and the shopping centres Injury Prevention Forum Information Exhibition For planning senior years Søndre Land municipality Volunteer centre Seniortråkk (Senior A participation model for Tested in Skjeberg in Sarpsborg Pathways) planning of age-friendly local municipality, Sagene district of Oslo communities municipality, and Skotterud in Eidskog municipality by the Norwegian Institute for Urban and Regional Research (NIBR) and the Work Research Institute (AFI) . Time frame Platform for sharing The demographic challenge knowledge, solutions and Æra Strategic Innovation inspiration for planning an age- friendly society 18 trails for everyone Universally designed walking 18 municipalities in Telemark trails near city centres County governor and county councils Age Friendly Ireland National superstructures for Run by Dublin City Council age-friendly networks of cities and regions The AARP Network Network of age-friendly states, Run by the American Association of cities, settlements and local Retired Persons (AARP) communities across the United States Patient hosts Patient hosts at hospitals assist University Hospital of North Norway with directions Old Enough Companies based on older persons Social entrepreneurs Old Enough AS Seniors helping Assistance in finding help in Klepp Volunteer Centre in Trondheim seniors daily life municipality Mentor+ Prevent loneliness among older Salvation Army persons

LIVE YOUR WHOLE LIFE 21 ACTIVITY AND SOCIALISATION

Live Your Whole Life is a reform for The challenges are summarised below: activity, participation and socialisation . The goal is to reinforce relationships • Loneliness among older persons between older persons and their families, related to changes in life situations, friends and social networks, and to death of a partner, declining health facilitate good experiences and and functional impairment encounters across generations . Physical, • Inactivity, or activities that are not social and cultural activities must be based on individual wishes and needs . based on individual interests, wishes and • Failure to meet social, cultural and needs . When life becomes more existential needs vulnerable, older persons need • Little systematic cooperation opportunities for dialogue, motivation between health and care services and and support . volunteer services/civil society • Lack of meeting places and In this way, older persons will have better collocations, as well as digital opportunities to live life - their whole lives . generational divides Five solutions have been recommended At the same time, feedback from dialogue to deal with these challenges, where the meetings, service user surveys and other goal is to increase activity, create good sources indicate that this is an area for experiences and improve socialisation: improvement for health and care services . Many older persons have expressed that • Enjoyable moments they are offered too few opportunities for • Faith and life philosophy a variety of suitable activities . In many • Generational encounters places, cooperation with the volunteer • Community contact sector is not part of the system . • Shared use and collocation

22 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .2 Local examples for inspiration, see box 4 .2

Title What Who

My life story Method of obtaining information Norwegian Association about individual life histories of Occupational Therapists

Activity Dosette Plan for daily activities for each Øyane nursing home in individual Stavanger municipality Activity Dosette AS

Memoria Digital communication tool based on Mørkved nursing home the user’s life history in Bøde municipality, Memoria AS

Activity companion Seniors with dementia do activities Norwegian National together with volunteers Association for Public Health, and about 200 municipalities

Strolling friend Seniors with dementia go on walks Songdalstunet in with volunteers Songdalen municipality

Cycling with MOTiview Cycling through familiar surroundings Several municipalities in with the aid of videos, music and Norway and the Nordic sound countries

Singing in care for the elderly Singing as part of the daily routine in National Association nursing homes of Folk Academies, Akershus Music Council

On the Farm Activities in a farm environment Around 400 On the Farm farms

Holiday with extra security A holiday to southern Europe for those Os municipality who cannot travel alone

Low-threshold services in the Different low-threshold services in Vestvågøy municipality district the district, such as senior dances and walking groups

Senior centre and cultural Activities, courses and social meeting Kristiansand municipality walker places for 60+ and a mobile cultural mediator

1. Enjoyable moments the senses, trigger memories, and Seniors should be offered at least one facilitate movement and participation in hour of activity daily, based on their own the social community . This requires interests, wishes and needs . Activities health and care services to obtain will provide enjoyable experiences and information and knowledge of individual moments in daily life, and will stimulate backgrounds, interests and life history,

LIVE YOUR WHOLE LIFE 23 and to use this to meet the needs of cultural and religious diversity, as it is in each person . Health and care services the rest of the population . Spiritual and must work systematically to create existential needs are an integral part of enjoyable moments and meaningful the lives we lead . For some, this involves activity in the daily lives of older persons . a religious affiliation, while for others This may involve physical, social and/or cultural experiences . There are many this involves a life philosophy without good examples of municipalities that religion . For most people, it involves the have that many systematic efforts to do most meaningful aspects of everyday this through cooperation with volunteer life, as well as the big questions in life . centres and the local community to Existential care should therefore be create enjoyable moments for older included in the comprehensive care of persons . patients and their families . These needs must be assessed responsibly, in the 2. Faith and life philosophy same manner as other needs . Health Health and care services must meet the and care services should introduce need to address individual faith and routine procedures and cooperation philosophical practices and the need to with faith and life philosophy resources discuss existential questions . Everyday in order to meet the needs of the service life in Norwegian care facilities and users and their families . nursing homes are characterised by

24 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .3 Local examples for inspiration, see box 5 .3

Title What Who

Procedures for faith Information and action plans for Fredrikstad municipality and life philosophy service users - separate faith and life Borg diocese practices philosophy practices

Guidelines for Safeguarding spiritual needs for Development centre for home care safeguarding service users of care services - films services and nursing homes in spiritual and and learning materials Nordland county existential needs

Interactions on the A training programme with theme Surnadal municipality in last watch days, reflection groups for personnel cooperation with Rindal and and volunteers who work with sick and Surnadal ecclesiastical councils dying patients

Spiritual and Dialogue offered to patients and St . Olavs Hospital existential family members conversations in a community open to all life philosophies

Guidelines for Guidelines for collaboration between The Council for Religious and Life interactions municipal health and care services Stance Communities in Norway, the regarding faith and religious and life philosophy Christian Council of Norway, the and life philosophy communities Church of Norway Council and the practices Norwegian Directorate of Health

3. Generational encounters it is essential that municipalities develop Facilitating encounters between policies and plans that involve closer generations requires the establishment of meeting places between young and cooperation between generations . old in everyday life, as well as the An important basis for generational organisation of cross-generational encounters is the knowledge that activities and enterprises . This may take interests and activities are not place at schools and workplaces, or in generationally bound . It’s all about nursing homes and local communities . finding natural meeting places and In order to create good meeting places, activities that are well-adapted and

LIVE YOUR WHOLE LIFE 25 Tabell 1 .4 Local examples for inspiration, see box 5 .4 well-established in the local community . Many municipalities have created Title What Who systems for enabling good generational Old meets young - EMU project A meeting place for high school Byåsen Upper encounters between young and old . students and older persons, with a Secondary School, variety of activities, including cooking, Byåsen Volunteer carpentry and computers . Centre in Trondheim 4. Community contact municipality Health and are services should consider Generational choirs Children in preschools and older Generational choirs establishing community contacts who persons in nursing homes sing can act as liaisons between health and traditional, familiar songs together care services and the local community, Seniors prepare school lunches Seniors prepare school lunches for Skage Volunteer including families, caregivers, volunteers students Centre in Overhalla and others in the community . The goal municipality

Listening partner Seniors offer basic reading education Several municipalities Tabell 1 .5 Local examples for inspiration, see box 5 .5 for children ages 7 to 9 in Agder county Title What Who Drop-in Unemployed youth and non-students Songdalen municipality volunteer at day centres for older Cooperation between Volunteer coordinators that Drammen municipality persons municipalities and systematise cooperation between volunteers public and volunteer sectors . Efforts for others Cooperation between schools and Tokerud School nursing homes and Stovnerskogen With a heart for Arendal Coordinator as a liaison between Arendal municipality, nursing home in Oslo the public sector and volunteer Norwgian Association municipality organisations of Local and Regional Authorities, and five Cycling at all ages Cycling trips for up to two passengers Many municipalities in volunteer organisations and a driver Norway Nedre Eiker coordinates Volunteer Centre coordinator that Nedre Eiker municipality Multicultural meeting place Meeting place to promote inclusion Sørum municipality mobilises and follows up volunteers and better integration between people in cooperation with of different cultures volunteer groups and Time as a gift Coordinator that organises volunteers Sandefjord municipality associations who provide care for patients with a and Development Centre short time left to live for nursing homes and Skånland fitness groups Low-threshold fitness classes for the Skånland municipality home care services in Skånland population Vestfold

Generation Games Sporting events where people of all Oslo municipality Willing and free Volunteers for day activity services Day activity centre Veglo in ages compete in different fields for people with dementia receive Førde municipality systematic follow-up Digital Thursdays Meeting place for volunteers and Asker Volunteer Centre older persons who need help with and the Cultural computers and digital media Corner at Asker Cooperation between Quality of life consultant that builds Sentrum nursing home and Cultural Centre in schools and nursing homes cooperation between schools and Bodø Upper Secondary Asker municipality nursing homes School in Bodø municipality

Active Senior Network - Network between services, volunteer Volunteer Centre and Active Together centres and high schools Vennesla municipality

Volunteer Coordinator Multidisciplinary education as Dignity Centres in Bergen education volunteer coordinator for care services and Oslo

26 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .4 Local examples for inspiration, see box 5 .4 well-established in the local community . of a community contact is to mobilise Many municipalities have created volunteer efforts in health and care Title What Who systems for enabling good generational services and to strengthen the Old meets young - EMU project A meeting place for high school Byåsen Upper encounters between young and old . cooperation between schools, students and older persons, with a Secondary School, variety of activities, including cooking, Byåsen Volunteer carpentry and computers . Centre in Trondheim 4. Community contact municipality Health and are services should consider preschools, organisations and civil Generational choirs Children in preschools and older Generational choirs establishing community contacts who society . Experiences from municipalities persons in nursing homes sing can act as liaisons between health and that have established community traditional, familiar songs together care services and the local community, contacts indicate a significant potential Seniors prepare school lunches Seniors prepare school lunches for Skage Volunteer including families, caregivers, volunteers for interactions and volunteer students Centre in Overhalla and others in the community . The goal involvement in the local community . municipality

Listening partner Seniors offer basic reading education Several municipalities Tabell 1 .5 Local examples for inspiration, see box 5 .5 for children ages 7 to 9 in Agder county Title What Who Drop-in Unemployed youth and non-students Songdalen municipality volunteer at day centres for older Cooperation between Volunteer coordinators that Drammen municipality persons municipalities and systematise cooperation between volunteers public and volunteer sectors . Efforts for others Cooperation between schools and Tokerud School nursing homes and Stovnerskogen With a heart for Arendal Coordinator as a liaison between Arendal municipality, nursing home in Oslo the public sector and volunteer Norwgian Association municipality organisations of Local and Regional Authorities, and five Cycling at all ages Cycling trips for up to two passengers Many municipalities in volunteer organisations and a driver Norway Nedre Eiker coordinates Volunteer Centre coordinator that Nedre Eiker municipality Multicultural meeting place Meeting place to promote inclusion Sørum municipality mobilises and follows up volunteers and better integration between people in cooperation with of different cultures volunteer groups and Time as a gift Coordinator that organises volunteers Sandefjord municipality associations who provide care for patients with a and Development Centre short time left to live for nursing homes and Skånland fitness groups Low-threshold fitness classes for the Skånland municipality home care services in Skånland population Vestfold

Generation Games Sporting events where people of all Oslo municipality Willing and free Volunteers for day activity services Day activity centre Veglo in ages compete in different fields for people with dementia receive Førde municipality systematic follow-up Digital Thursdays Meeting place for volunteers and Asker Volunteer Centre older persons who need help with and the Cultural computers and digital media Corner at Asker Cooperation between Quality of life consultant that builds Sentrum nursing home and Cultural Centre in schools and nursing homes cooperation between schools and Bodø Upper Secondary Asker municipality nursing homes School in Bodø municipality

Active Senior Network - Network between services, volunteer Volunteer Centre and Active Together centres and high schools Vennesla municipality

Volunteer Coordinator Multidisciplinary education as Dignity Centres in Bergen education volunteer coordinator for care services and Oslo

LIVE YOUR WHOLE LIFE 27 These resources can best be achieved local communities do not have local through systematic efforts for meeting places . A communal use of recruitment, organisation, supervision facilities provides a basis for mutual and clear cooperative agreements . activities, informal meetings and the joint use of resources . Ensuring that care 5. Communal use and collocation service activities are open to others in Nursing homes and residential care the local community will enrich the lives homes should be constructed such that of those who live there, and provide they become an integral part of the local better services to other residents in the community, preferably with communal municipality . meeting places and neighbourhoods across generations and functions . Many

Tabell 1 .6 Local examples for inspiration, see box 5 .6 Title What Who

Students Move In Students are offered reasonably Braarudtoppen priced flats and meals on the condition and Åsentunet that they spend a certain number care homes of hours on social activities with the in Horten residents . municipality

Health and activity centre The centre offers activities and Bråta Health and services for all municipal residents Activity Centre in Nedre Eiker municipality

The open nursing home - a meeting Nursing homes will become meeting The Church City place for the local community places for the local community, with a Mission café, cultural events, etc .

Cultural centre and care service centre Nursing home places and care Tysværtunet homes that share an entrance with Activity and Care the cultural centre, which includes a Centre in Tysvær library, cinema, theatre and concert municipality hall, gym and pool .

Local shop as a service point and Local shop as a social arena, with older Ullensvang, meeting place persons as an important target group Vingrom and Kvænangen municipalities Activity park Outdoor sports and activity park for Buen Care everyone in Melhus centre Centre in Melhus municipality

28 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE FOOD AND MEALS

Live Your Whole Life is a reform for to many older persons . Feedback from greater meal enjoyment . The goal is to dialogue meetings and knowledge in the create good meal experiences and field indicates that the basic needs of reduce the risk of undernourishment . many older persons with regard to food, Good food is essential for good health nutrition and good mealtime and quality of life throughout our lives . experiences are not yet met . Seniors should have nutritional meals that look, smell, and taste good . Meals The main challenges are summarised as should be suited to individual needs, and follows: be served in a pleasant setting . Seniors should have better opportunities to • Lack of systematic follow-up choose what they wish to eat and when • Lack of social community and little they wish to eat, and to share a good emphasis on mealtime surroundings meal with others . • Few meals and long nightly fasts • Little variation and freedom of In this way, older persons will have choice better opportunities to live life - their • Large distance between production whole lives . and serving

Nutrition and mealtimes for older persons have been put on the agenda in recent years in Norway, yet is still a significant gap between recommendations by the health and care authorities and the services offered

LIVE YOUR WHOLE LIFE 29 1. Good mealtimes Five solutions have been recommended A good meal should consist of nutritious to deal with these challenges, where the food that looks, smells and tastes good . goal is to reduce undernourishment and Meals should be suited to individual create good food and mealtime needs, and be served in a pleasant setting . experiences for each individual: This means that food should contain an adequate and correct amount of energy • Good mealtimes and nutrients, and also have an appetising • Mealtimes appearance, to stimulate the senses . • Freedom of choice and variation • Systematic nutritional measures There should be opportunities for social • Local kitchens and competency mealtimes for those who prefer to dine with others . Municipalities may wish to consider the idea of dining companions for facilitating social mealtimes

Tabell 1 .7 Local examples for inspiration, see box 6 .2 Title What Who

Golden mealtime Good food and pleasant Døli residential care centre in Nittedal moments surroundings suited to the municipality, Blidensol nursing home individual resident . in Stavanger municipality, and Nygård residential care centre in Sandefjord municipality .

Consistency-adapted Research-based project aimed at Sandnes municipality meals developing methods and tools for a consistency-adapted menu for residents at home and in nursing homes

Enjoyment and Health centre with a homey feel, Åfjord Health Centre in Åfjord socialisation during and a warm, secure atmosphere municipality mealtimes

Granitten Café and A gathering place for all district Grorud district of Oslo municipality Diner residents

Local meeting place A social and cultural service with Tyholmen Volunteer Centre in for meals dining facilities for all Arendal municipality

Community meals A service for mealtime community Senior centre in Oslo municipality

Dining and mealtime A service that facilitates mealtime Horten and Bergen municipalities companions companionship for lonely older persons

Mealtime Home nurses eat together with Hamar, Oslo and Rælingen companionship for older persons who are at risk of municipalities older persons living undernourishment at home

30 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE 2. Mealtimes 3. Freedom of choice and variation Health and care services should aim to Each individual must be given the provide services for older persons who opportunity, to the extent this is possible, require meal and nutritional assistance to maintain their own meal traditions and that are adapted to the person’s own eating habits with regard to menus, mealtime schedule . Mealtimes should be mealtime schedules and mealtime distributed evenly across the day and companions . This means that health and evening, with no more than 11 hours care services must try to between the evening meal and breakfast . Several municipalities have altered their identify individual wishes and needs . A mealtime schedules for health and care systematic assessment can form the services, with good results . General foundation for adapted meal services and feedback from these municipalities is that ensure greater variation of meals and the older persons have regained weight mealtimes for each individual . and improved their nutritional status . These changes have also facilitated more time for meals, a calmer atmosphere in the evenings, better sleep and more time for morning activities

Tabell 1 .8 Local examples for inspiration, see box 6 .3 Title What Who Altered mealtime schedules Altered schedules for serving Bjørkelia residential dinner . Introduction of lunch and a collective in Gjøvik later evening meal . municipality, Døli residential care centre in Nittedal municipality, Nannestad nursing home in Nannestad municipality, Kåfjord nursing home in Alta municipality, Birtavarre nursing home in Kåfjord municipality and Hovli nursing home in Søndre Land municipality

Fourth meal Introduced a fourth meal for Stange municipality residents in nursing homes

Reduced nightly fast in nursing Mealtimes have been moved Time municipality homes based on the assessed needs of the individual, and nightly fasts have been reduced

LIVE YOUR WHOLE LIFE 31 Tabell 1 .9 Local examples for inspiration, see box 6 .4 Title What Who

Collaboration on menus Nursing home menus are created Gloppen residential together with the residents . care centre in Sandane Considerable daily frewedom and municipality frequent renewal of menus .

Menu - involvement in practice Kitchen manager involves the Sundheim residential residents in menu planning care centre in Nord-Fron municipality

Sami food for residents Book with an introduction to Tysfjord Dementia traditional Sami meals Association in Tysfjord municipality

APPETITE The “Appetitus” app for tablets will The University of Oslo, help to simplify mealtime planning Institute of Health and Society

Electronic menu Electronic solutions for ordering food Namsos and Trondheim for older persons living at home, municipalities to increase freedom of choice and service flexibility

4. Systematic nutritionalmeasures Systematic nutritional measures involve the follow-up of individual nutritional needs in order to prevent improper nutrition or malnutrition . Older persons receiving health and care services in hospitals, nursing homes, or in their own homes from home care nurses should be assessed for nutritional status . Health and care services must assess the risk of improper nutrition or malnutrition and determine whether an individual nutritional plan is necessary . This means that health and care services must set aside enough time and adequate competency to assess, evaluate and document nutritional status, evaluate meals and nutritional services, and initiate targeted measures for each individual .

32 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .10 Local examples for inspiration, see box 6 .5 Title What Who

Nutritional resource persons in the Clinical nutritional physiologists as Trondheim individual plan for older persons resource persons for improving the municipality quality of nutritional measures

Education in food and nutrition Competency enhancement Oslo programmes for food, mealtimes and municipality, Hol nutrition municipality, Development Centre for nursing homes and home care services in Nordland and Møre og Romsdal counties

Targeted nutritional measures Assessment of nutrition and shared Tromsø procedures for follow-up of nutritional municipality status among older persons

Nutritional status for food and meals Nutritional strategy to ensure quality Stavanger in hospitals of nutritional measures Health Trust and Haukeland University Hospital Food and meal policies for older A plan to ensure that older persons Copenhagen persons are served tasty and nutritious food, municipality and that mealtimes create a sense of community and enjoyable experiences

5. Local kitchen and competency All municipalities should have culinary Denmark, where the goal is to provide competency in health and care services, older residents with better meal regardless of where the meals are experiences, and to make food produced . To ensure good food and preparation a larger part of daily life . The proper nutrition, it is also important to contents of this grant will be assessed in ensure good routines for meal 2019 . preparation and serving . The government will assess a separate grant for the renovation, establishment or re-establishment of local kitchens in nursing homes, starting in 2020 . This will be modelled on a similar scheme in

LIVE YOUR WHOLE LIFE 33 Tabell 1 .11Local examples for inspiration, see box 6 .6 Title What Who

Cooperation between commercial Cooperation between kitchens and Bærum and kitchens and health and care services health and cares services Grimstad municipalities

Cooperation on food and nutrition Cooperation between kitchens and Glomstua care wards, nursing home management centre in Molde and municipal politicians municipality

Local kitchens Cooperation between local kitchens Ørnes nursing and nursing home wards, where home in Meløy kitchen staff serve the meals municipality

Job Winner Health and Social Care students Olav Duun Upper participate in nutritional measures at Secondary School Namsos Helsehus and Namsos Helsehus in Namsos municipality

34 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE HEALTHCARE

Live Your Whole Life is a reform to disease and functional impairment . create health and care services for older Many wish to have health and care persons, where the essential question is: services that are more suited to the What is important to you? Older persons needs of older persons, where older should feel valued and seen, and be be persons are given the opportunity to able to participate in decisions that make decisions regarding their lives for involve them . Older persons should have as long as possible . the opportunity to live at home as long as possible, and receive support in The challenges are summarised below: mastering their everyday lives, regardless of illness or functional • Lack of attention to mastery and impairment . They should also feel prevention secure in knowing that help is available • Poor overview of complex needs and when needed . When nearing the end of problems their lives, they should receive good • Little use of physical activity and palliative care . training • New types of treatment are not used In this way, older persons will have • Assessment and follow-up of better opportunities to live life - their individuals is not systematic whole lives . Five solutions have been recommended to deal with these challenges, where the Feedback from dialogue meetings and goal is to increase mastery and improve knowledge in the field indicates many quality of life, prevent functional older persons do not have sufficient impairment and provide the right help at healthcare and assistance for preventing the right time:

LIVE YOUR WHOLE LIFE 35 • Daily life mastery and care services should assess the • Proactive services needs of each individual, as well as the • Targeted use of physical fitness potential for rehabilitation and self-care training before implementing measures that • Environmental measures compensate for loss of function . Daily • Systematic assessment and follow-up life rehabilitation is important for increasing independence in the activities 1. Mastery of daily life of daily life, improve function and Older persons must have the postpone later functional impairment . opportunity to remain as independent Welfare technology solutions aimed at as possible, and to manage themselves if maintaining quality of life, independence they are able . This means that health and mastery are important tools .

Tabell 1 .12 Local examples for inspiration, see box 7 .2 Title What Who

Live Your WHOLE LIFE Restructuring of services from Stavanger compensatory to preventive measures municipality through daily life rehabilitation, welfare technology, preventive home visits, etc .

Early intervention and daily life Occupational therapists visit the Trondheim rehabilitation service user at home and assist with municipality preventive measures Daily life rehabilitation for older persons living at home, who are already receiving home care services

Vossa Model Multidisciplinary model for daily life Voss municipality rehabilitation and Western Norway University of Applied Sciences

Daily life A trial study of daily life rehabilitation Trials in 47 with an evaluation of results municipalities rehabilitation Centre for Care Research West and at the University of Oslo

Public health stations for older A preventative and health promoting Harstad persons measure for older persons over 67 municipality living at home

36 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE 2. Proactive services Proactive services are services that are It is important to identify individuals who initiated at an early stage, before serious have a risk of early functional illness has developed . In proactive impairment, in order to prevent a services, service providers actively seek growing need for assistance, and to out residents who have not sought ensure that older persons have the healthcare services themselves, and opportunity to live independently for as offer follow-up. This can help to prevent long as possible . The mastery of further health decline and greater activities in daily life is essential for functional impairment, and ensure that independent living in one’s own home . older persons have continued mastery Assessment by health and care services of life for a greater length of time . should therefore take place in the older person’s own environment, in the form Healthcare services should use tools and of home visits . The reform also proposes checklists to detect risks associated with that health and care services should disease development and functional evaluate the use of preventative home impairment at an early stage . This visits, not only when the resident has measure must be viewed in relation to reached a certain age, but also when the development of team-based serious incidents occur, such as the services, such as a primary healthcare death of a partner, discharge from team and follow-up team in the hospital, or new chronic diagnosis . municipality .

Tabell 1 .13 Local examples for inspiration, see box 7 .3 Title What Who

Digital assessment A digital assessment form for Stovner district of Oslo assessing needs for welfare municipality technology services among residents

Resource centre for seniors Proactive measures to help avoid or Steinkjer municipality postpone the need for assistance

Guidelines for preventative Establishment and implementation Norwegian Directorate home visits of preventative home visits for older of Health persons

Patient-centred healthcare Measures to detect health problems Tromsø and Harstad services team at an earlier stage to avoid acute municipalities and the admissions or readmissions to University Hospital of hospital North Norway

LIVE YOUR WHOLE LIFE 37 3. Targeted use of physical Organised services for group training is fitness training the most effective. Many municipalities Older persons should be offered have services that provide physical physical fitness training and activity fitness training in a systematic and services as a preventative, therapeutic targeted manner . and rehabilitative measure . This can be done through municipal health Fitness training services aimed at older promotion services, by establishing persons should: fitness training services or groups for older persons, and by offering fitness Be carried out in smaller fitness training training tailored to the individual . groupsOffer a combination of balance training and training of bone strength Physical activity is a measure that has considerable potential for preventing Be offered by instructors who can falls, loss of physical function and provide individual follow-up and cognitive impairment and dementia . guidance

Tabell 1 .14 Local examples for inspiration, see box 7 .4 Title What Who

Bowling for seniors Modified bowling aimed especially at Mental Health Moss older men and Older Life at Moss Volunteer Centre

Strong and Stable A knowledge-based training Trondheim municipality programme aimed at preventing falls Norwegian University of among older persons Science and Technology and the Norwegian Pensioner Association

On Steady Feet A course for older persons who have Bjerke district in Oslo fallen, or who are afraid they may fall municipality

Group training in fall Group training for older persons with Tromsø municipality prevention some functional impairment, and older persons with reduce balance, tendency for falling, or those who have fallen

Active older persons in Fitness training programme for Norwegian Nurses nursing homes nursing home residents Organisation, Løvåsen nursing home and the Administration for Nursing Homes and Care Facilities in Bergen municipality

38 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE 4. Environmental measures An environmental measure as a single Environmental measures may improve measure directed at an individual or a mastery and a sense of well-being, group, e .g . with the use of music or create new opportunities for singing during care, or organised as a communication, reduce anxiety and collective activity . distress, and reduce the unnecessary Environmental therapeutic methods use of medication among older persons . used in memory or reminiscence Environmental measures may involve activities, for stimulation of the senses, the integrated use of music and other in physical activity or during cultural expression in treatment and accommodated mealtimes . daily activities, memory and recognition activities, and stimulation of the senses . Environmental measures involving the Environmental measures may be facilitation of good physical and provided at three levels: psychosocial frameworks .

Tabell 1 .15 Local examples for inspiration, see box 7 .5 Title What Who

Films for memories Films with content that is accommodated Production company for persons with dementia, which can Glefs, in combination with be used for stimulation and activity the Norwegian National measures . Advisory Unit on Ageing and Health and Asker municipality

Music-based Systematic use of singing, music and Feviktun residential environmental measures movement integrated in daily activities care centre in Grimstad and tasks municipality Ytterøy Helsetun in Levanger municipality

Gjenklang A training measure for the use of singing Songdalen municipality for persons with dementia

Writing course for older Older persons in nursing homes, at senior The Church City Mission persons centres and day centres write texts about and Mortensnes nursing their own lives home and day centre in Tromsø municipality

Art therapy for older Expressing emotions and experiences Hamar municipality persons creatively through painting, creating a picture, sculpting, movement, etc .

Sami Centre A living meeting place rooted in Sami Karasjok School and traditions and culture for persons with Karasjok nursing home in dementia Karasjok municipality

LIVE YOUR WHOLE LIFE 39

5. Systematic assessment and Such assessment and follow-up must follow-up include nutritional status, oral and dental The detection of signs of developing health, impairment of the senses, mental disease, functional impairment or health and social circumstances, in addition problems is essential for the provision of to physical health and function . This measures at an early stage for older requires personnel with broad competency, persons living at home and in nursing and often collaboration between several homes . Health and care services should professionals including dental hygienists, therefore enhance and utilise health and occupational therapists, social workers, care personnel competency in systematic personnel with competency in nutrition, in assessment, observation and follow-up . addition to nurses and doctors, and must be viewed in context with the development of team-based services .

Tabell 1 .16 Local examples for inspiration, see box 7 .6 Title What Who Nursing clinics for older Municipal nursing services in Stavanger municipality persons living at home accommodated buildings

Acute care package Home health nurses bring a package Skedsmo municipality with necessary equipment when meeting patients with acute illnesses

ALERT A competency programme to enhance Development Centre for competency in the use of systematic nursing homes and home care observation and communication services in Akershus

ABCDE A competency programme intended Development Centre for to develop systematic observation and nursing homes and home care action competency among personnel services in Rogaland, Sola and in nursing homes and home health Stavanger municipalities services Intravenous treatment Nursing home personnel receive Vestfold Hospital Trust, in nursing homes theoretical and practical training in University of South-Eastern intravenous treatment for dehydration Norway, University of Oslo, and and infections 30 nursing homes in Vestfold county Systematic competency Training services based on systematic Verdal municipality assessment assessment of competency in the municipality

Dental health Agreements on cooperation between Buskerud, Troms, and Sogn and cooperation dental health services and health and Fjordane county councils, and care services the University of South-Eastern Norway

Network for older Motivational dialogue to uncover the Network for older persons persons and substance harmful use of substances among and substance abuse in Oslo abuse in Oslo older persons living at home municipality (NERO)

40 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE

Such assessment and follow-up must include nutritional status, oral and dental health, impairment of the senses, mental health and social circumstances, in addition to physical health and function . This requires personnel with broad competency, and often collaboration between several professionals including dental hygienists, occupational therapists, social workers, personnel with competency in nutrition, in addition to nurses and doctors, and must be viewed in context with the development of team-based services . COHERENCE Tabell 1 . 16 Local examples for inspiration, see box 7 6. Title What Who Live Your Whole Life is a reform to create • Inadequate person-centred approach Nursing clinics for older Municipal nursing services in Stavanger municipality more coherent services for older persons • Inadequate amount of respite care persons living at home accommodated buildings and their families . The goal is to provide and support for family caregivers older persons with a greater sense of • Poor continuity and security, too many Acute care package Home health nurses bring a package Skedsmo municipality with necessary equipment when security and predictability throughout staff rotations, and uncertainty as to meeting patients with acute illnesses the patient trajectory and during when or whether help will be provided

ALERT A competency programme to enhance Development Centre for transitions between their own homes, • Too many interruptions of services competency in the use of systematic nursing homes and home care hospitals and nursing homes, with fewer and too many transitions between observation and communication services in Akershus staff rotations. Another goal is to care for municipal services those who are caring for their loved • Poor continuity and security in the ABCDE A competency programme intended Development Centre for to develop systematic observation and nursing homes and home care ones, and provide family caregivers with transition between the different action competency among personnel services in Rogaland, Sola and support and respite/relief measures to service levels in nursing homes and home health Stavanger municipalities prevent exhaustion . Five solutions have been recommended services to deal with these challenges, where the Intravenous treatment Nursing home personnel receive Vestfold Hospital Trust, In this way, older persons will have better goal is to increase security and in nursing homes theoretical and practical training in University of South-Eastern intravenous treatment for dehydration Norway, University of Oslo, and opportunities to live life - their whole predictability in the patient trajectory of and infections 30 nursing homes in Vestfold lives . older persons and their family members: county Systematic competency Training services based on systematic Verdal municipality Feedback from dialogue meetings and • Individual needs assessment assessment of competency in the knowledge in the field indicates that • Respite care and support for family municipality many older persons feel that services are caregivers Dental health Agreements on cooperation between Buskerud, Troms, and Sogn and too fragmented and lack wholeness and • Fewer staff rotations and better cooperation dental health services and health and Fjordane county councils, and care services the University of South-Eastern continuity . This may cause insecurity and continuity Norway concerns, especially among those with • Easier transitions between

Network for older Motivational dialogue to uncover the Network for older persons the greatest needs . municipalities and hospitals persons and substance harmful use of substances among and substance abuse in Oslo • Planned transitions between abuse in Oslo older persons living at home municipality (NERO) The challenges are summarised above: municipalities and hospitals

LIVE YOUR WHOLE LIFE 41 Tabell 1 .17Local examples for inspiration, see box 8 .2 Title What Who

Person-centred care for Personnel use a person-centred Vågan municipality and persons with dementia approach for providing services for Taste nursing home in persons with dementia Stavanger municipality

Work teams using a person- Home care services are divided into Hamar municipality centred approach work teams Primary contact or work team leader carries out an assessment and makes plans for measures

What is important to you? Learning network for good patient Around 200 municipalities trajectories based on the question: What is important to you?

1. Individual 2. Respite care and support needs forfamily caregivers Services must be based on what is Many families have demanding care important to each individual . A person- tasks, and are burdened with too many centred approach involves the responsibilities . It is therefore essential comprehensive care of older persons, for family caregivers to receive the and not just a focus on illness and proper support and respite care, and to functional impairment . The goal is for have their efforts acknowledged. In each individual to use their resources order to provide better support and and maintain independence for as long respite care for family caregivers, the as possible . All individuals must be reform highlights three solutions: valued, regardless of age or functional ability . The individual’s life story, values • More flexible municipal respite care and wishes should form the basis for that fulfils the needs of caregivers health and care services . This also with respect to time, duration, and requires respect and consideration for provision of services in their own language, culture and identity . home, in an institution or in some other manner To achieve this, health and care services • Information and dialogue with the use must assess the needs of the individual, of digital tools design an individual plan and ensure • Family caregiver schools and support regular conversations with the service groups that provide learning and user and family members . mastery

42 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .18 Local examples for inspiration, see box 8 .3 Title What Who

Flexible respite care Respite care that is also offered in the Maurtuva Vekstgård in evening and at night Inderøy municipality, Råkhaugen care center in Molde municipality, and Vittersø Farm in Larvik municipality

Friskus - information A digital tool for communication and Førde, Voss and and dialogue with family cooperation between municipalities, Naustdal municipalities, caregivers local communities, volunteers and Development Centre for families home care services and nursing homes, Norwegian National Association for Public Health and the Red Cross in Sogn and Fjordane

Information for family Website for families with relevant Gjøvik municipality caregivers information

KOMP Data screen for easy contact with Norwegian Cancer Society family and social networks and No Isolation

Wholistic family services Broad family services for the public, Ålesund municipality including low-threshold services

Family caregiver schools and Family caregiver schools and support 258 municipalities support groups groups for families of persons with dementia

Long-term and extensive care may new organisational structures and work increase the risk of health problems schedules, as well as alternative shift among family caregivers . A schedules . The reform highlights four comprehensive family caregiver policy proposals for solutions that can help must take this into account and individual service users and their implement measures to prevent family families, by ensuring fewer staff caregivers from burn-out and the need rotations and better security and for their own healthcare services . continuity of services .

3. Fewer staff rotations - better continuity Service users and family caregivers need services that are accessible, secure and reliable, with good continuity . Municipalities have used various methods to meet these needs, including

LIVE YOUR WHOLE LIFE 43 Primary contact person Alternative shift rotation schemes Health and care services should organise Several municipalities have tested out their services such that nursing home alternative shift plans to .provide older residents and older persons receiving persons with better and more home care services each have a primary comprehensive health and care services . contact person . The purpose of a Alternative shift schedules, such as primary contact person is for service longer shifts, can enable accommodated users and their families to feel more services by having staff members spend secure through a clear division of more time with service users, with fewer responsibility and a close relationship staff shifts in a 24-hour period. Several with one person . The primary contact Norwegian studies have found that person will help to provide better longer shifts tend to reduce stress continuity and predictability in the daily among staff members and ensures life of older persons . better continuity and time for service users . Longer shifts include shifts with The right help at the right time daily and weekly work schedules that All service users of home care services deviate from working hour regulations should feel secure in knowing that help stipulated by the Working Environment will arrive at the designated time and Act . Agreements on alternative shift that they will be contacted about any schedules would therefore be a matter changes in the schedule . The goal is of negotiation between the parties in the better predictability of services and workplace . greater security for individual service users and their families . A variety of tools can be used to ensure this, including electronic programs that optimise planning of work schedules and task distribution .

New work and organisational structures Many municipalities have tested out different work and organisational structures to provide better continuity of services for service users . Common to all structures is the division of functions through work teams . Each team consists of a small group with a stable staff that provide patients with a simpler and more secure daily life, and more predictable services .

44 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 .19 Local examples for inspiration, see box 8 .4 Title What Who Primary contact person All older persons are given a primary Bodø, Eidskog, Tromsø, contact person to ensure individual Sortland and Kristiansund follow-up and services that are municipalities accommodated to the service user

Help at the designated time - Logistic solutions for more optimal Horten municipality logistics driving routes and better distribution of tasks

Service Shop Web-based calendar and booking Larvik municipality function where service recipients can book municipal services at a time that suits each individual

Digital resident services Digital service that sends notifications Helsenorge .no between residents, family members and home care services Service users can book and cancel appointments

New work and organisational Home care services with work teams Hamar municipality structures divided by function

Alternative shift schedules Long shifts in residential care homes Lillevollen residential for persons with intellectual disabilities care facility in Bodø municipality

A number of different work schedule plans, including longer shifts Bergen municipality

Tromsø Model Permanent weekend stand and several Tromsø municipality full-time positions through special agreements with labour unions

4. Easier transitions between respite care and support prior to municipalities and hospitals moving, and an invitation to continue to Municipalities should facilitate better contribute after the move. For staff, this patient trajectories and an easier may involve a better overlapping of care transition between the patient’s own during the move . For the municipalities home and the nursing home . this may involve better coordination of resources across home care services and For older service users, this may involve nursing homes, and better overlapping greater security and less stress when between services . For the state, this may moving . For families, this may involve involve an assessment of whether there

LIVE YOUR WHOLE LIFE 45 Tabell 1 .20 Local examples for inspiration, see box 8 .5 Tabell 1 .21 Local examples for inspiration, see box 8 .6 Title What Who Title What Who

Integrated services The nursing home is integrated with home Kvitsøy municipality Early planning and case Collaboration between administrative Akershus University care services. Staff provides assistance in processing for discharge levels to coordinate municipalities Hospital and Romerike both the home and institution . in cooperation and negotiation with municipalities hospitals . Certain parts of home care services and Bardu municipality institutional services are integrated Multidisciplinary Multidisciplinary assessment team in Helsehuset (“Health assessment team the project Innovative Rehabilitation House”) in Indre Østfold Decisions on content of Residents of nursing homes have the same Fræna municipality for Indre Østfold services in nursing homes right to have decisions on the content of services as home care recipients . Assessment team Assessment team that has contact Stovner district of Oslo with hospitals upon patient admission municipality and discharge are barriers in state regulations that The reform proposes a continuation of Secure discharge from Patient security programme “In Safe Norwegian Directorate of prevent coordination and good patient the learning network for good patient nursing homes and Hands 24-7” in collaboration with the Health trajectories between the patient’s own trajectories from 2020 to 2022, so that hospitals national learning network, to share the Several municipalities home and the nursing home . all municipalities and health trusts have measure package for secure discharge the opportunity to participate in the 5. Planned transitions between learning network . The purpose is to Secure discharge Team with responsibility for “Secure Kristiansand municipality discharge” with the patient as an equal municipalities and hospitals support the municipalities and health party Ensuring good transitions between trusts in improving the transitions of the service levels requires early planning patient trajectories and to ensure service Mutual transfer of Guidelines for mutual transfer of St . Olavs Hospital and competency competency between hospitals and municipalities in the and case processing prior to discharge in users’needs for secure, comprehensive municipal health and care services catchment area agreement with the patient and family, and coordinated services . for mutual transfer of competency Strategy for healthcare Strategy for healthcare services for Diakonhjemmet Hospital between service levels . The goal is good services for older persons older persons and Oslo municipality continuity of treatment and follow-up to SAM-AKS Collaboration project between the Department of Geriatric prevent unwanted readmissions . Department of Geriatric Psychiatry Psychiatry at Innlandet and municipal nursing homes Hospital Trust (SAM-AKS) for training and supervision in individual cases .

KVALAP Quality Registry for Geriatric Psychiatry Norwegian National Advisory Unit on Ageing and Health

46 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE Tabell 1 21. Local examples for inspiration, see box 8 .6 Title What Who

Early planning and case Collaboration between administrative Akershus University processing for discharge levels to coordinate municipalities Hospital and Romerike in cooperation and negotiation with municipalities hospitals .

Multidisciplinary Multidisciplinary assessment team in Helsehuset (“Health assessment team the project Innovative Rehabilitation House”) in Indre Østfold for Indre Østfold

Assessment team Assessment team that has contact Stovner district of Oslo with hospitals upon patient admission municipality and discharge The reform proposes a continuation of Secure discharge from Patient security programme “In Safe Norwegian Directorate of the learning network for good patient nursing homes and Hands 24-7” in collaboration with the Health trajectories from 2020 to 2022, so that hospitals national learning network, to share the Several municipalities all municipalities and health trusts have measure package for secure discharge the opportunity to participate in the learning network . The purpose is to Secure discharge Team with responsibility for “Secure Kristiansand municipality discharge” with the patient as an equal support the municipalities and health party trusts in improving the transitions of the patient trajectories and to ensure service Mutual transfer of Guidelines for mutual transfer of St . Olavs Hospital and competency competency between hospitals and municipalities in the users’needs for secure, comprehensive municipal health and care services catchment area and coordinated services . Strategy for healthcare Strategy for healthcare services for Diakonhjemmet Hospital services for older persons older persons and Oslo municipality

SAM-AKS Collaboration project between the Department of Geriatric Department of Geriatric Psychiatry Psychiatry at Innlandet and municipal nursing homes Hospital Trust (SAM-AKS) for training and supervision in individual cases .

KVALAP Quality Registry for Geriatric Psychiatry Norwegian National Advisory Unit on Ageing and Health

LIVE YOUR WHOLE LIFE 47 BASIS FOR THE REFORM

In the years to come, there will be a public health initiatives, measures for higher number of older people, and the competency enhancement and service percentage of older persons in the capacity, and by the development of new population will continue to rise . In time solutions and types of work in municipal there will also be a significant rise in the health and care services and in special oldest group of older persons . On a healthcare services . This follows from national level, both the percentage and the White Paper, Report to the Storting number of people over the age of 80 will 11 (2015–2016) National Health and double by 2040 . There may also be Hospital Plan 2016–2019, White Paper fewer health and care personnel, family Report to the Storting 19 (2014–2015) members and volunteers who are willing Public Health Report - Mastery and to take on care tasks . The greatest Opportunities and White Paper Report challenges may be the growing regional to the Storting 26 (2014–2015) The differences associated with demographic primary health and care services of changes . By 2040, more than one of tomorrow - localised and integrated, as every three residents in many of the well as Competency Enhancement 2020 municipalities will be over the age of 65 . and Care 2020, with investment grants for nursing homes and residential care Many problems due to the changes in homes, dementia plan and studies with the population composition will be dealt government funding . Implementation of with by previously presented white the measures in these white papers and papers and action plans . plans form the basis for Live Your Whole Life . The government has made some attempts to develop good and sustainable solutions through various

48 LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE LIVE YOUR WHOLE LIFE 49 Published by: Norwegian Ministry of Health and Care Services

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Publication number: I-1186 E Design: Kord Print: Norwegian Government Security and Service Organisation 03/2019 – Impression 1000