Recommended by researchers: The care sector needs a return to a comprehensive approach and low-threshold services

More attention should be paid to the social problems of older adults, and the lack of care labour should, for ethical reasons, be addressed through national efforts. Associate Professor Minna Zechner proposes solutions to the current points of contention in the care sector.

Importing care labour must be rethought

Hierarchical structures that do not promote equality have already been established in the care sector. They should be dismantled.

“Hierarchical structures have been established particularly in paid care where men largely hold the leadership positions and women carry out the work closest to the clients, often including the dirtiest work. On the bottom rung of the care work hierarchy you can find racialised women,” says Associate Professor of Social Work with specialisation in social welfare and health services Minna Zechner, who transferred from the University of Lapland to Helsinki at the turn of the year.

Hierarchical thinking is combined with the unpleasant flavour of post-colonialism.

“It has been suggested in many contexts that the deficit of care providers could be resolved by bringing in workforce from developing countries. I think this resembles closely our way of utilising the natural resources of these countries, not giving consideration to anything other than our own needs.”

In fact, Zechner points out that it is not easy for care workers to go work abroad. Who will take care of the older adults and children in the countries from which developed countries are funnelling the workforce?

“For instance, lately there’s been talk of bringing Kenyan nurses to Finland. They do need nurses in Kenya too! As it happens, the Philippines is probably the only country where nurses are actively trained to work abroad. In other words, trained nurses are, in a way, their export product. However, this does not mean that there are enough nurses locally.”

Making the income-related price of services transparent

Freedom of choice and marketisation, or the transformation of the provision and, to a certain degree, organisation of publicly funded services according to market principles, have been increased in the care sector since the 1990s.

However, freedom of choice is not an equally good thing, as not everyone has equal opportunities to compare and use services.

“International studies show that the freedom to choose which services to use works best for people with physical disabilities. In contrast, older people often consider it a burden to compare and choose services and mull over their prices. Consequently, they try to outsource the task to, for example, their children, but not everyone has children. Nor are all children able or willing to assist their parents.” Zechner notes.

Binding home care fees to income levels is a good thing as such, but it also makes anticipation increasingly difficult. It is difficult for clients to know in advance how much the service will cost specifically for them.

“Clients are wondering what they can afford. Even professionals may not be able to estimate what a certain service would cost according to the client’s income level and service needs.”

The costs of services must also be actively monitored by the clients, as no automated notifications are sent when the maximum payment limit for the fees charged to municipal healthcare clients is exceeded.

Low-threshold services must be reintroduced

The service needs of older people living at home often become evident at a point when a great deal of help is needed for coping. The lower the income of the client, the longer the service needs can be overlooked, as the threshold for utilising public care services is high.

Minna Zechner wonders whether service needs could be assessed already at the stage when there is no substantial need for assistance. In this, it would be a good idea to reach back a few decades to the work of home care assistants.

“The low-threshold services would entail a review, with the client, of matters related to living at home. How ought we to transform the surroundings and the client’s condition so that they can cope at home for longer and do more on their own? This way, we can avoid or at least delay drastic breakdowns and the substantial service needs that may follow.”

A comprehensive approach to home care services is needed

According to Minna Zechner, home care services should also be steered back in an increasingly comprehensive direction. Currently, individual care home clients can be visited by several different care workers every day, one of whom helping them get out of bed, another bringing porridge, a third administering drugs, a fourth bathing them, a fifth bringing them lunch and a sixth disposing of rubbish.

Because of fragmented services, the overall situation is not controlled by any one person. Furthermore, persons hired for specific positions cannot take care of matters belonging to the remit of another employee.

Educational requirements of the field should not be lowered

Different levels of education and their associated professions also lead to fragmentation. The short training of care assistants does not enable them to complete all duties they encounter, making it necessary to call, for example, a practical nurse for assistance.

Minna Zechner calls into question the creation of the profession of care assistants.

“I think a degree in practical nursing is a generic degree that makes it possible to carry out a very broad range of duties in the care sector. Many practical nurses are also trained in drug dosage and administration.”

Resources needed for social work aimed at older people

The discussion on care for older adults often focuses on physical and memory-related problems. In contrast, social work focused on older people is conspicuous in its absence.

This easily gives the impression that the social problems experienced by the younger adult population disappear upon retirement. Of course, this is not the case.

“Older adults not only have problems related to care needs: they have problems with substance abuse, gambling and mental health, as well as experiences of financial, physical, mental and sexual abuse and violence. Many of these things can have a long history. It may also be that the mental health problems of older people are easily interpreted as relating to memory disorders, and the actual problem is not detected without further investigation.”

Breaking free from the blame game

Ageing, older adults, their need for care and the associated costs are often treated negatively in the public eye. Expressions of concern and the incitement of panic lead to many people becoming fearful of ageing.

“The discussions may highlight the fact that we cannot afford to provide care. And yet, those in particular need of care were born mostly in the 1930s and the 1940s. Some of them are baby boomers. In time, these age groups will diminish, which will reduce costs. Of course, the subsequent age groups are also smaller.

“In addition, the vast majority of expenses associated with old age are made up of pensions, not care. Pensions must be paid, of course, but care is blamed in vain.”

Researcher’s recommendations for improving care
  1. The correct placement of and resources for older people’s social work in new structures must be ensured. Existing mental health, substance abuse, gambling and other problems do not disappear in the retirement age. Their onset among older adults is also possible.
  2. At the moment, home care is targeted at people with extensive care needs. We need services provided at home that respond to smaller needs and that can help coping at home. 
  3. In home care, a return to increasingly comprehensive services is needed, instead of having several individuals who complete individual tasks visit the client on the same day. 
  4. People must be given a clear understanding of their income-related fee well in advance of becoming home care clients.
  5. Care work requires expertise, which is why the educational requirements should not be lowered.
  6. The shortage of nurses and care workers must be addressed at the national level. Recruiting staff from abroad is not an ethical method, as professionals in the field are often needed also in their countries of origin.