The current organization of elderly care in Oslo is not sustainable in the future
The population is increasing and the population is aging:
The population of Oslo is growing; Oslo is actually the fastest growing city in Europe in percentage of existing population. Meanwhile, improved public health and life expectancy increases.
But we know that with longer life expectancy the incidence of illness and injuries will also increase. Population trends tell us that by 2040, Oslo will double the number of residents over 67 years.
A corresponding increase in the services provided to the aging population will therefore not be sustainable in the future.
Nor will it be enough health workers available to meet such needs and demands.
The services provided today appears, seen from the citizens point of view, as fragmented and complex.
To succeed, it is necessary with an innovative approach to the organization of health and social services, and moreover also the coordination of use of resources.
Tomorrow's users will have higher expectations and demands of services
Oslo's inhabitants will have completely different requirements and expectations for services in the future than what we see with today's residents of nursing homes.
For example, the expectation being that also the last phase of life should be in an environment which is a personal home with the rights it entails ‐ and not an institution where the services are largely directed in relation to the part of life that is being a patient, as it is today. Another important expectation for the future is that the elderly must not move when the need of health care changes which is the reality in Oslo today.
Decreasing government revenues
Elderly care in Norway:
Health and social care sector is publicly financed. And health care services are organized in primary care (municipalities) and secondary/specialized care (hospitals). The municipality is responsible for home care services and institutionalized care.
Oslo municipality has in recent years increased their number of nursing homes and as a consequence a more comprehensive coverage than the rest of the country.
You may have heard about the Norwegian Petroleum fund which is now called the Government pension fund global, which is one of the largest pension funds in the world. This fund derives its financial backing from taxes from oil profits and invests the money, mostly in stock contributions and it`s meant to guarantee Norways citizens' prosperity for decades to come.
The problem is that Norway's oil revenues, on which we have been living quite comfortably for a long time, will decrease in the future. Already now we see these tendencies and the consequence is that in the future there will be less public revenue to pay for elderly care.
So the future elderly in Norway must take more responsibility for their own appearing old age
Population of Norway: 5 million Population of Oslo: 620 000 Population of larger Oslo: 900 000
The population 67 and above will increase from 22%/620 000 (2015) to 30%/780 000 (2030) Pensionexpenses will increase from 120 MRNOK/ 10 BGBP (2015) to 190 MNOK / 16 BGBP (2030) The expectation and demand among elders is increasing
First a few words about my organisation, Sykehjemsetaten; The Nursing home Agency in The City of Oslo.
Health houses have competence to safeguard patients discharged from hospitals, and also people living at home who are in need of good medical service, rehabilitation and training in daily life skills. The aim is that patients are going home after their stay in a health house.
The nursing homes are long‐term housing, health and care services for those who can no longer stay at home. The aim is that there should be continuity and a homely atmosphere, and that it should be organized in such a way that they can maintain everyday life activities as far as possible in line with the individual residents preferences.
Municipal nursing homes 17 long-term nursing homes 3 health houses
Private nursing homes 13 long-term nursing homes operated by non-profit providers 14 long-term nursing homes operated by commercial providers 1 health house operated by a commercial provider
The Agency also purchases individual places at four nursing homes outside Oslo
Residents and patients The long-term nursing homes house 3900 residents. The average stay is approximately 2.1 years 4500 patients go for short-term and rehabilitation stays at the health house annualy. The average stay is approximately 3 weeks.
Overall objective of the project
The main focus is that older people in Oslo shall be able to live independently, active and secure lives and stay healthy as long as possible.
The overall objective of our project is therefore that Oslo's population will live in their own homes as long as possible with a good quality of life and cope with everyday life with minimal publicly funded services.
Project Background: The project started in 2014 by decision of the Department of Health, Seniors and Social Affairs. 4 regional health houses would be established in the City of Oslo. The Nursing home Agency was commissioned to implement this in collaboration with the 15 Districts of Oslo. This was a major adjustment for The Nursing home Agency where a total of 24 nursing homes had to change operational model.
And I was lucky enough to be asked if I could lead this major change project in The Nursing home Agency.
And in the course of 2015, we established 4 health houses while the other 40 nursing homes were changed to long‐term establishments. 450 patients and 450 employees moved as a result of the establishment of health houses.
But when we started this change project in 2014, I wanted to use this opportunity to lift the ambition level, rethink and develop new service models with an eye for tomorrow's challenges and solutions for tomorrow's users.
Election of innovation tools
With high ambitions, long‐term and innovative look we thought that future solutions should be based on user needs and perspectives if we should succeed. The intention was then to identify and describe the good user experiences and show how they can be delivered in 2025.
With this focus on user experience, it was quite obvious to choose service design as a tool for innovation. We chose to involve a Design and Architecture firm that could assist us with this project. And this led to a partnership with Livework that started in November 2014.
The assignment (Scope)
1. How can we organize housing, health and care services so that seniors who need live‐in care, feel that they have a good last home? = "My home" (long term care – nursing home)
2. How can seniors live as long as possible in their own home, with the best possible support for rehabilitation and self-sufficiency, so that their needs are met while service provisions are getting more efficient?
• Rehabilitation and self-sufficiency services at home
• Health house
TREATMENT AND CARE: The mandate and reason d’aitre for the whole organisation is proper treatment, nursing and care. This is why they are in contact in the first place.
PREVENT: «We should probably consider it, but we will probably wait and see…» Help me to plan my older days ”We must teach people that they grow old.” Loneliness and depression is often the actual reason
CAPTURE Difficult to catch the disadvantaged «This is not people that book an appointment themselves…»
LONG TERM Short term = costly «The trend is high quality single services. But the services are isolated …»
COMPREHENSIVE Need coordination between the high quality isolated services, seeing the entire user, including their life situation and relatives, not only treating the desease and symptoms No one see the patient 360 degrees «We coudl rehabilitate the leg, but the issue is the abuse problem…» «Who´s got the responsibility to ensure entirety across the services? » Lack of data sharing across – dysfunctional confidentiality Lack of common platform across services.
ENSURE VALUE Speed and timing = increased chance of good results «Window of opportunity for rehabilitation is limited, and it is a challenge to get started as early as requested…» Common target across services «The common target must be in accordance with the patient… »
HOME No one wants to leave their own home, they want to remain there and hopefuly die there A well functioning home must provide the experience of safety and security
Non desease dependent triggers for nursing home seats: living alone, need of help to exit, weary relatives, lack of network, lonelisness, not adapted housing, nutrition failure
Key drivers to achieve goal Planned aging Experienced feeling of safe and secure Accurate services at accurate timing
Threshold value: nursing home >15 h/w home care. Average for users in Oslo is 3,7 h/w. Cost reduction potential for bringing it up to 4,7 h/w is 920 MNOK / 75 MGBP. Not full cost reduction due to increased services at home. Potential up to 15 h/w is enourmous
Potensialet for kostnadsreduksjon ved å øke t/u til St. Hanshaugen-standard for hele Oslo kommune er 923 MNOK, men en vesentlig del må investeres i utvidet hjemmetjenester.
Antall risikofaktorer pr. pasient er i snitt 7 (2-13). Data basert på et tilfeldig uttrekk av 97 brukere i BFR, BNO, BOS
What are the key solutions to help people living longer at home?
Future elderly care will provide early help to plan own aging, provide different forms of housing and accurate services and care in own home, independent of where, customised the individual and their situation
We made a short film to describe the services and experiences that we would like the inhabitants to have in the future
9 principles for delivering elderly care. The principles are answering the key insights and needs that are mapped out for inhabitants, users, patients and their relatives, considering the economical and organisational aspect: Facilitate – Advise me so that I can be prepared and avoid potential problems Intercept – Discover when something goes wrong and make sure that it gets addressed Predictability – Make the road ahead clear. Help me to understand what is going to happen and why. Important to me – Understand my situation and focus on what is important to me Holistic – Make sure that all the services I experience make sense together Early efforts – Be willing to use resources on me early on, so that I got the most out of the treatment Motivation – Support and motivate me, so that I can do most of it myself Caretakers – help those who are close to me so that it is easier for them to give good support Human – Treating users as human beings, not as assignments or tasks
Predictable and smooth transitionEarly, clear and precise informationSmooth cooperation between institutions and services at transition of patient. Accurate reception and swift clarificationWarm and informative welcome on the reason and content of the stay Common strategy for patient based on needs and target. Established through interdisciplinary cooperation across services Targeted stayStay is targeted and all invovled work along to ensure that the patient reaches his or her goals. Activities and offering are directed to motivate and build competence for patients and relatives at home. Patient and relatives receive guidance and advisory to improve life at home. Safe and smooth transition home The life and total condition of the patient and relatives are mapped befreo transition to own home, and a follow up plan is defined across services and activities.
You will in 2025 live in your own home independent of need, situation and form of living
A range of different adapted properties are facilitated All permanent locations are home All services available at all locations 24/7 offering is a home equal to other homes. 24/7 consists of a range of different forms of living 24/7 offering are flexible on degree and level of services
The 24/7 nursing home offering must address two issues: Being sick and getting proper health and care services Living in a home
In all cases the user is living in their own home A relevant every day for each inhabitant Involve relatives Flexible in terms of change in needs of inhabitant Themes adapted to groups of users Common arearepresent society
Tilbakemeldingene etter pilotene viste at velkomsten og oppstartsamtalen var tiltak som fungerte svært godt og hadde den effekten vi var på jakt etter. Rådgivningsmøtet og avsluttende møte ble i mindre grad gjennomført. Til dels på grunn av opplevelsen av at man dekket det meste i det første møtet, til dels pga. tidspress og gjennomføringsevne i piloten. Det tverrfaglige møtet var hovedsakelig på tvers av helse og omsorg, og representerte i begrenset grad alle områder av pasientens liv og mulige behov.
Piloting and business as usual is demanding A pilot may need several takes Solutions may demand slide in time Balance the utopia and pragmatic solutions Design for people that are sufficiently sick Road from vision to start implementation is long
Living at home longer - a 2025 vision for elderly care
Current healthcare services are
not economically sustainable
in the future.
This future is already
upon us in 2017.
Those who are sick
The Nursing Home Agency (Sykehjemsetaten)
Norway's largest operator of nursing homes and the second biggest municipal
agency within the City of Oslo
• 4 short term care and rehabilitation
• 44 long-term nursing homes
• Professional Development and
• Apprenticeship Training Office for
Health, Childhood and Youth Services
• 9,000 residents and patients annually
• 1.6 million nights annually
• 12,000 employees
• 5 Billion NOK / 410 Million GBP annual
Specialised Health Services
Treat & care
Triggers for moving to a Nursing Home
Non-disease dependent triggers
Average home care h/w
Potential annual cost reduction -
Threshold value: Nursing home > 15 h/w home care
Planning and facilitation
in addition to long-term
with a separation
between private and
Accurate, holistic efforts
towards common goals
Future care for the elderly will
provide early help to plan own
aging, facilitate different forms
of housing and provide
accurate care services at best
timing in each home,
customised the individual and
their holistic situation
• Facilitate a range of different
• All permanent locations are
• All services available at all
• The 24/7 nursing home is
a home equal to other
• 24/7 consist of a range of
different forms of living.
• 24/7 are flexible in degree
and level of services
Property with a
Treatment, care and nursing Experience of one’s own home
Safety & Quality of Life
INNSATS OG EFFEKTVURDERING
MÅNED 1 2 3 4 5 6 7 8 9 10 11 12
ROLLE FORLØP KR/TIME
STANDARD FORLØP 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33
IDEELT FORLØP 4 2
IDEELT FORLØP 1
IDEELT FORLØP 15 15 15 15 15 15 15 15 15 15 15 15
IDEELT FORLØP 2,5 1,5 1 1 1 1
IDEELT FORLØP 0,5
IDEELT FORLØP 0,5 0,5
HELSEHUS 2 000
EKSTRAORDINÆR LEGE (HELSEHUS) 440
EKSTRAORDINÆR FYSIOTERAPEUT (HELSEHUS)
EKSTRAORDINÆR ERGOTERAPEUT (HELSEHUS)
EKSTRAORDINÆR SYKEPLEIER (HELSEHUS)
FYSIO/ERGO FAGKONSULENT (H.REHAB.)
SENIORSENTER OG ANDRE ELDRE TJENESTER
RUS OG PSYKIATRI
BARN OG UNGE
EKSTRAORDINÆR HJELPEPLEIER (HELSEHUS)
Female, 70 years
If the city of Oslo had invested accurate
and timely from first contact
in 2013, they would have saved
2010 2011 2012 2013 2014 2015 2016 2017 2018
IDEAL STANDARD DIFFERENCE
- 1 850 000
1. Male, 84: - 1
2. Female, 40: - 200
3. Male, 75: -
4. Female, 70: - 1 850
5. Male, 79: + 600
Total cost reduction for entire period:
Average cost reduction per year:
- 3 750 000
# users in Oslo municipality > 67: 20% = 12 600
# users in Oslo municipality < 67: 0,5% = 2 700
# users interdisciplinary assessment: 50%
Estimated annual cost reduction: