PU B LIC ATIO N S | 2024:## PUBLICATIONS | 2024:19 of the Ministry of Social Aff airs and Health Quality recommendation to guarantee active and functional ageing and sustainable services in 2024–2027 Kansallinen m ielenterveysstrategia ja itsem urhien ehkäisyohjelm a vuosille 2020–2030 Quality recommendation to guarantee active and functional ageing and sustainable services in 2024–2027 Ministry of Social Affairs and Health, Wellbeing services county company Hyvil Oy, Association of Finnish Local and Regional Authorities Ministry of Social Affairs and Health Helsinki 2024 Publications of the Ministry of Social Affairs and Health 2024:19 Ministry of Social Affairs and Health CC BY-NC-ND 4.0 ISBN pdf: 978-952-00-7191-2 ISSN pdf: 1797-9854 Layout: Government Administration Department, Publications Helsinki 2024 Finland Publication distribution Institutional Repository for the Government of Finland Valto julkaisut.valtioneuvosto.fi https://julkaisut.valtioneuvosto.fi/ Description sheet 29 May 2024 Quality recommendation to guarantee active and functional ageing and sustainable services in 2024–2027 Publications of the Ministry of Social Affairs and Health 2024:19 Publisher Ministry of Social Affairs and Health Group author Ministry of Social Affairs and Health, Hyvinvointialueyhtiö Hyvil Oy, the Association of Finnish Local and Regional Authorities Language English Pages 113 Abstract The purpose of this quality recommendation is to support the wellbeing services counties and municipalities in preparing for population ageing. The aim is to ensure active and functional ageing along with high-quality and sustainable services. The quality recommendation supports the implementation of the Government Programme, the Act on Care Services for Older Persons, the Social Welfare Act and the amendments made to them. The Ministry of Social Affairs and Health and the Association of Finnish Local and Regional Authorities issued quality recommendations for developing services for older people previously in 2001, 2008, 2013, 2017 and 2020. This quality recommendation is published jointly by the Ministry of Social Affairs and Health, Hyvinvointialueyhtiö Hyvil Oy and the Association of Finnish Local and Regional Authorities. The quality recommendation aims to serve as a tool for decision-makers, management, personnel, those conducting supervision and other operators in the wellbeing services counties and municipalities when planning, developing and assessing services. The quality recommendation is also intended for older people themselves and their families and other people close to them. The recommendations given in the quality recommendation have arisen from different projects carried out under the National Programme on Ageing and the Future Health and Social Services Centres programme, and they draw on research-based data. They provide more general-level guidance, and their implementation leaves room for taking into account the local conditions of the wellbeing services counties and municipalities. The key themes of the quality recommendation are promoting active ageing and the working careers and functional capacity of older people; participating in voluntary work; using technology in promoting wellbeing; housing and the age-friendliness of living environments; providing services in a sustainable manner; using quality indicators for monitoring quality and effectiveness; and making scenario calculations based on an estimated number of clients. Keywords services for older people, ageing, health and wellbeing, functional capacity, quality, recommendations, sustainable development ISBN PDF 978-952-00-7191-2 ISSN PDF 1797-9854 URN address https://urn.fi/URN:ISBN:978-952-00-7191-2 https://urn.fi/URN:ISBN:978-952-00-7191-2 Kuvailulehti 29.5.2024 Laatusuositus aktiivisen ja toimintakykyisen ikääntymisen ja kestävien palvelujen turvaamiseksi 2024–2027 Sosiaali- ja terveysministeriön julkaisuja 2024:19 Julkaisija Sosiaali- ja terveysministeriö Yhteisötekijä Sosiaali- ja terveysministeriö, Hyvinvointialueyhtiö Hyvil Oy, Suomen Kuntaliitto Kieli englanti Sivumäärä 113 Tiivistelmä Laatusuosituksen tarkoituksena on tukea hyvinvointialueiden sekä kuntien varautumista väestön ikääntymiseen. Tavoitteena on aktiivinen ja toimintakykyinen ikääntyminen sekä laadukkaat ja kestävät palvelut. Laatusuositus tukee hallitusohjelman, vanhuspalvelulain sekä sosiaalihuoltolain toimeenpanoa sekä niihin tehtyjä uudistuksia. Sosiaali- ja terveysministeriö ja Suomen Kuntaliitto ovat antaneet iäkkäiden ihmisten palvelujen kehittämistä koskevan laatusuosituksen vuosina 2001, 2008, 2013, 2017 ja 2020. Tämä laatusuositus julkaistaan yhdessä Sosiaali- ja terveysministeriön, Hyvinvointialueyhtiö Hyvil Oy:n sekä Suomen Kuntaliiton kanssa. Laatusuosituksen tavoitteena on toimia hyvinvointialueiden ja kuntien päättäjien, johdon, henkilöstön sekä valvonnan ja muiden toimijoiden työvälineenä palvelujen suunnittelussa, kehittämisessä ja arvioinnissa. Lisäksi laatusuositusta voivat hyödyntää iäkkäät itse sekä heidän läheisensä. Laatusuosituksessa annettavat suositukset ovat kansallisen Ikäohjelman ja Tulevaisuuden Sote-keskus ohjelman eri hankkeiden pohjalta nousevia sekä tutkittuun tietoon perustuvia suosituksia. Ne ovat yleisempää ohjusta, joiden toimeenpano jättää tilaa hyvinvointialueiden ja kuntien paikallisten olosuhteiden huomioimiselle, kun niitä otetaan käyttöön. Laatusuosituksen keskeiset sisällöt ovat iäkkäiden aktiivisuuden, työurien ja toimintakyvyn edistäminen, vapaaehtoistoimintaan osallistuminen, teknologian hyödyntäminen hyvinvoinnin edistäjänä, asuminen ja asuinympäristöjen ikäystävällisyys, palvelujen toteuttaminen kestävällä tavalla, laatuindikaattorit ladun ja vaikuttavuuden seurannassa sekä skenaariolaskelmat ennakoidun asiakasmäärän mukaan. Asiasanat iäkkäiden palvelut, ikääntyminen, terveys- ja hyvinvointi, toimintakyky, laatu, suositukset, kestävä kehitys ISBN PDF 978-952-00-7191-2 ISSN PDF 1797-9854 Julkaisun osoite https://urn.fi/URN:ISBN:978-952-00-7191-2 https://urn.fi/URN:ISBN:978-952-00-7191-2 Presentationsblad 29.5.2024 Kvalitetsrekommendation för att trygga en aktiv och funktionsduglig ålderdom och hållbara tjänster 2024–2027 Social- och hälsovårdsministeriets publikationer 2024:19 Utgivare Social- och hälsovårdsministeriet Utarbetad av Social- och hälsovårdsministeriet, Välfärdsområdesbolaget Hyvil Ab, Finlands kommunförbund Språk engelska Sidantal 113 Referat Syftet med kvalitetsrekommendationen är att stödja välfärdsområdena och kommunerna när de förbereder sig på att befolkningen åldras. Målet är ett aktivt och funktionsdugligt åldrande och hållbara tjänster av hög kvalitet. Kvalitetsrekommendationen stöder genomförandet av regeringsprogrammet, äldreomsorgslagen och socialvårdslagen samt de reformer som gjorts av dem. Social- och hälsovårdsministeriet och Finlands Kommunförbund har gett ut en kvalitetsrekommendation om utveckling av tjänster för äldre år 2001, 2008, 2013, 2017 och 2020. Denna kvalitetsrekommendation publiceras av social- och hälsovårdsministeriet, Välfärdsområdesbolaget Hyvil Ab och Finlands kommunförbund. Målet med rekommendationen är att fungera som ett verktyg för beslutsfattarna, ledningen, personalen, tillsynen och andra aktörer i välfärdsområdena och kommunerna när de ska planera, utveckla och utvärdera tjänsterna. Dessutom kan äldre och deras närstående själva utnyttja kvalitetsrekommendationen. Kvalitetsrekommendationen innehåller rekommendationer som härstammar från olika projekt inom åldersprogrammet och programmet Framtidens social- och hälsocentral samt rekommendationer som bygger på forskningsrön. De är allmänna anvisningar som lämnar utrymme för välfärdsområdena och kommunerna att beakta de lokala förhållandena när de införs. Kvalitetsrekommendationens centrala innehåll handlar om främjande av äldres aktivitet, yrkeskarriärer och funktionsförmåga, medverkan i frivilligverksamhet, utnyttjande av teknik som främjar välfärd, äldrevänliga boenden och boendemiljöer, tillhandahållande av service på ett hållbart sätt, kvalitetsindikatorer i uppföljningen av kvaliteten och effektiviteten och scenarioberäkningar enligt det förutsedda antalet kunder. Nyckelord tjänster för äldre, åldrande, hälsa och välfärd, funktionsförmåga, kvalitet, rekommendationer, hållbar utveckling ISBN PDF 978-952-00-7191-2 ISSN PDF 1797-9854 URN-adress https://urn.fi/URN:ISBN:978-952-00-7191-2 https://urn.fi/URN:ISBN:978-952-00-7191-2 Contents For the reader. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1 Introduction.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2 Better work ability of employees in services for older people.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.1 Wellbeing at work and employee attraction and retention.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.2 Working hours and adaptation of work.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3 Sufficient personnel resources.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.4 Development of management.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.5 Meaningful careers and competence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3 Older people are maintaining good functional capacity for a longer time. . . . . . . . . . . 27 3.1 Anticipation and preventive services.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.1.1 Anticipation of life course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.1.2 Outreach services for older people. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.1.3 Mental wellbeing/positive mental health.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.1.4 Cultural wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.1.5 Exercise and physical activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.2 Supporting functional capacity and wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.2.1 Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3.2.2 Functional capacity assessment tools.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 3.3 Right to self-determination and self-motivation, support for agency.. . . . . . . . . . . . . . . . . . . 42 4 People are increasingly participating in voluntary work.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.1 Inclusion, community, active citizenship and volunteering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.2 Wellbeing services counties, municipalities and organisations support voluntary activities and coordinate them together. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.3 Voluntary activities of organisations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5 Technology is increasing wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.1 The technology promoting the functional capacity, wellbeing, safety and inclusion of older people.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 5.2 Accessibility, user-friendliness and ethicality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3 Technology that supports living at home.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 5.4 Technology to support employees.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6 Age-friendly housing and living environments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 6.1 Supporting the anticipation and preparation of older people. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 6.2 Promoting the renovation of the housing stock and solutions of new production. 63 6.3 Age-friendly living environments.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 6.4 Municipalities and wellbeing services counties play a key role. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 7 Services are arranged in sustainable ways. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 7.1 Services are client-oriented. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 7.2 Centralised counselling and client guidance.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7.3 Services provided at home and the safety of living at home.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.4 Housing services.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.5 Ecologically sustainable service system.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 7.6 Knowledge-based management and quality.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 8 Scenario calculations.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 9 Quality indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 9.1 How to read the indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 9.2 The indicators are divided into phenomenon baskets.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 9.2.1 Statutory services for older people.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 9.2.2 Functional capacity is supported. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 9.2.3 Agency is supported.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 9.3 Process of preparing the quality indicators.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 9.4 Monitoring and development of quality indicators in the future. . . . . . . . . . . . . . . . . . . . . . . . . . 105 10 Quality recommendation development needs.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Appendices.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Appendix 1. Quality framework for assessing the content and recommendations of the quality recommendation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Appendix 2. Forecast of client numbers and needs for employees by service in the wellbeing services counties. The forecast is based on the population forecast.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 8 Publications of the Ministry of Social Affairs and Health 2024:19 F O R T H E R E A D E R The objective of the Programme of Prime Minister Orpo’s1 Government is a strong and committed Finland where people will have the opportunity to increase their knowledge and competence, find work, live on their pay or pension, and live in safety, and where people can enjoy the right and freedom to pursue a good life on their own terms. The strong and committed Finland will allow people to feel included and able to take care of older and vulnerable people and guarantee that citizens receive the health and social services they need. In accordance with the Government Programme, the quality recommendation to guarantee active and functional ageing and sustainable services is updated. This quality recommendation takes into account the priorities of the Government Programme and aims to pay increasing attention to the prevention of a decline in functional capacity and the effectiveness of care. This quality recommendation is intended to support the preparedness of wellbeing services counties and municipalities for the ageing of the population. The aim is to ensure active and functional ageing along with high-quality and sustainable services. The impact objectives of the quality recommendation content are based on the impact objectives of the National Programme on Ageing to 20302, therefore supporting previous development efforts. The quality recommendation proposes measures and recommendations that are in line with the impact objectives. To implement these, the quality recommendation contains good, research-based practices that have been proven to be and experienced as good in practice. The recommendations are based on the different projects carried out under the National Programme on Ageing to 2030 and the Future Health and Social Services Centres Programme3 as well as research-based knowledge. They involve more general guidance whose implementation leaves room for taking the local conditions of wellbeing services counties and municipalities into account. 1 Programme of Prime Minister Petteri Orpo’s Government: http://urn.fi/ URN:ISBN:978-952-383-763-8 2 National Programme on Ageing to 2030: http://urn.fi/URN:ISBN:978-952-00-6865-3 3 Future Health and Social Services Centres Programme: https://thl.fi/fi/tutkimus-ja-kehittaminen/ tutki- mukset-ja-hankkeet/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma http://urn.fi/URN:ISBN:978-952-383-763-8 http://urn.fi/URN:ISBN:978-952-383-763-8 http://urn.fi/URN:ISBN:978-952-00-6865-3 https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma 9 Publications of the Ministry of Social Affairs and Health 2024:19 Figure 1.  Impact objectives of the quality recommendation. A cross-administrative follow-up group was established to prepare the quality recommendation in late autumn 2022 and included members from different ministries, wellbeing services counties, municipalities and organisations as well as representatives of other bodies. Members of councils for older people and representatives of older people have participated in the preparation of the quality recommendation through various workshops, forums and discussion sessions. The work on the content areas has made use of quality recommendation workshops and the further planning workshops of the National Programme on Ageing as well as working groups and feedback obtained from the round for comments for the Government resolution on the Programme on ageing to involve a group of participants that is as extensive and diverse as possible in the work. The content of the quality recommendation was divided per each impact objective and worked on in teams whose participants included both experts from and outside the follow-up group. The person in charge of each team was a member of the follow-up group. The progress of the content was monitored at the meetings of the follow-up group for the quality recommendation, which provided the teams with feedback to guide their further work. To support its work, the follow-up group for the quality recommendation compiled a quality framework (Appendix 1). The framework was compiled based on the results obtained from the joint workshops for the preparation of the National Programme on Ageing and the Quality Recommendation as well as the workshop for the management of services for older people, surveys sent to all Finnish councils Better work ability of employees in services for older people Older people are maintaining good functional capacity for a longer time People are increasingly participating in voluntary work Technology is increasing wellbeing Housing and living environments are age-friendly Services are arranged in sustainable ways 10 Publications of the Ministry of Social Affairs and Health 2024:19 for older people during the work on the National Programme on Ageing and the responses obtained from the comment round for the resolution of the National Programme on Ageing, which were further developed in the two workshops of the follow-up group. Eight objectives for the examination of the content were formed in the quality framework: 1. the core themes have been identified precisely, 2. the recommendations serve the practical work of the management, personnel and operators of the wellbeing services counties and municipalities in the implementation of services for older people and in supporting older people, 3. a preventive and promoting perspective is visible throughout the recommendation, 4. the recommendations support older people in taking responsibility for maintaining their functional capacity, 5. the recommendation emphasises inclusion and the right to self-determination, 6. the most effective contents have been found for the recommendation based on knowledge/research, 7. the quality recommendation identifies different older people and their life situations, 8. the recommendations are clear and realistic (e.g. finances, a personnel perspective). The good practices were selected by the expert teams for the impact objectives. The good practices are based on research knowledge or practical experience gathered from different projects and/or further developed operating models. The draft version of the quality recommendation was submitted for an official consultation round between 26 October 2023 and 17 November 2023. Comments received in the consultation round were taken into account in the final document. 11 Publications of the Ministry of Social Affairs and Health 2024:19 1 Introduction In a positive future, ageing will be valuable, meaningful and appreciated. It will provide older people with opportunities to participate in maintaining a sustainable society, trusting that they have a place in their community and knowing that they will receive support from it if necessary. Ageing is about much more than merely being an infirm care subject. The needs of older people are not just determined based on their condition, but also on their background, wishes and interests. The voices of older people must be heard to identify factors affecting their everyday coping and wellbeing and to maintain their mental welfare. However, there are many fragile, indigent and lonely older people who do not have or want a safety net. Nevertheless, as people, we have a need to be seen as individuals, which also increases the significance of interpersonal relations. The number of older people and their proportion of the population will grow sharply over the next two decades. According to Statistics Finland’s population projection4, the share of people aged 75 or over in Finland was approximately 10 per cent in 2021, and the number is expected to increase to 14 per cent in 2030 and 16 per cent in 2040. In 2022, the number of persons aged 75 or over in Finland was around 600,000, and the number is expected to climb to around 780,000 by 2030, and around 900,000 in 2040. This demographic trend will lead to a significant increase in the number of older people in need of health and social services during the current decade, reducing the sustainability of social welfare and health care systems and therefore affecting the capability of the service system to provide adequate services for those in need. The increase in the need for services and costs will lead to a substantial need for financing the services in the current decade. Without the introduction of new measures, the financing of the wellbeing services counties is expected to grow by more than EUR 8 billion by 2031, exceeding the EUR 30 billion level at the end of the decade. Although this growth in funding is necessary from the perspective of ensuring the availability and quality of services, the increase in costs must be more manageable than currently. 4 Official Statistics of Finland (STV) https://www.stat.fi/til/vaenn/2019/ vaenn_2019_2019- 09-30_kuv_005_fi.html https://www.stat.fi/til/vaenn/2019/vaenn_2019_2019-09-30_kuv_005_fi.html https://www.stat.fi/til/vaenn/2019/vaenn_2019_2019-09-30_kuv_005_fi.html https://www.stat.fi/til/vaenn/2019/vaenn_2019_2019-09-30_kuv_005_fi.html 12 Publications of the Ministry of Social Affairs and Health 2024:19 According to the Programme of Prime Minister Petteri Orpo’s Government5, the Government aims to curb the growth of the costs of wellbeing services counties primarily by means of structural measures, such as developing the service structure and operating methods. Highlighted urgent measures that require special attention include the coping at home of older people and the situation of the most vulnerable groups. The equality and coping of informal carers will be supported by various measures and the opportunities of becoming an informal carer will be increased. The key measures of the Programme of Prime Minister Petteri Orpo’s Government are related to improving the functioning of the healthcare and social welfare services system, scaling services as well as strengthening prevention, digital services, case management and opportunities for self-care that allow people to maintain their health. The personnel structure must be diversified and, within the limits set by ensuring humanity, technology must be utilised diversely in supporting independent living at home, maintaining functional capacity and services provided at home. The availability of services is impaired by the adequacy and availability of personnel, which can be responded to through short-term and long-term measures, such as extending working careers from the beginning, centre and end. Sustainable development is influenced by how the continuation of careers and retention at work can be influenced. Problems with the availability of staff are becoming increasingly commonplace in services for older people. For this reason, there is a need to improve the opportunities for older working-age people to continue their careers with good activity and wellbeing through means such as strengthening the resources of work and aiming to reduce workload factors. Particular attention must be paid to solving ethically stressful situations at work. The development of wellbeing at work is concerned with the development of work that involves examining working conditions, working arrangements, approaches and management. To ensure the sufficiency and availability of personnel, the Good Work Programme will be launched in accordance with Orpo’s Government Programme5. The attraction and retention of services for older people should be promoted and their public image improved by reporting on successes. 5 Good Work Programme: http://urn.fi/URN:ISBN:978-952-00-5396-3 http://urn.fi/URN:ISBN:978-952-00-5396-3 13 Publications of the Ministry of Social Affairs and Health 2024:19 Anticipatory and preventive activities and services for the wellbeing, health, safety and functional capacity of older people can enable more good, active years of life. The wellbeing services counties must invest in prevention in cooperation with the municipalities, organisations and other actors in their regions, and this must be taken into account when reforming service structures. It is important to support older people in promoting their own wellbeing and health. Outreach services for older people can also be used to support the wellbeing of the most vulnerable older people. Mental and cultural wellbeing, physical activity and rehabilitation are particularly emphasised in supporting functional capacity. Volunteering is a significant activity that increases wellbeing and a sense of belonging, and it also supports civic participation and democracy. Its potential and benefits must be identified and volunteering must be made possible in a way that benefits society and volunteers. Pensioners are increasingly involved in volunteering activities that improve their inclusion and opportunities to exert influence. Rising up to the challenges of accelerating retirement rates and increase in service needs caused by the ageing of the population requires taking a number of measures one of which involves the diverse use of technology. Technology provides opportunities for promoting wellbeing, health, safety and functional capacity. The options offered by technological solutions can be used to support the living at home of older people and to improve the sufficiency of services and personnel. The use of technological and digital tools gives professionals new ways to provide better service and care and, when the solutions work well, they free up professionals’ time for encountering people. However, the utilisation of digitalisation and technology involves issues related to user-friendliness, attitudes, competence and information security, which must be solved and alternative methods must also be provided for people to manage their affairs. Living at home for older people is also supported by housing solutions. The need for age-friendly housing and residential areas increases as living at home is becoming more commonplace among the ageing population. Good living conditions support the functional capacity and day-to-day lives of older people and can contribute to reducing their need for services. Municipalities and wellbeing services counties should anticipate and prepare for future housing needs with various measures and to support older people in taking steps of their own in anticipation and preparedness. These measures are related to improving the existing housing stock, different housing solutions and developing age-friendly residential areas and the community in them. This requires strong cooperation between municipalities and wellbeing services counties. 14 Publications of the Ministry of Social Affairs and Health 2024:19 The ageing population is increasingly diverse, which requires respect for the differences in personal identity, equality and the right to self-determination as well as the promotion of cultural competence in services. This requires skills in encountering different people in a client-oriented manner that includes respecting clients’ values and attitudes. The provision of services must also take into account the principles of sustainable development: social, cultural, ecological and economic sustainability Sustainable development is influenced by how social development promotes and maintains the wellbeing of citizens and meets their needs without depriving future generations of the same opportunities. The purpose of social sustainability is to secure the opportunities of individuals for a good, active life and health, being treated equally, participating in decision-making and receiving the necessary services. Social sustainability can have a significant impact on economic sustainability, which aims to promote equal growth. Economic sustainability requires changes to existing public services within the limits of available resources to achieve stability and functionality. Attention must be paid to how economic, social and ecological sustainability are interlinked; the sustainable development goals cannot be achieved from an economic perspective alone. Ecological sustainability is promoted in services through choices aimed at reducing excessive consumption that causes strain on the environment. Sustainable production and consumption habits and material functions must remain within the limits of the carrying capacity of the environment. More attention should be paid to ecological efficiency and material consumption in the service system. In the long term, economically sustainable development will only be achieved if the activities are ecologically sustainable. The sustainability of the implementation of services is promoted by efficient advice and case management as well as lightening the service system structure, for example increasing services aimed at preventing diseases and a decline in functional capacity or developing communal housing instead of 24-hour care. This sustainable development thinking must also pay attention to cultural sustainability, in which the realisation of cultural rights plays a key role in ensuring that older people have the opportunity to learn, participate in culture and express themselves in all life situations. Cultural activities support wellbeing and a meaningful life. 15 Publications of the Ministry of Social Affairs and Health 2024:19 When organising services, there should be an aim to respond based on data and knowledge to whether the current and planned services help maintain and improve the wellbeing, health and functional capacity of older people. It must be examined whether the older people are receiving the right services at the right time, whether the selection of activities and services to promote wellbeing and services respond to the needs of older people. The quality of services for older people has been developed for a long time under the guidance of the quality recommendation. However, the monitoring of quality development has remained fragmented, and it has particularly been difficult to highlight good quality in the past. Now, the quality indicators provide a way to highlight the good quality of services for older people. The wellbeing services counties have an opportunity to verify that their clients have received better-than-average services in the different areas of the recommendation and highlight successes when developing their service quality. Thanks to the more intense monitoring carried out using the indicators, outcomes will be visible more quickly. RAI indicators describing quality have also been included in the quality recommendation. Experts from the wellbeing services counties have been involved in selecting the indicators. The phenomena described by all proposed quality indicators can be influenced by good care practices and by developing the service system. The development of the service system requires anticipation and the comparison of different alternatives. The Finnish Institute for Health and Welfare has prepared two scenario forecasts for the quality recommendation, which assess the potential impacts of increasing communal housing on the need for additional personnel. Some of the clients in sheltered housing with 24-hour assistance and old people’s homes would be better suited for communal living based on their service needs. There are also clients in home care whose need for services is already so great that they would need a safe living environment or an opportunity for night-time services, even though they do not yet meet the criteria for 24-hour sheltered housing. An examination of the scenarios provides information to support change in the service structure. 16 Publications of the Ministry of Social Affairs and Health 2024:19 2 Better work ability of employees in services for older people Ensuring employees’ work ability and wellbeing at work is important and is a prerequisite for good care as well as client and patient safety. Extending careers and making workplaces attractive is based on a workplace culture that strengthens wellbeing at work. Working in a caring atmosphere is safe and rewarding successes strengthen a good working atmosphere. Students and new employees will form a positive view of the sector and work unit through a good job orientation and an encouraging work community. It is important that employees receive verbal and non-verbal feedback for a job well done. There are a lot of positive aspects in the work of employees in services for older people: encountering clients and family members and receiving feedback from them, a versatile job description, diverse work contents and tasks, opportunities for development and career progress, and possibilities to influence one’s work6. Just highlighting positive issues related to the work is enough to increase the attractiveness of the sector, and it is also important to ensure sufficient resources and promote wellbeing at work. Meanwhile, negative press and discussions centred around problems may increase the ethical workload of professionals. In services for older people, as in other health and social services, problems related to the availability of personnel have increased rapidly in recent years. This shortage of labour particularly applies to practical nurses, who form a key share of the professionals working on these tasks. To increase the attractiveness of the sector and extend working careers, it is essential to develop and strengthen the functioning of the work community and the work of managers as well as the management of workloads. There is room for improvement in the wellbeing at work and management of psychosocial workloads of the employees in services for 6 Korkiakangas et al. 2022. Vanhustyössä työskentelevien hoitajien ja esihenkilöiden näke- myksiä vanhustyön vetovoimaisuutta edistävistä tekijöistä (Views of nurses and managers working in services for older people on the factors promoting the attractiveness of work with older clients). https://sairaanhoitajat.fi/ vanhustyossa- tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta- edistavista-tekijoista/ https://sairaanhoitajat.fi/vanhustyossa-tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta-edistavista-tekijoista/ https://sairaanhoitajat.fi/vanhustyossa-tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta-edistavista-tekijoista/ https://sairaanhoitajat.fi/vanhustyossa-tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta-edistavista-tekijoista/ https://sairaanhoitajat.fi/vanhustyossa-tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta-edistavista-tekijoista/ https://sairaanhoitajat.fi/vanhustyossa-tyoskentelevien-hoitajien-ja-esihenkiloiden-nakemyksia-vanhustyon-vetovoimaisuutta-edistavista-tekijoista/ 17 Publications of the Ministry of Social Affairs and Health 2024:19 older people7, 8. As a result, there is a need for both measures targeted at individual employees’ work ability as well as the development of the activities of supervisors and the work community as well as high-quality collaboration with occupational healthcare. Changing the operating culture requires multifaceted methods, which should take advantage of the opportunities offered by technology. 2.1 Wellbeing at work and employee attraction and retention Recommendations • Increasing the attractiveness of the sector and wellbeing at work by highlighting positive aspects of the older people care and good operating practices, for instance, on a website of services for services for older people, advertisements and brochures, professional journals in the field and widely in society. • Systematically developing wellbeing at work, a sense of community and work as a continuous process and reserving time for this. Integrating the development into a fixed part of the management of services for older people. • Encouraging employees to foster and strengthen their physical functional capacity, mental wellbeing and health as well as their recovery from work. • Supporting the creation of positive experiences in the field already during education and training. In this context, the development of versatile, high-quality and well-guided practical training and on-the-job learning play a key role. In addition, it is a good idea to make used of students’ opportunities for language-supported practical training. 7 Kivimäki et al. 2003. Organisational justice and health of employees: prospective cohort study. Occupational and Environmental Medicine. 1 January 2003;60(1):27–34. 8 Selander et al. 2022. Association between work ability and work stressors: cross- sectional survey of elderly services and health and social care service employees. Archives of Public Health. 15 March 2022;80(1):83. 18 Publications of the Ministry of Social Affairs and Health 2024:19 The development of the activities in the work community and supervisory work and improving the management of workloads and the resource factors of work are important means of increasing attractiveness and extending careers9. The wellbeing at work of the employees of services for older people is poorer compared to the employees in other social and health care services, and these shortcomings in wellbeing at work impair their work ability6, 7. Therefore, in addition to measures targeted at individual employees’ work ability, the activities of supervisors and the work community need to be developed. It is important to reserve time for the joint development of wellbeing at work and work performance already in the context of shift planning. The planning of development measures and assessing their impacts needs to be supported by data and information on the wellbeing at work of personnel, for example, from occupational wellbeing surveys and other information sources available at the workplace, such as the number of sickness absences and employee turnover rates. Such knowledge-based development work can focus on the most important issues, both solving problems and enhancing strong areas. Extending careers requires promoting health and work ability over the long term with a goal-oriented approach and developing wellbeing at work with the support of the organisation’s management. It is important to link the activities to work processes, work contents and workplace structures (e.g. annual clock activities, regular meetings at the work unit, orientation, performance appraisals, etc.) as well as statutory measures, such as self-monitoring. Coffee and meal breaks must be provided to employees during the working day, as they support coping and recovery at work. Employees must be given breaks and rest periods in accordance with the Working Time Act and the complied collective agreement, as they support coping and recovery at work. Sufficient rest, recovery and reduction of monotonous workload play an important role in maintaining the work ability of employees with high workloads. 9 Korkiakangas et al. 2022. Vanhustyössä työskentelevien hoitajien ja esihenkilöiden näkemyksiä vanhustyön vetovoimaisuutta edistävistä tekijöistä (Views of nurses and managers working in services for older people of the factors promoting the attractiveness of work with older clients). Tutkiva Hoitotyö. 2022:20(1):3–11. 19 Publications of the Ministry of Social Affairs and Health 2024:19 Good practices y Model for attractive services for older people: https:// vetovoimainenvanhustyo.fi/vanhustyonvetovoimamalli/ y Good Work Programme: http://urn.fi/URN:ISBN:978-952-00-5396-3 y Pötki pitkälle – Keinoja työn kuormitustekijöiden hallintaan sosiaali- ja terveys-alan yrittäjille ja työntekijöille (You’ll get far – Means for managing workload factors for entrepreneurs and employees in healthcare and social welfare services): https://www.ttl.fi/potki-pitkalle-keinoja-tyon- kuormitus-tekijoiden-hallintaan-sosiaali-ja-terveysalan-yrittajille-ja y The Mental Health Toolkit for workplaces and occupational healthcare providers. Perspectives and solutions for building a work culture that promotes mental wellbeing: https://hyva-tyo.ttl.fi/mielityo/tyokalut y Off we go! Health at workplaces recommendations | Finnish Institute of Occupational Health (ttl.fi): https://www.ttl.fi/teemat/ tyohyvinvointi-ja-tyokyky/elintavat/terveytta-tyopaikoille-suositukset y Operating models | Tekojen Tori: https://tarkeissatoissa.fi/tekojentori 2.2 Working hours and adaptation of work Recommendations • Introducing structures and operating practices to improve employees’ opportunity to influence their work and its development, working hours and work-related decision-making. Shift work affects the reconciliation of work and leisure time more than regular daily work in different life situations. This can be influenced by ergonomic work shift planning, which aims at finding a suitable balance between work and rest, for instance. Work shifts should support the employee’s wellbeing, health and work ability, as shift work puts a strain on social life and night work is particularly associated with a particular risk of illness during working hours. https://vetovoimainenvanhustyo.fi/vanhustyonvetovoimamalli/ https://vetovoimainenvanhustyo.fi/vanhustyonvetovoimamalli/ http://urn.fi/URN:ISBN:978-952-00-5396-3 https://www.ttl.fi/potki-pitkalle-keinoja-tyon-kuormitus-tekijoiden-hallintaan-sosiaali-ja-terveysalan-yrittajille-ja https://www.ttl.fi/potki-pitkalle-keinoja-tyon-kuormitus-tekijoiden-hallintaan-sosiaali-ja-terveysalan-yrittajille-ja https://hyva-tyo.ttl.fi/mielityo/tyokalut https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/elintavat/terveytta-tyopaikoille-suositukset https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/elintavat/terveytta-tyopaikoille-suositukset https://tarkeissatoissa.fi/tekojentori 20 Publications of the Ministry of Social Affairs and Health 2024:19 An ability to influence one’s working hours makes it easier for employees to reconcile work with the other aspects of their lives. This is important in coordinating work and informal caregiving, for instance. The introduction of participatory shift planning in units supports employees’ individual needs. In participatory shift planning, the work community plans work shifts first at the individual and subsequently at the communal level to suit the work community while taking client needs into account. Individual flexibility and shift preferences are important, but in taking them into consideration, it must be ensured that they do not cause excessive strain on the work community. Various forms of working time flexibility according to employees’ individual life situations are means of improving the availability and wellbeing of personnel. Regional substitute staff systems and recruitment arrangements support the work of supervisors, leaving them with more time to support employees and develop their work and wellbeing at work. The adaptation of work refers to the measures taken at a workplace that allow making work, work processes and working environment aligned with employees’ competence and work ability and enable the employees to develop their professional skills. It allows finding a balance between the requirements of work and employees’ personal characteristics. The adaptation of work is part of work ability management, supporting and rehabilitating employees’ work ability. Providing employees with opportunities to influence the way they work and their development at work increases their work engagement and commitment to the workplace, and improves their coping and performance.10 Fair decision-making in the organisation and the fairness of supervisors are linked to the smoothness of employees’ work and their wellbeing at work, commitment to work and also a lower sickness absence rate11. Improving the mutual appreciation, trust and psychological safety of employees is also important12. 10 Hakanen et al. Uudistu ja onnistu hyvällä henkilöstöjohtamisella (Renewal and success through good management of personnel). [Internet]. 2019. Available at: https://www. kuntaliitto.fi/julkaisut/2019/1977. 11 Lönnqvist et al. 2022. Organizational justice among registered nurses: A scoping review. Int J Nurs Pract. February 2022;28(1):e12983. 12 Kröger et al. 2018. Hoivatyö muutoksessa: suomalainen vanhustyö pohjoismaisessa vertailussa (Nursing care in transition: Finnish work with older people in a Nordic comparison). University of Jyväskylä. YFI publications, 6. [Internet]. 2018. Available at: http://urn.fi/ URN:ISBN:978-951-39-7372-8 https://www.kuntaliitto.fi/julkaisut/2019/1977-uudistu-ja-onnistu-hyvalla-henkilostojohtamisella-acta-nro-272 https://www.kuntaliitto.fi/julkaisut/2019/1977-uudistu-ja-onnistu-hyvalla-henkilostojohtamisella-acta-nro-272 https://jyx.jyu.fi/handle/123456789/57183 https://jyx.jyu.fi/handle/123456789/57183 21 Publications of the Ministry of Social Affairs and Health 2024:19 Good practices y Examples of work shift planning: https://www.ttl.fi/teemat/ tyohyvinvointi-ja-tyokyky/ tyoaika/vuorotyo/epasaannollisten- tyoaikojen-suunnittelu 2.3 Sufficient personnel resources Recommendations • Diversifying the personnel structure and competence in services for older people by increasing the number of for example, geriatricians, social workers, physiotherapists, occupational therapists, rehabilitation counsellors and cultural wellbeing professionals. • Building structures for making arrangements on the division of labour and clarifying basic job descriptions according to employees’ competence, qualifications and clients’ needs. Sufficient personnel resources and a versatile personnel structure are prerequisites for providing clients with high-quality services while ensuring the wellbeing at work of employees. Provisions have been laid on the quantitative staffing minimum for 24-hour care for older people and the division of work into direct and indirect work to ensure client safety. The personnel resources reserved in home care must be sufficient for ensuring that clients receive the statutory services in accordance with their service needs assessment and a decision made based on the assessment. Other services, such as medical and oral health care and rehabilitation, must also have sufficient personnel resources. Developing work ability and wellbeing at work is a means of improving the adequacy of the workforce, as shortcomings increase employees’ sickness absences and their willingness to change jobs and industries. In addition to developing wellbeing at work, it is important to enable practical nurses to focus on tasks corresponding to their education and competence. Increasing the number of care assistants in operating units enables this division of labour, as their job description is focused on tasks that involve assistance. https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/tyoaika/vuorotyo/epasaannollisten-tyoaikojen-suunnittelu https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/tyoaika/vuorotyo/epasaannollisten-tyoaikojen-suunnittelu https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/tyoaika/vuorotyo/epasaannollisten-tyoaikojen-suunnittelu https://www.ttl.fi/teemat/tyohyvinvointi-ja-tyokyky/tyoaika/vuorotyo/epasaannollisten-tyoaikojen-suunnittelu 22 Publications of the Ministry of Social Affairs and Health 2024:19 For clients living in housing service units, the unit constitutes the main part of the clients’ living environment in which they receive treatment and care according to their individual needs, health services, activities that maintain and promote their functional capacity, rehabilitation and activities that promote inclusion and social interaction13. In addition to social welfare and health care, the personnel must have versatile competence to carry out other activities. The increasing labour shortage in health and social services also requires gaining access to and making use of all the competence required to meet clients’ needs. Good practices y Roadmap for 2022–2027: Ensuring the sufficiency and availability of healthcare and social welfare personnel: http://urn.fi/ URN:ISBN:978-952-00-7178-3 y For employers – Väestöliitto.fi (vaestoliitto.fi): https://www. vaestoliitto. fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/ tunnista- kansainvalinen-osaaja/tyonantajalle/ y Trainee programme: https://innokyla.fi/fi/toimintamalli/trainee- ohjelma- ryhmamuotoisella-tyokokeilulla-onnistumisen-kokemuksia- tyoelamasta 2.4 Development of management Recommendations • Ensuring sufficient resources for front-line management. • Strengthening the competence of managers and supervisors on management and wellbeing at work with new research knowledge and by improving management competence utilising a coaching- like approach. • Including the promotion of wellbeing at work and work ability in the job requirement assessment criteria for managers. 13 Social Welfare Act 1301/2014: https://www.finlex.fi/fi/laki/ajantasa/2014/20141301 http://urn.fi/URN:ISBN:978-952-00-7178-3 http://urn.fi/URN:ISBN:978-952-00-7178-3 https://www.vaestoliitto.fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/tunnista-kansainvalinen-osaaja/tyonantajalle/ https://www.vaestoliitto.fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/tunnista-kansainvalinen-osaaja/tyonantajalle/ https://www.vaestoliitto.fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/tunnista-kansainvalinen-osaaja/tyonantajalle/ https://www.vaestoliitto.fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/tunnista-kansainvalinen-osaaja/tyonantajalle/ https://www.vaestoliitto.fi/maahanmuuttajat/tyoelama-ja-maahanmuuttajat/tunnista-kansainvalinen-osaaja/tyonantajalle/ https://innokyla.fi/fi/toimintamalli/trainee-ohjelma-ryhmamuotoisella-tyokokeilulla-onnistumisen-kokemuksia-tyoelamasta https://innokyla.fi/fi/toimintamalli/trainee-ohjelma-ryhmamuotoisella-tyokokeilulla-onnistumisen-kokemuksia-tyoelamasta https://innokyla.fi/fi/toimintamalli/trainee-ohjelma-ryhmamuotoisella-tyokokeilulla-onnistumisen-kokemuksia-tyoelamasta https://innokyla.fi/fi/toimintamalli/trainee-ohjelma-ryhmamuotoisella-tyokokeilulla-onnistumisen-kokemuksia-tyoelamasta https://www.finlex.fi/fi/laki/ajantasa/2014/20141301 23 Publications of the Ministry of Social Affairs and Health 2024:19 The management of the wellbeing and work ability of employees plays a key role in the management of services for older people. Managers and front-line managers need continuous training in the management of personnel’s competence, work ability and wellbeing as well as in the utilisation of technology. The work of front- line managers is demanding and diverse, which means that sufficient resources, time and support must be allocated to it. To ensure the availability of a sufficient workforce in the healthcare and social welfare sector, careers must be extended from the beginning, centre and end. This requires that the management of services for older people possesses new kind of competence and understanding of the activities of diverse work communities that utilise the strengths and skills of people of different ages and backgrounds. Particular attention must be paid to employees’ work ability and wellbeing at work, and management practices must be based on the latest research knowledge. Practices for making use of new research knowledge in day-to-day work must be created. Front-line managers may be responsible for several units, which makes the work challenging and requires mutual trust as well as a community-based and self- directed working approach for the employees. The role of psychological safety is emphasised in the combination of in-person and remote work, i.e. hybrid work as well as the work involving the input of several different units. Psychological safety refers to an atmosphere of the work community and the organisation in which the employees are feeling well and appreciated, and where failures are also permitted. Building psychological safety is important from the perspective of the wellbeing of the work community, high-quality care, work efficiency and innovativeness. This can be achieved through a management style that uses a coaching-like and people- oriented approach and involves building trust and accommodating the employees. Trust in colleagues, supervisors and employers reduces sickness absences and desires to retire prematurely. The management of services for older people must also pay particular attention to ethics-related stress and the management of psychosocial strain factors at work. Building an ethical operating culture for workplaces is important from the perspective of the quality of work and care, the wellbeing of employees and the attraction and retention of the industry. The significance of the supervisor’s support is emphasised in demanding and stressful work in services for older people, in which professionals are often faced with a sense of inadequacy, time pressures and limited opportunities to influence 24 Publications of the Ministry of Social Affairs and Health 2024:19 the work 14. Shortcomings in the front-line management and high stress levels experienced by employees predict the intentions to leave among professionals15. Supervisors are expected to both support their employees’ work and improve their work efficiency16. Strengthening supervisors’ capabilities and opportunities to support employees promotes work ability and wellbeing at work and leads to better employee commitment13. Good practices y Pelotta töissä – psykologinen turvallisuus työyhteisössä (At work without fear – psychological safety at work): https:// www.ttl.fi/ oppimateriaalit/pelotta-toissa-psykologinen-turvallisuus- tyoyhteisossa y Työyhteisön pieni kirja luottamuksesta (The small book of trust in a work community): https://www.julkari.fi/ handle/10024/146097 14 Van Aerschot et al. 2022 15 Olakivi et al. 2021. 16 Olakivi et al. 2019. https://www.ttl.fi/oppimateriaalit/pelotta-toissa-psykologinen-turvallisuus-tyoyhteisossa https://www.ttl.fi/oppimateriaalit/pelotta-toissa-psykologinen-turvallisuus-tyoyhteisossa https://www.ttl.fi/oppimateriaalit/pelotta-toissa-psykologinen-turvallisuus-tyoyhteisossa https://www.ttl.fi/oppimateriaalit/pelotta-toissa-psykologinen-turvallisuus-tyoyhteisossa https://www.julkari.fi/handle/10024/146097 https://www.julkari.fi/handle/10024/146097 25 Publications of the Ministry of Social Affairs and Health 2024:19 2.5 Meaningful careers and competence Recommendations • Enabling ethical practices. To reduce ethical burden in organisations and work communities, the transparency of activities must be strengthened and increase open, fair discussion. • Developing operating models that allow work communities to use the experiences of older persons and the recent information of new employees to produce common operating practices for the work unit and ensure that new and inexperienced employees receive job orientation and support. The role of the diversity of work communities and including people with different educational backgrounds in the services for older people is important. • The competence management in services for older people ensures that sufficient resources and time are reserved for orientation for new employees. In addition, a continuing education plan for all personnel is applied in managing the development of employees’ competence. Sufficient and competent personnel is a prerequisite for the implementation of high-quality services that meet clients’ needs. Sufficient human resources also enable the necessary time to be spent on developing work, wellbeing at work and competence. Services for older people require different competences and educational backgrounds (e.g. social welfare, healthcare, rehabilitation). It must be ensured that the personnel structure extensively meets client needs. It is also important that the work has been built so that everyone gets to utilise their competence based on their educational background and keep developing it. When work is correctly scaled and roles have been correctly assigned, the work of the working community is clear. When each employee’s professional competence is appreciated, the employees feel motivated and their coping at work is promoted. It is also important to take into consideration employees’ self-development as professionals, enable horizontal career development and also bind this to pay. 26 Publications of the Ministry of Social Affairs and Health 2024:19 Staff competence can be increased in many ways. In addition to traditional continuing education, it is a good idea to take advantage of mentoring, peer development, participation in experiments and development and research projects, job rotation, online learning environments and developer employees. Care assistants are encouraged to train as practical nurses through apprenticeship training. The level of competence must be monitored and assessed regularly. The future work community will be increasingly diverse and multicultural, and it must also be a safe place for young people who find employment in various ways, people with partial work ability and persons with disabilities. Employees’ expectations of working life may be very different, but at best they can work in an environment where everyone has the opportunity to learn, use their strengths, develop their work and operating methods and produce high-quality services. It is important to utilise the experience and tacit knowledge of older employees. On the other hand, utilising the new information that young employees have obtained through their education is valuable. At best, mentor-actor pairs can work in working communities. Appreciating older employees, listening to them and tailoring their tasks where possible allows them to maintain their ability to work and coping at work. It is important to coach and prepare employees approaching retirement age for their oncoming life change and to enable those willing to continue working as their resources allow, for example as part-time employees, gig workers or full-time employees. This makes it possible to extend working careers at their end. Good practices y The Vanhustyön vatupassi model provides the supervisors and management of services for older people with concrete and functional solutions for managing ethics-related stress and creating an ethical work culture: https:// www.ttl.fi/vanhustyon-vatupassi y Mielen hyvinvointia iäkkäille – tietoa, taitoa ja toimintatapoja ammattilaisille (Mental wellbeing for older people – knowledge, skills and approaches for professionals): https://www.ikainstituutti.fi/ tuote/mielen-hyvinvointia- iakkaille-tietoa-taitoa-ja-toimintatapoja- ammattilaisille/ y Työnantajan monimuotoisuusopas TEM (Diversity guide for employers), Flipsnack https://www. flipsnack.com/ilmio/tyonantajan- monimuotoisuusopas-tem.html https://www.ttl.fi/vanhustyon-vatupassi https://www.ttl.fi/vanhustyon-vatupassi https://www.ikainstituutti.fi/tuote/mielen-hyvinvointia-iakkaille-tietoa-taitoa-ja-toimintatapoja-ammattilaisille/ https://www.ikainstituutti.fi/tuote/mielen-hyvinvointia-iakkaille-tietoa-taitoa-ja-toimintatapoja-ammattilaisille/ https://www.ikainstituutti.fi/tuote/mielen-hyvinvointia-iakkaille-tietoa-taitoa-ja-toimintatapoja-ammattilaisille/ https://www.ikainstituutti.fi/tuote/mielen-hyvinvointia-iakkaille-tietoa-taitoa-ja-toimintatapoja-ammattilaisille/ https://www.flipsnack.com/ilmio/tyonantajan-monimuotoisuusopas-tem.html https://www.flipsnack.com/ilmio/tyonantajan-monimuotoisuusopas-tem.html https://www.flipsnack.com/ilmio/tyonantajan-monimuotoisuusopas-tem.html 27 Publications of the Ministry of Social Affairs and Health 2024:19 3 Older people are maintaining good functional capacity for a longer time The entity of preventive work and promotion of functional capacity continues the implementation recommendations and themes set out in the previous quality recommendation. Municipalities, organisations, wellbeing services counties, and parties organising and producing social welfare and health care services have the opportunity to influence the wellbeing and functional capacity of ageing citizens in different ways. The recommendations guide older people to maintain their wellbeing and functional capacity and serve as an important source of support for development and renewal activities for those providing the services. Proactive support for the functional capacity of older people requires visible discussion and communication in society. The guiding information produced by the recommendations can be used to influence the challenges of wellbeing and health in various ways. The recommendation perceives functional capacity as a broad- based concept in which the perspectives of a person’s physical, psychological, social and cognitive functional capacity are constantly interacting with each other and with the different dimensions of the environment. For a person, functional capacity lays the foundation for leading a life on their own terms and coping with everyday activities that are meaningful and necessary (work, study, leisure time, hobbies, taking care of oneself and others). 28 Publications of the Ministry of Social Affairs and Health 2024:19 3.1 Anticipation and preventive services Recommendations • Utilising, developing and strengthening the operating models for the promotion of wellbeing, health, functional capacity and safetyin an effective cooperation between the wellbeing services counties, municipalities and national communities and civil society. The models will be included in the service plans, welfare reports, strategies and programmes on ageing of municipalities and wellbeing services counties. • The statutory wellbeing and health activities for which the municipalities and wellbeing services counties are responsible are clear and actors support each other with their expertise.17 The aim of the anticipatory and preventive services is that the number of active life years of older people during which people retain their functional capacity has increased and the average time for needing intensive care and nursing will be shorter. The aim is to develop new innovative ways of supporting and motivating older people in promoting health, wellbeing and safety, for instance through improving nutrition, promoting lifelong learning, physical activity and culture and active citizenship, mental wellbeing and inclusion and strengthening social relationships. Older people can be helped maintain their functional capacity through such perspectives. Investing in the early identification of health risks and targeting preventive measures will reduce the loss of functional capacity and a reduction of morbidity, especially memory disorders. Functional capacity and a meaningful life for an ageing population are maintained by the possibility to participate equally in society for as long as possible, manage one’s affairs, engage in personal development, meet friends and enjoy culture. This requires that different services in municipalities and wellbeing services counties 17 Act on Organising Healthcare and Social Welfare Services: https://www.finlex.fi/fi/laki/ alku- p/2021/20210612#Pidm45843170429168 6 § ja 7 § https://www.finlex.fi/fi/laki/alku- p/2021/20210612#Pidm45843170429168 https://www.finlex.fi/fi/laki/alku- p/2021/20210612#Pidm45843170429168 29 Publications of the Ministry of Social Affairs and Health 2024:19 are planned and implemented so that mobility, encounters and accessibility of activities are as accessible and safe as possible. Services that prevent the decline of wellbeing and functional capacity are also included in the planning of services for older people. The use of preventative services and services promoting wellbeing is facilitated if they are easy to find, accessible, obstacle-free, and available in many forms, also digitally alongside other local services. Taking the broad scope of functional capacity into account requires paying attention to the need for multi-professional competence and the inclusion of older people in the planning of services. Good practices y Elintapaohjaus on kunnan ja hyvinvointialueen yhteinen tehtävä (Lifestyle guidance is a joint task of the municipality and the wellbeing services county) – THL. y Elämäntapaohjauksen tarkistuslistoista tukea yhdyspintatyön suunnitteluun (Supporting the planning of interface work with checklists for lifestyle guidance) THL. y The National memory care pathway project: https://urn.fi/ URN:ISBN:978-952-408-226-6 3.1.1 Anticipation of life course Recommendations • Encouraging older people to anticipate and prepare for ageing and their life course. • Encouraging older people to foster and strengthen their functional capacity, wellbeing, health and safety through independent and meaningful activities, offering opportunities for lifelong learning, being involved in everyday life and society, promoting their mental wellbeing, engaging in exercise and spending time in nature, and engaging in physical activity and culture. https://thl.fi/fi/web/hyvinvoinnin-ja-terveyden-edistamisen-johtaminen/hyvinvointijohtaminen/yhdyspinnat-hyvinvoinnin-ja-terveyden-edistamisessa/elintapaohjaus-on-kunnan-ja-hyvinvointialueen-yhteinen-tehtava https://thl.fi/fi/web/hyvinvoinnin-ja-terveyden-edistamisen-johtaminen/hyvinvointijohtaminen/yhdyspinnat-hyvinvoinnin-ja-terveyden-edistamisessa/elintapaohjaus-on-kunnan-ja-hyvinvointialueen-yhteinen-tehtava https://thl.fi/fi/web/hyvinvoinnin-ja-terveyden-edistamisen-johtaminen/hyvinvointijohtaminen/yhdyspinnat-hyvinvoinnin-ja-terveyden-edistamisessa/elintapaohjaus-on-kunnan-ja-hyvinvointialueen-yhteinen-tehtava https://thl.fi/fi/web/sote-palvelujen-johtaminen/-/elintapaohjauksen-tarkistuslistoista-tukea-yhdyspintatyon-suunnitteluun-1?redirect=%2Ffi%2Fweb%2Fsote-palvelujen-johtaminen%2Fajankohtaista%2Fartikkelit https://thl.fi/fi/web/sote-palvelujen-johtaminen/-/elintapaohjauksen-tarkistuslistoista-tukea-yhdyspintatyon-suunnitteluun-1?redirect=%2Ffi%2Fweb%2Fsote-palvelujen-johtaminen%2Fajankohtaista%2Fartikkelit https://thl.fi/fi/web/sote-palvelujen-johtaminen/-/elintapaohjauksen-tarkistuslistoista-tukea-yhdyspintatyon-suunnitteluun-1?redirect=%2Ffi%2Fweb%2Fsote-palvelujen-johtaminen%2Fajankohtaista%2Fartikkelit https://urn.fi/ URN:ISBN:978-952-408-226-6 https://urn.fi/ URN:ISBN:978-952-408-226-6 30 Publications of the Ministry of Social Affairs and Health 2024:19 Preparing for ageing is concerned with anticipation and planning to enable good ageing. Anticipating one’s ageing is part of life course planning. Functional capacity, skills, mental wellbeing and brain health can also be promoted in a preventive manner in municipalities by providing opportunities for lifelong learning, e.g. at a municipal adult education centre or community college18. Minor changes and choices that promote wellbeing are often more beneficial than major lifestyle transformations. It is a good idea to start preparing for retirement financially in good time. In preparations related to housing, it is a good idea to consider one’s wishes and plan them ahead in good time before retirement. When planning housing, safety, functionality, the living environment and the related social relationships should be taken into account. It is important that older people make sure that their matters are handled based on their wishes, even if he or she is no longer able to do so by preparing the necessary documents. A continuing power of attorney prepared with the guidance of an expert can be used to appoint a safe custodian for one’s affairs. Other important documents include an advance directive and last will and testament/digital testament.19 A meaningful life refers to feeling good and engaging in meaningful activities in one’s life. Ageing involves many changes, having to let go and a new kind of freedom. Good relationships should be fostered. When facing life changes, such as retirement, it is a good idea to stop and think about one’s own needs, wishes and expectations. Good practices y The Finger model: https://thl.fi/fi/tutkimus-ja-kehittaminen/ tutkimukset-ja-hankkeet/finger-tutkimushanke y Preparation in one’s own terms: www.vanheneminen.fi y Housing, Alzheimer Society of Finland: https://www.muistiliitto.fi/fi/ muistisairaudet/ asuminen 18 Hyvinvointia ja sosiaalista pääomaa – kansalaisopiston hyödyt osallistujille, kaupungille ja alueelle. Publication of the Municipal Development Foundation 24. 19 Anticipation for old age https://vtkl.fi/vanhuuden-ennakointi https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/finger-tutkimushanke https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/finger-tutkimushanke http://www.vanheneminen.fi/ https://www.muistiliitto.fi/fi/muistisairaudet/asuminen https://www.muistiliitto.fi/fi/muistisairaudet/asuminen https://www.muistiliitto.fi/fi/muistisairaudet/asuminen https://vtkl.fi/vanhuuden-ennakointi 31 Publications of the Ministry of Social Affairs and Health 2024:19 3.1.2 Outreach services for older people Recommendations • Strengthening the operating conditions and possibilities of outreach services for older people. Outreach services for older people20 aim to find older people living at home in need of support through outreach activities or network collaboration. Outreach services help older people whose ability to cope independently in everyday life and participation in activities outside the home has declined, and whose experiences of loneliness and marginalisation have increased. This work is client-driven and goal- oriented, strongly emphasises psychosocial support and strengthens meaningful and safe living at home and agency. Outreach services consist of work carried out by professionals in multiagency networks. Volunteering helps support the inclusion of older people and outreach services promote maintaining the achieved change. Good practices y Etsivä vanhustyö auttaa katveeseen jääneitä ikäihmisiä (Outreach services for older people help older people not otherwise covered by services): https://www. valli.fi/wp-content/uploads/2023/12/Etsiva- vanhustyo_julkaisu-2023_ VALLIry.pdf y Löytävä vanhustyö ikääntyneiden tukena (Outreach services for older people supporting older people): https://innokyla.fi/fi/ toimintamalli/ loytava-vanhustyo-ikaantyneiden-tukena y Mereon etsivä vanhustyö (Mereon outreach services for older people): https://innokyla.fi/fi/toimintamalli/mereon- etsiva-vanhustyo y Elämänote: Löydetyksi tuleminen (Grasp of life: Being reached): https://innokyla.fi/fi/kokonaisuus/ elamanote-loydetyksi-tuleminen/ toimintamallit 20 Etsivä ja löytävä vanhustyö (Outreach services for older people): https://www.valli.fi/ tyomuotomme/verkostokeskus/materiaalit/ https://www.valli.fi/wp-content/uploads/2023/12/Etsiva-vanhustyo_julkaisu-2023_VALLIry.pdf https://www.valli.fi/wp-content/uploads/2023/12/Etsiva-vanhustyo_julkaisu-2023_VALLIry.pdf https://www.valli.fi/wp-content/uploads/2023/12/Etsiva-vanhustyo_julkaisu-2023_VALLIry.pdf https://www.valli.fi/wp-content/uploads/2023/12/Etsiva-vanhustyo_julkaisu-2023_VALLIry.pdf https://innokyla.fi/fi/toimintamalli/loytava-vanhustyo-ikaantyneiden-tukena https://innokyla.fi/fi/toimintamalli/loytava-vanhustyo-ikaantyneiden-tukena https://innokyla.fi/fi/toimintamalli/loytava-vanhustyo-ikaantyneiden-tukena https://innokyla.fi/fi/toimintamalli/mereon-etsiva-vanhustyo https://innokyla.fi/fi/toimintamalli/mereon-etsiva-vanhustyo https://innokyla.fi/fi/kokonaisuus/elamanote-loydetyksi-tuleminen/toimintamallit https://innokyla.fi/fi/kokonaisuus/elamanote-loydetyksi-tuleminen/toimintamallit https://innokyla.fi/fi/kokonaisuus/elamanote-loydetyksi-tuleminen/toimintamallit https://www.valli.fi/tyomuotomme/verkostokeskus/materiaalit/ https://www.valli.fi/tyomuotomme/verkostokeskus/materiaalit/ 32 Publications of the Ministry of Social Affairs and Health 2024:19 3.1.3 Mental wellbeing/positive mental health Recommendations • Identifying the perspective of mental wellbeing as part of the comprehensive wellbeing and functional capacity of older people. • Providing older people and parties working with them with information on mental wellbeing and the means to strengthen it, and supporting the goal-oriented cooperation between various actors to promote the mental wellbeing of older people. Mental wellbeing refers to a person’s experience of their wellbeing and mental balance21. Mental wellbeing is about more than merely the absence of mental health disorders. The positive dimensions of mental wellbeing include satisfaction with life and an experience of purpose, positive emotions, the ability for self- actualisation and personal growth and the management of the social environment. Mental wellbeing lays the foundation for the health, functional capacity and wellbeing of older people and related promotion.22, 23 Changes and losses due to ageing may pose a risk to mental wellbeing. Older people within the scope of the services may also experience challenges related to their mental wellbeing, such as a decline in their abilities and capabilities, feelings of loneliness, insecurity or concern about their coping or future. On the other hand, older people have many ways to maintain their mental wellbeing and their life experiences and skills are a resource when faced with challenges.24 21 Vorma H et al.2020. National Mental Health Strategy and Programme for Suicide Prevention 2020–2030. Publications of the Ministry of Social Affairs and Health 2020:6. http://urn.fi/ URN:ISBN:978-952-00-4139-7 22 Kokko K & Heimonen S (2022) Mielen hyvinvointi ja positiivinen mielenterveys (Mental wellbeing and positive mental health). In: Rantanen Taina, Kokko Katja, Sipilä Sarianna & Viljanen Anne (eds.) Gerontologia. Duodecim, 298–305. 23 Jyväkorpi, S. K., Strandberg, T., Urtamo, A., Pitkälä, K., Suominen, M., Kokko, K., & Heimo- nen, S. (2020). Ikääntyneiden terveys, elämänlaatu, toimintakyky ja mielen hyvinvointi (Health, quality of life, functional capacity and mental wellbeing of older people). Gerontologia, 34(4), 339–344. 24 Björkqvist T. et al. 2022. Mielen hyvinvointi iäkkäiden palveluissa (Mental wellbeing in services for older people). Helsinki: Ikäinstituutti ja Sosiaalitaito. http://urn.fi/ 33 Publications of the Ministry of Social Affairs and Health 2024:19 Positive dimensions related to mental wellbeing anticipate better functional capacity of older people, smooth everyday activities and reduced use of health services. Mental wellbeing contributes to physical health and resilience. Tools for assessing mental wellbeing include a positive mental wellbeing scale (WEMWBS).12, 25 Good practices y Positive mental health (mental wellbeing): https://thl.fi/ fi/ web/mielenterveys/mielenterveyden-edistaminen/ positiivinen- mielenterveys-eli-mielen-hyvinvointi y Addressing the mental wellbeing of informal caregivers: https:// innokyla.fi/fi/ toimintamalli/omaishoitajien-mielen-hyvinvointi-puheeksi y Mental wellbeing: https://ukkinstituutti.fi/liikkumisen-turvallisuus/ kaatumisten-ehkaisy-jarjestotoimijoille/mielen-hyvinvointi/ y Circle of Friends activities: https://vtkl.fi/toiminta/ystavapiiri y Mental Wellbeing in Older Age; Current State of Affairs in Finland: https://urn.fi/ URN:ISBN:978-952-408-123-8 3.1.4 Cultural wellbeing Recommendations • Identifying the significance of art and culture in supporting functional capacity and rehabilitation in municipalities, wellbeing services counties and social networks and integrating cultural wellbeing activities into multidisciplinary activities and the promotion of wellbeing. • Recognising also the work to promote cultural education in liberal adult education institutions and cultural organisations and its significance in promoting wellbeing and inclusion. 25 https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/ positiivinen-mielen- terveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://innokyla.fi/fi/toimintamalli/omaishoitajien-mielen-hyvinvointi-puheeksi https://innokyla.fi/fi/toimintamalli/omaishoitajien-mielen-hyvinvointi-puheeksi https://innokyla.fi/fi/toimintamalli/omaishoitajien-mielen-hyvinvointi-puheeksi https://ukkinstituutti.fi/liikkumisen-turvallisuus/kaatumisten-ehkaisy-jarjestotoimijoille/mielen-hyvinvointi/ https://ukkinstituutti.fi/liikkumisen-turvallisuus/kaatumisten-ehkaisy-jarjestotoimijoille/mielen-hyvinvointi/ https://vtkl.fi/toiminta/ystavapiiri https://urn.fi/ URN:ISBN:978-952-408-123-8 https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi https://thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen/positiivinen-mielenterveys-eli-mielen-hyvinvointi 34 Publications of the Ministry of Social Affairs and Health 2024:19 The challenges to the wellbeing and health of the ageing population can be influenced by means of art and culture. The WHO recommends the use of art and culture in promoting the health and wellbeing of older people.26 Evidence has shown that cultural wellbeing plays a major role in the promotion of preventive functional capacity. Cultural outreach services promote the accessibility of cultural services by targeting services by taking into account the needs and interests of users and bringing the services to the places where potential service users spend their time, also paying attention to older persons within the scope of the services. Cultural outreach services for older people rely on knowledge and understanding, perceiving clients comprehensively from the perspective of health as well as wellbeing promotion.27 Maintaining the experience of inclusion and agency prevents problems from escalating.28 Cultural wellbeing activities allow older people to lead a high- quality and meaningful life on their own terms and ensure that cultural rights are being met. Through inclusion and agency, the activities aim at narrowing wellbeing disparities.29 Art makes the lives of older people visible as a form of active citizenship and promotes a well-functioning democracy. Art and cultural services involve the enjoyment of art and related recreational activities as well as targeted services. Good practices y Cultural outreach services for older people: https://innokyla.fi/fi/ toimintamalli/ etsiva-kulttuurinen-vanhustyo y The AILI network for cultural services for senior citizens and older people: http://ailiverkosto.fi/ index.html 26 Fancourt, Daisy & Finn, Saoirse. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/329834. License: CC BY-NC-SA 3.0 IGO 27 Selin & Siponkoski (2022) Etsivä kulttuurinen vanhustyö. Toimintamallin kuvaus ja vink- kejä soveltamiseen (Cultural outreach services for older people. Description of the model and tips for its application). City of Rovaniemi. https://www.expressmagnet.eu/ pub/135/ Etsiva-kulttuurinen-vanhustyo/ 28 Lars Leemann et al. 2022 Suomalaisten hyvinvointi, THL. 29 Kivelä, Antti et al. 2023 Impacts of culture and sports on wellbeing as part of the decision-making and guidance system http://urn.fi/URN:ISBN:978-952-263-959-2 https://innokyla.fi/fi/toimintamalli/etsiva-kulttuurinen-vanhustyo https://innokyla.fi/fi/toimintamalli/etsiva-kulttuurinen-vanhustyo https://innokyla.fi/fi/toimintamalli/etsiva-kulttuurinen-vanhustyo http://ailiverkosto.fi/index.html http://ailiverkosto.fi/index.html https://iris.who.int/handle/10665/329834 https://www.expressmagnet.eu/pub/135/Etsiva-kulttuurinen-vanhustyo/ https://www.expressmagnet.eu/pub/135/Etsiva-kulttuurinen-vanhustyo/ https://www.expressmagnet.eu/pub/135/Etsiva-kulttuurinen-vanhustyo/ http://urn.fi/URN:ISBN:978-952-263-959-2 35 Publications of the Ministry of Social Affairs and Health 2024:19 3.1.5 Exercise and physical activity Recommendations • Providing older people with physical activity counselling, guided physical activities (especially muscle strength and balance training) and opportunities for everyday physical activity and independent and supported outdoor activities. Exercise and physical activity can promote the health and functional capacity of older people, slow down or fully prevent many illnesses, reduce the harm caused by them, and improve the independent coping and quality of life of older people.30 Physical activity also improves the quality of sleep and sleep patterns, appetite and nutritional status and mental wellbeing of older people and promotes their inclusion in society 31. Key ways to promote physical activity and functional capacity of older people include ensuring the accessibility, safety and comfort of homes and their surroundings, providing accessible walking routes, resting places and local sports facilities, training peer instructors and health and social services personnel in promoting physical activity, supporting physical activity and exercise as part of home and remote visits, offering low-threshold guidance and advice, providing guided outdoor activities and physical activities adjusted based on the individuals’ functional capacity and fitness level, offering assistant services, mobility aids, safety equipment and transport services, and supporting associations in providing physical activities to older people.32 30 Jyväkorpi S et al. 2020. Ikääntyneiden terveys, elämänlaatu, toimintakyky ja mielen hyvinvointi (Health, quality of life, functional capacity and mental wellbeing of older people). Gerontologia 34 31 Physical activity, Current Care Guidelines, Duodecim 13 January 2016. https://www. kaypahoito.fi/ xme-dia/hoi/hoi50075.pdf 32 National Sports Council 31 August 2022. https://www.liikuntaneuvosto.fi/wp-con-tent/ uploads/2022/08/VLN-lausunto-Ikaohjelmasta-vuoteen-2030.pdf https://www.kaypahoito.fi/xmedia/hoi/hoi50075.pdf https://www.kaypahoito.fi/xmedia/hoi/hoi50075.pdf https://www.kaypahoito.fi/xmedia/hoi/hoi50075.pdf https://www.liikuntaneuvosto.fi/wp-con-tent/uploads/2022/08/VLN-lausunto-Ikaohjelmasta-vuoteen-2030.pdf https://www.liikuntaneuvosto.fi/wp-con-tent/uploads/2022/08/VLN-lausunto-Ikaohjelmasta-vuoteen-2030.pdf 36 Publications of the Ministry of Social Affairs and Health 2024:19 3.2 Supporting functional capacity and wellbeing Functional capacity refers to a person’s physical, psychological and social capacity to cope with everyday activities that are meaningful and essential to them (work, study, leisure time, hobbies, taking care of oneself and others) in the environment in which they live. A person’s functional capacity depends on the positive and negative effects of their environment. While it has been recognised that all matters affect health, wellbeing and functional capacity, we can expand the perspective and argue that health and functional capacity affect the person’s entire life. The assessment of rehabilitation needs and the necessary support for rehabilitation must be secured for older people in all operating environments. Rehabilitation support must meet the rehabilitee’s individual needs; it must support the older person’s humane life and smooth everyday life, and at the same time increase safety and reduce loneliness. Services that support rehabilitation promote rehabilitees’ and their family members’ resources, independent life, employability and social inclusion. Rehabilitation is part of the welfare service system and requires timely and seamless services and benefits from several actors.32, 33 33 Vitality in later years: food recommendation for older adults: https://www.julkari.fi/ handle/10024/139415 https://www.julkari.fi/handle/10024/140764 https://www.julkari.fi/handle/10024/140764 37 Publications of the Ministry of Social Affairs and Health 2024:19 3.2.1 Rehabilitation Recommendations • Identifying the physical, psychological, social and safety risk factors related to the functional capacity of older people. Creating operating models for anticipating the emergence of risks and addressing recognised risk factors in a timely manner. • Strengthening the inclusion of older people when identifying rehabilitation needs and creating opportunities to utilise technology to support rehabilitation. • Older people whose physical functional capacity, cognition, senses, memory or mood have declined must be referred to rehabilitative support and rehabilitation support services and aids considered necessary must be arranged for them. • Creating opportunities for older people to engage in meaningful encounters in various food environments such as communal meals33. 38 Publications of the Ministry of Social Affairs and Health 2024:19 Means are available for promoting the functional capacity of older people which older people can adopt independently or with guidance and advice. Paying attention to the functioning of the housing and living environment also enables identifying needs for changes that can support the safety and continuity of independent or supported activities. Concrete measures include taking into account the accessibility of the living environment and home renovations. Functional capacity includes a cognitive dimension, which includes the joint action of the different dimensions of information processing. As the incidence of memory disorders increases, it should be noted that the promotion of the functionality of housing and living environments also includes examining accessibility from cognitive and sensory perspectives.34, 35, 36 It is important for older people to participate in assessing their functional capacity and rehabilitation needs. Examining older people’s functional capacity broadly and listening to them about their experiences of their mood, wellbeing and health is meaningful. Participation in the assessment of functional capacity also supports older people in putting their goals for their rehabilitation into words. The older person’s loved ones can also be involved in the process of assessing functional capacity. When the person’s functional capacity is at risk or has declined, rehabilitation promotes functional capacity and guides older persons to maintain their functional capacity independently. Rehabilitation is a process in which an older person promotes their functional capacity through a goal-oriented plan and support provided by experts. Rehabilitation may also be preventive, systematic and goal- oriented promotion of functional capacity. When planning rehabilitation and its objectives with older people, pay attention to functional capacity extensively, as the dimensions of functional capacity (physical, psychological, cognitive and social) are constantly interacting. Nutrition has a significant impact on the health 34 What is functional capacity? https://thl.fi/fi/web/toimintakyky/mita-toimintakyky-on 35 Kinnunen, M. 2 November 2022. Toimintakyky ja terveys (Functional capacity and health). In Patja, K., Absetz, P. & Rau- tava, P. Terveyden edistäminen. Duodecim 36 Cieza, A., Causey, K., Kamenov, K., Wulf Hanson, S., Chatterji, S. & Vos, T. 2020. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. The 17 Lancet. Vol.396 (10267), 2006–2017. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019 – The Lancet https://thl.fi/fi/web/toimintakyky/mita-toimintakyky-on 39 Publications of the Ministry of Social Affairs and Health 2024:19 and functional capacity of older people. Good nutritional status prevents illnesses, speeds up recovery from illnesses, promotes living at home and improves alertness and quality of life. 17, 37, 38 Good practices y Strength in old age: https://www.voimaavanhuuteen.fi/ y Ikäihmisen kotona kuntoutumisen polku (Path for rehabilitation at home for older people): https://www.terveyskyla. fi/ kuntoutumistalo/kuntoutujalle/ik%C3%A4%C3%A4ntyneille/ ik%C3%A4ihmisen-kotona-kuntoutumisen-polku y Screen for falls: https://ukkinstituutti.fi/liikkumisen-turvallisuus/ kaatumisseula/ y Kotona asuvien ikäihmisten ruokaan liittyvien palvelujen kehittäminen (Development of food-related services for older people living at home): https://urn.fi/URN:ISBN:978-952-344-462-1 y Valtakunnalliset lääkinnälliseen kuntoutukseen ohjaamisen perusteet 2022 (National Criteria for Referring People to Medical Rehabilitation 2022): https://urn.fi/URN:ISBN:978-952-00-5423-6 3.2.2 Functional capacity assessment tools Recommendations • Strengthening the use of RAI assessment data in the assessment of older people’s functional capacity and in the planning, implementation and monitoring of their care. • Developing the measurement and assessment of functional capacity towards uniform functional capacity assessment practices. • Encouraging municipalities and wellbeing services counties to introduce self-assessment tools aimed at older people. 37 Rostgaard, T., Parssons, J. & Tuntland, H. 2023. Reablement in Long-Term Care for Older People. International perspectives and future directions. Bristol University Press. Policy Press. 38 Duodecim health library: https://www.terveyskirjasto.fi/dlk01086 https://www.voimaavanhuuteen.fi/;%20https://www.voimaavanhuuteen.fi/en https://www.terveyskyla.fi/kuntoutumistalo/kuntoutujalle/ik%C3%A4%C3%A4ntyneille/ik%C3%A4ihmisen-kotona-kuntoutumisen-polku https://www.terveyskyla.fi/kuntoutumistalo/kuntoutujalle/ik%C3%A4%C3%A4ntyneille/ik%C3%A4ihmisen-kotona-kuntoutumisen-polku https://www.terveyskyla.fi/kuntoutumistalo/kuntoutujalle/ik%C3%A4%C3%A4ntyneille/ik%C3%A4ihmisen-kotona-kuntoutumisen-polku https://www.terveyskyla.fi/kuntoutumistalo/kuntoutujalle/ik%C3%A4%C3%A4ntyneille/ik%C3%A4ihmisen-kotona-kuntoutumisen-polku https://ukkinstituutti.fi/liikkumisen-turvallisuus/kaatumisseula/ https://ukkinstituutti.fi/liikkumisen-turvallisuus/kaatumisseula/ https://urn.fi/URN:ISBN:978-952-344-462-1 https://urn.fi/URN:ISBN:978-952-00-5423-6 https://www.terveyskirjasto.fi/dlk01086 40 Publications of the Ministry of Social Affairs and Health 2024:19 As of 1 April 2023, carrying out functional capacity assessments with the RAI system (Resident Assessment Instrument) in the regular services for older people has been a statutory duty39. RAI equipment must be used in the assessment of functional capacity when an older person is considered to need regular social welfare services according to an initial assessment performed by a social welfare or healthcare professional for safeguarding their treatment and care40. The RAI system must also be applied to assess changes in the situation of older people receiving services26. However, RAI assessments are always performed in services at least once every six months in accordance with the operating principles set for the RAI system41. In addition to this statutory use, RAI assessment instruments can also be used in other services based on discretion42. The RAI assessment provides comprehensive data on the older person’s physical, psychological, cognitive and social functional capacity, resources and health as well as the related risk factors. The RAI assessment data helps to plan the timing and contents of services, treatment and rehabilitation based on individual needs and goals and to follow the achievement of these goals. If necessary, the assessment can also be supplemented with other reliable functional capacity scales43. The data generated by the assessment of functional capacity is used as the basis for the preparation and implementation of an individual and goal-oriented client and service plan. 39 National Institute for Health and Welfare: Service needs assessment using the RAI system: https://thl.fi/fi/web/ikaantyminen/palvelutarpeiden-arviointi-rai-jarjestelm