National Programme on Ageing 2030 For an age-competent Finland PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Internet: stm.fi /en/publications PUBLICATION SALES: julkaisutilaukset.valtioneuvosto.fi ISSN PDF 1797-9854 ISBN PDF 978-952-00-8431-8 X/2020 TEO KSEN N IM I National Programme on Ageing 2030 For an age-competent Finland Ministry of Social Affairs and Health, Helsinki 2020 Publications of the Ministry of Social Affairs and Health 2020:38 Ministry of Social Affairs and Health ISBN PDF: 978-952-00-8431-8 Cover pictures: Tuula Holopainen, Irmeli Huhtala, Kuvatoimisto Rodeo, Shutterstock Layout: Government Administration Department, Publications Helsinki 2020 Description sheet Published by Ministry of Social Affairs and Health 16 December 2020 Authors Preparatory group for the programme on ageing Title of publication National Programme on Ageing 2030 For an age-competent Finland Series and publication number Publications of the Ministry of Social Affairs and Health 2020:38 ISBN PDF 978-952-00-8431-8 ISSN (PDF) 1797-9854 Website address (URN) http://urn.fi/URN:ISBN:978-952-00-8431-8 Pages 45 Language English Keywords programme on ageing, impact objective, ageing, measures Abstract Preparation of the programme on ageing is included in the Government Programme of Prime Minister Marin’s Government (2020). This report discusses the cross-administrative measures of the programme on ageing, which will be implemented during this government term, and describes the factors related to ageing and the anticipated changes in the operating environment. The work has been prepared by the preparatory group for the programme on ageing. The key impact objectives of the programme on ageing 2030 are to direct to older people and risk groups preventive measures that improve functional ability; to extend the functional ability and working careers of older working-age people, especially in social and health care; to increase and enable voluntary work; to ensure the equality, more efficient coordination and economic sustainability of services for older people; to increase the age-friendliness of housing and residential environments; and to highlight the development and utilisation of Finnish technology for ageing. The action plan outlines measures for both the current government term (2020–2023) and, provisionally, future government terms (2023–2030) in relation to six main impact objectives. During the current government term, the objectives of the programme on ageing will also be implemented as part of other measures such as the health and social services reform. The other planned measures will focus on supporting voluntary work, planning the introduction of welfare technology, developing housing and residential environments, developing services for older people, and projects related to the wellbeing and availability of personnel. The part of the ageing programme for the years 2023–2030 will be prepared by the end of the current government term. Publisher Ministry of Social Affairs and Health Distributed by/ Publication sales Online version: julkaisut.valtioneuvosto.fi Publication sales: julkaisutilaukset.valtioneuvosto.fi http://urn.fi/URN:ISBN:978-952-00-8431-8 https://julkaisut.valtioneuvosto.fi/ http://julkaisutilaukset.valtioneuvosto.fi/Etusivu Kuvailulehti Julkaisija Sosiaali- ja terveysministeriö 16.12.2020 Tekijät Ikäohjelman valmisteluryhmä Julkaisun nimi Kansallinen ikäohjelma vuoteen 2030 Tavoitteena ikäkyvykäs Suomi Julkaisusarjan nimi ja numero Sosiaali- ja terveysministeriön julkaisuja 2020:38 ISBN PDF 978-952-00-8431-8 ISSN PDF 1797-9854 URN-osoite http://urn.fi/URN:ISBN:978-952-00-8431-8 Sivumäärä 45 Kieli englanti Asiasanat ikäohjelma, vaikuttavuustavoite, ikääntyminen, toimenpiteet Tiivistelmä Ikäohjelman valmistelu sisältyy Marinin hallitusohjelmaan (2020). Tässä raportissa käsitellään tämän hallituskauden ajalla toteutettavia poikkihallinnollisia ikäohjelman toimenpiteitä ja avataan ikääntymiseen liittyviä tekijöitä sekä toimintaympäristön ennakoituja muutoksia. Työtä on valmisteltu ikäohjelman valmisteluryhmässä. Ikäohjelman 2030 keskeisinä vaikuttavuustavoitteina on suunnata ennaltaehkäiseviä ja toimintakykyä parantavia toimia iäkkäälle väestölle ja riskiryhmille, pidentää ikääntyvien työikäisten toimintakykyä ja työuria, erityisesti sosiaali- ja terveydenhuollossa, lisätä ja mahdollistaa vapaaehtoistyötä, varmistaa iäkkäiden palvelujen yhdenvertaisuus, tehokkaampi koordinaatio ja taloudellinen kestävyys, lisätä asumisen ja asuinympäristöjen ikäystävällisyyttä ja nostaa esille suomalaista ikäteknologian kehittämistä ja hyödyntämistä. Toimintasuunnitelmassa on linjattu sekä nykyisen hallituskauden (2020–2023) että alustavasti tulevien hallituskausien (2023–2030) toimenpiteitä suhteessa kuuteen isoon vaikuttavuustavoitteeseen. Nykyisen hallituskauden aikana ikäohjelman tavoitteita toteutetaan myös osana muuta toimintaa mm. tulevaisuuden sote-uudistuksessa. Muu osa suunnitelluista toimenpiteistä kohdentuu vapaaehtoistyön tukemiseen, hyvinvointiteknologian käyttöönoton suunnitteluun, asumisen ja asumisympäristöjen kehittämiseen sekä ikäihmisten palveluiden kehittämiseen sekä henkilöstön hyvinvointiin ja saatavuuteen liittyviin hankkeisiin. Vuosien 2023–2030 ikäohjelman osuus valmistellaan kuluvan hallituskauden loppuun mennessä. Kustantaja Sosiaali- ja terveysministeriö Julkaisun myynti/ jakaja Sähköinen versio: julkaisut.valtioneuvosto.fi Julkaisumyynti: julkaisutilaukset.valtioneuvosto.fi http://urn.fi/URN:ISBN:978-952-00-8431-8 https://julkaisut.valtioneuvosto.fi/ http://julkaisutilaukset.valtioneuvosto.fi/Etusivu Presentationsblad Utgivare Social- och hälsovårdsministeriet 16.12.2020 Författare Beredningsgruppen för åldersprogrammet Publikationens titel Nationellt åldersprogram fram till år 2030 För ett ålderskunnigt Finland Publikationsseriens namn och nummer Social- och hälsovårdsministeriets publikationer 2020:38 ISBN PDF 978-952-00-8431-8 ISSN PDF 1797-9854 URN-adress http://urn.fi/URN:ISBN:978-952-00-8431-8 Sidantal 45 Språk engelska Nyckelord åldersprogram, effektmål, åldrande, åtgärder Referat Beredningen av åldersprogrammet ingår i Marins regeringsprogram (2020). I den här rapporten behandlas de förvaltningsövergripande åtgärder som genomförs under innevarande regeringsperiod och redogörs för olika faktorer som ansluter sig till åldrandet samt de prognostiserade förändringarna i omvärlden. Arbetet har beretts i en särskild beredningsgrupp för åldersprogrammet. De centrala effektmålen för Åldersprogrammet 2030 är att rikta in förebyggande åtgärder och åtgärder som förbättrar funktionsförmågan på den äldre befolkningen och riskgrupperna, förlänga funktionsförmågan och arbetskarriärerna bland äldre i arbetsför ålder i synnerhet inom social- och hälsovården, öka och möjliggöra frivilligarbete, säkerställa likabehandling, effektivare samordning och ekonomisk hållbarhet inom äldreservicen, öka äldreanpassningen i boendet och boendemiljöerna och lyfta fram utvecklingen och utnyttjandet av finländsk teknik för äldre. Handlingsplanen drar upp riktlinjer för åtgärderna under innevarande regeringsperiod (2020–2023) och preliminärt också för åtgärderna under kommande regeringsperioder (2023–2030) i förhållande till sex övergripande effektmål. Under innevarande regeringsperiod genomförs arbetet för att nå åldersprogrammets mål också inom ramen för annan verksamhet, bl.a. framtidens vårdreform. De övriga planerade åtgärderna riktar sig på att stödja frivilligarbete, planera införandet av välfärdsteknik, utveckla boende och boendemiljöer och tjänsterna för äldre samt genomföra projekt kring personalens välbefinnande och tjänsternas tillgänglighet inom äldreservicen. Beredningen av åtgärder som hänför sig till 2023–2030 slutförs före utgången av innevarande regeringsperiod. Förläggare Social- och hälsovårdsministeriet Beställningar/ distribution Elektronisk version: julkaisut.valtioneuvosto.fi Beställningar: julkaisutilaukset.valtioneuvosto.fi http://urn.fi/URN:ISBN:978-952-00-8431-8 https://julkaisut.valtioneuvosto.fi/ http://julkaisutilaukset.valtioneuvosto.fi/Etusivu Table of Contents FOR THE READER ................................................................................................................................................................... 9 1 Background ................................................................................................................................................................... 11 2 An operating environment in transition ............................................................................................ 14 2.1 Population ageing............................................................................................................................................................ 15 2.2 Wellbeing of the ageing population............................................................................................................. 17 2.3 Urbanisation........................................................................................................................................................................... 19 2.4 Climate change................................................................................................................................................................... 20 2.5 Funding and preparedness..................................................................................................................................... 21 2.6 Technological breakthrough ................................................................................................................................ 22 2.7 Change in inclusion........................................................................................................................................................ 22 2.8 Reforming health and social service structures ............................................................................... 24 3 Cross-administrative programme on ageing 2030 – An age-competent Finland ..................................................................................................................................................................... 26 3.1 Programme on ageing 2030 – impact objectives............................................................................ 28 3.2 Operational programme 2020–2023 and preliminary proposals for measures 2023–2030.................................................................................................................................................... 29 3.2.1 Older people retain their functional capacity for a longer time................................................ 29 3.2.2 The functional capacity of older working-aged people has improved and careers have a longer duration, particularly in the services for older people ..................................... 33 3.2.3 Technology, artificial intelligence and robotics have increased wellbeing............................. 35 3.2.4 Voluntary work has an established position in the ageing society .......................................... 38 3.2.5 Housing and living environments are age-friendly ...................................................................... 41 3.2.6 Services are implemented in a socially and economically sustainable manner.................... 43 9 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND F O R T H E R E A D E R The Finnish population is ageing at an increasingly rapid pace. In its programme, Prime Minister Marin’s Government has outlined that a cross-administrative programme on ageing will be drawn up in cooperation with various ministries, municipalities, the third sector and other actors to prepare for the societal change resulting from the ageing of the population. Preparations for drawing up this programme have been carried out as part of official work, but they have also included extensive participation from various stakeholders since autumn 2018. One of the tasks of the working group on the reform of the services for older people, which operated from 2019 to 2020, was to guide the preparation of the Programme on Ageing. Based on a proposal by the working group, a cross-administrative expert group was established. The expert group prepared the present plan for operational programmes based on the content areas of the National Programme on Ageing, the measures to be launched during this government term, and the organisation of the programme in spring 2020. Preparation group for the National Programme on Ageing: Satu Karppanen, Ministry of Social Affairs and Health Raija Hynynen, Ministry of the Environment Mikko Martikainen, Ministry of Economic Affairs and Employment Anne Mårtensson, Ministry of Education and Culture Maria Wakeham-Hartonen, Ministry of Justice Anna Haverinen, Association of Finnish Municipalities Anja Noro, Finnish Institute for Health and Welfare 10 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 11 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 1 Background The ageing of the Finnish population is not only a question of an increase in the number of older people but also of a change in the age structure of the entire population. Its underlying factors include Finland’s baby boomer generation coming to old age, and a decrease in birth rate and mortality. Population projections indicate that the number of older persons in the oldest age groups will particularly increase while the number of children and working-age population will decline. Over the following decades, the change will be so significant that it will affect society as a whole and everyone involved in it. It poses such challenges for the welfare society that require determined preparedness and adaptation to the needs of the older population. The Government Report on the Future 20041 concerned demographic development, population policy and preparing for ageing. The report defined the objectives of a broad- based ageing policy. The report required conducting regular assessment of the trends in population ageing, its consequences and related preparedness utilising updated demographic projections. The first of these kinds of broader reports on ageing was published in 20092. The aim was to update the outlook on demographic trends and to form an overall view of the impacts of ageing development, the preparation policy implemented or decided on, and the need for new policy measures. At the time, the key challenge was considered to involve determining how public finances can be prevented from derailing due to accelerating indebtedness, while securing the welfare of the non-working population at reasonable tax levels. The solution to the challenge was considered to involve breaching the sustainability gap of public finances through measures promoting a rise of the employment rate, enhancing the efficiency of public service provision and improving the health and functional ability of citizens. The key aspects of population ageing discussed 1 Hyvä yhteiskunta kaikenikäisille: valtioneuvoston tulevaisuusselonteko väestökehityksestä, väestöpolitiikasta ja ikärakenteen muutokseen varautumisesta. [A good society for people of all ages: the Government’s foresight report on demographic development, demographic policy and preparing for change in the age structure.; in Finnish] Prime Minister’s Office Publications 27/2004. 2 Ageing Report. Overall assessment of the effects of ageing and the adequacy of preparation for demographic changes. Prime Minister’s Office Publications 1/2009. 12 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 in the 2009 ageing report continue to be topical today. Where appropriate, the currently prepared National Programme on Ageing 2030 is built on the previously completed work, continuing and completing it. In its meeting held in 1992, the UN General Assembly decided that each member state should establish a national body for preparing a strategy and action plan related to ageing. The Suomen Vanhuspolitiikka vuoteen 2001 (Finland’s old age policy until 2001) committee report 3 highlights a number of themes that remain topical, including the deterioration of the population dependency ratio as a result of the ageing of large age groups, urbanisation, changing families and the work ability of ageing workers. Although the operational programme only extended to 2001, the report also outlined a longer-term vision for the future all the way until 2020. In the National Programme on Ageing Workers 1998-20024, the key measures were concerned with preserving employees’ health and work ability, and coping with work. The aim of the programme was to increase the employment of population aged 55 and above, and to reduce the labour shortage caused by the exit of large age groups from the labour market. Indeed, the programme resulted in the employment rate of older age groups developing faster in Finland than in the EU countries on average. The employment rate of those aged over 55 also increased faster than for younger age groups. A total of 300,000 new jobs were created in Finland between 1999 and 2001, and as many as three quarters of these jobs benefited women and men over the age of 55. Ageing is also an international trend, which also makes phenomena related to the ageing of the population, including an increase in memory disorders, an area of interest in the arena of international activities. In 20175 , the WHO published a global strategy and action plan on ageing and health. The strategy defines a vision of a world in which everyone has an opportunity to live a long and healthy life. The strategic objectives identified in the document include the commitment to promoting healthy (and prosperous) ageing in all countries, developing age-friendly environments, adapting health systems (and social welfare systems) to the needs of an ageing population, developing sustainable and fair systems for long-term care for older people (home, communities and institutions) and improving the measurement, monitoring and research of healthy ageing (with good wellbeing). The strategy also includes the preparation of the Decade of Healthy Ageing 2020–2030. The preparatory phase involves defining the impacts we are aiming to achieve 3 Vanhuspolitiikkaa vuoteen 2001: Suomen vanhuspoliittisen tavoite- ja strategiatoimikunnan mietintö. Ministry of Social Affairs and Health, Committee report B:1996:1. 4 National Programme on Ageing Workers 1998–2002. Measures in the administrative branch of the Ministry of Social Affairs and Health in the implementation of the National Programme on Ageing Workers (1998–2002) in the period 1998–1999. Ministry of Social Affairs and Health Working group memorandum 1998:13. 5 Global strategy and action plan on ageing and health. Geneva: World Health Organization; 2017. 13 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND by 2030, describing what the best-case scenario will look like both globally and nationally, and assessing what measures are needed to achieve the desired impacts. The national programme on ageing 2030, which has now been prepared, is a natural part of this international work, as the presented needs and objectives are similar. The challenges posed by the ageing of the population are complex and interdependent. We need to find solutions quickly because ageing is progressing rapidly. However, no single entity is responsible for solving the challenges associated with this phenomenon. Several administrative branches are examining the topic from their own perspectives without a shared vision, coordination and cooperation. The issues related to the ageing of the population will also not be solved during a single government term; instead, managing them requires long-term cross-administrative commitment and development. One of the aims of this work is to define a shared direction and a set of approaches for examining the issues beyond individual parliamentary terms and within a broader perspective than the sectoral division of the ministries. (Adapted from an op-ed by Sitra’s Mikko Kosonen in the Helsingin Sanomat, 29 August 2018) Sitra’s Megatrends 20206 list the ageing and increased diversity of the population as one of the key trends. The megatrends related to ageing also include the integration of technology in everything, the strengthening of relational power and a search for a new direction in the economic system. A new challenge emerging in 2020 is the COVID-19 outbreak, for which neither the megatrends nor any national activities in Finland had prepared, but which corresponds to “Disease X” identified by the WHO’s preparedness activities.7 COVID-19 has proven to be particularly dangerous for the ageing population. The currently prepared programme on ageing sets long-term, measurable impact objectives related to the challenges arising from the ageing of the population for 2030. Each government term will involve drawing up an action plan specifying the necessary measures and assessing their implementation in relation to the long-term objectives. The implementation of the set objectives will lend itself to monitoring and assessment. Alongside the measures, it is important to understand the mechanisms of change that enable adapting the system to changing circumstances flexibly and in a timely manner in relation to the long-term objectives. 6 Dufva M. Megatrends 2020. Sitra reports 162, January 2020. 7 “List of Blueprint priority diseases”. World Health Organization. 7 February 2018. (Last accessed on 6 May 2020 2020. http://origin.who.int/blueprint/priority-diseases/en/ https://en.wikipedia.org/wiki/World_Health_Organization 14 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 2 An operating environment in transition The futures reviews8 by the ministries published in early summer 2018 outlined changes in the operating environment and the measures required in rising up to the emerging challenges from the perspective of each administrative branch. Factors significant from the perspective of preparing for the ageing of the population included in the futures reviews are examined in this programme. According to the futures review by the Ministry of Social Affairs and Health (2018)9, Finland’s and Finnish people’s position in the world will be increasingly defined by much closer global interdependencies during Finland’s coming government terms. As a result, major global megatrends will affect the wellbeing, equality and safety of Finns. Technological development and the transformation of competencies and work will contribute to shaping society. Climate change, demographic development and urbanisation will force Finland to redirect its resources in a new way. In the 2030s, the world will be both networked and fragmented and the Finnish society will be even more diverse than it is now. The futures review of the Ministry of Finance (2018)10 highlights the functioning of public administration as a prerequisite for the sustainability of public finances, a level playing field for companies, and equal access to services and benefits provided to inhabitants. Social welfare and health care structures need to be reformed to ensure that they can provide people with more equal services. Cooperation between different agents should reduce inequalities in welfare and health, and curb an increase in expenditure as the ageing of the population increases demand for services, including social and health services. The implementation of the health and social services reform and ensuring the implementation and monitoring of the objectives set for the will be among the key tasks of the following government term. 8 https://vnk.fi/tulevaisuuskatsaukset 9 A cohesive society and sustainable wellbeing – Futures Review by the Ministry of Social Affairs and Health. Finnish government publication series 22/2018. 10 Work, well-being and future – Futures review of the Ministry of Finance. Finnish government publication series 17/2018. https://vnk.fi/tulevaisuuskatsaukset 15 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND However, the challenges posed by the 2020 COVID-19 pandemic may also reduce global dependency, and the pandemic also demonstrates the need for preparedness. COVID-19 has proved particularly dangerous for the older population, requiring a wide range of societal measures to protect the older population and other risk groups, especially those already covered by regular services. 2.1 Population ageing The decline in birth rates will be reflected in the future demographic development in Finland’s regions. According to the 2019 population projection by Statistics Finland11, in 15 years, there will be no counties in Finland where the number of people born will be higher than the number of deaths if the birth rate remains at the currently observed level. Based on the current trend, the population number will start declining in 2031, and will be around 100,000 lower than today by 2050. A comparison of the 2019 population projection with the 2015 and 2018 projections reveals that, in addition to the trends in the population number, the biggest differences in the short term will concern the projected trends in the number of young people and, in the longer term, the working-age population. In the 2019 projection, the number of people under the age of 15 in 2040 would be 688,000, which is 178,000 less than in the 2015 and 47,000 less than in the 2018 projection. The number of people of working age (aged between 15 and 64) was highest in Finland in 2009, when there were 3.55 million people of working age in Finland. Between 2010 and 2018, the number of people of working age has decreased by 122,000. Over the next two decades, the decline in working-age population is expected occur more slowly, i.e. by 111,000 people by 2040. The decline in the working-age population would accelerate in the 2040s as a result of the decline in birth rates. The working-age population would decrease by 132,000 people in the period 2041–2050 and further by 163,000 people in the period 2051–2060. At the end of 2060, the working-age population would amount to 3.19 million people, which is slightly above 400,000 less than today. According to the Statistics Finland projection, the working-age population accounted for 62 per cent of the population in 2019. The share is estimated to drop to 60 per cent by 2040 and 57 per cent by 2060. In the 2019 projection, the share of the working-age 11 Official Statistics of Finland (OSF): Population projection [online publication]. ISSN=1798-5137. 2019. Helsinki: Statistics Finland [referenced on 8 May 2020]. Accessed at: http://www.stat.fi/til/vaenn/2019/ vaenn_2019_2019-09-30_tie_001_fi.html http://www.stat.fi/til/vaenn/2019/vaenn_2019_2019-09-30_tie_001_fi.html http://www.stat.fi/til/vaenn/2019/vaenn_2019_2019-09-30_tie_001_fi.html 16 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 population of the entire population will remain higher than in the two previous projection until 2060, as the lower birth rate will cause the population rate to also take a downward turn at an earlier point. The demographic dependency ratio of Statistics Finland (Figure 2) indicates that there are major regional differences. The situation in South Savo was already the worst in 2019 and the projection for 2030 continues to be poor. Similarly, the situation in Uusimaa is fairly good and will remain fairly good until 2030, as is the case in Pirkanmaa. The situation with population ageing is already fairly poor in some regions, particularly those with smaller populations and the regions of Eastern and Northern Finland. Figure 1.  The share of different age groups in the population in 1970 to 2018, and years 2020 to 2070 (projection), per cent. According to the Ministry of Economic Affairs and Employment12, the projection scenarios indicate that the demand for labour in 2030 seems to be 458,000 higher than previously estimated, and, with regard to the attrition rate, the number of job vacancies would be around 283,000. When taking into account people graduating with degrees or qualifications by 2030, around 211,000–248,000 people would be available to the labour market assessed based on previous trends. Based on this very rough estimate, the number of graduates would only just suffice to fill the deficit. However, the estimate is based on rather uncertain assumptions about an increase of GDP, growth in labour productivity and a delay in service needs by half of life expectancy. 12 Koponen E-L. Sosiaali- ja terveysalan työvoiman riittävyys nyt ja tulevaisuudessa. Ministry of Economic Affairs and Employment reports 13/2015. 17 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 0 10 20 30 40 50 60 70 80 90 100 2019 2030 So ut h Sa vo Ka in uu Ce nt ra l O st ro bo th ni a So ut he rn O st ro bo th ni a Sa ta ku nt a Ky m en la ak so Pä ijä t- H äm e So ut he rn K ar el ia Ka nt a- H äm e O st ro bo th ni a N or th K ar el ia La pl an d N or th S av o Ce nt ra l F in la nd N or th er n O st ro bo th ni a So ut hw es t F in la nd W H O LE C O U N TR Y Ta m pe re R eg io n U us im aa Figure 2.  Demographic dependency ratio in 2019 and forecast for 2030, sorted by region based on the situation in 2019. Source: Population projection, Statistics Finland. As the average age of the population increases and the population of working age decreases, immigration could partly secure the availability of labour in different sectors. Annual immigration should grow to 34,000 immigrants to meet the needs for labour force (study produced by the Finnish Business and Policy Forum EVA in 2015). The Ministry of the Interior’s futures review13 estimates that immigration should be continuous and immigrants’ employment rate high, if the intention is to create a positive change in the dependency ratio through immigration. 2.2 Wellbeing of the ageing population In 2019, there were 1.2 million citizens aged 65 or over in Finland. One in five Finnish men and one in four Finnish women are aged 65 or over. Nearly one in a hundred Finns is at least 90 years old. Ageing also extensively affects public health. The challenges that should be prevented include lack of physical activity, nutritional problems for older people, such as overweight and underweight and undernutrition, and substance abuse, mental health problems and loneliness. The promotion of wellbeing and health is jointly implemented 13 Finland to be the safest country in the world – Futures Review of the Ministry of the Interior. Finnish government publication series 12/2018. 18 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 by municipalities, social welfare and health care providers, and non-governmental organisations. While age does not in itself cause limitations to people’s functional capacity, there are more prevalent in older people as a result of many diseases increasing with older age, especially memory disorders. Globally, the number of people with memory disorders is growing significantly. In 2015, around 50 million people worldwide were estimated to have memory disorders, and the number is expected to double once every 20 years. It is estimated that there are more than 190,000 people with memory disorders in Finland, and some 14,500 people have been estimated to develop a memory disorders in Finland every year. Although the majority of those with memory disorders are over 80 years old, more than 7,000 people of working age (between 35 and 65 years old) have also been diagnosed with progressive memory disorders. Three out of four older people in long- term care have a memory disorder, and even more have cognitive disorders14. Population aged 75 or over, not covered by regular services or allowances for older people Persons cared for under informal care support aged over 75 during the year as a percentage of the population in this age group Clients aged over 75 who regularly received home care on 30 Nov as a percentage of the population in this age group Clients aged over 75 in ordinary sheltered housing for older people on 31 Dec as a percentage of the population in this age group Clients aged over 75 in sheltered housing with 24-hour assistance for older people on 31 Dec as a percentage of the population in this age group Long-term clients of health centres aged over 75 on 31 Dec as a percentage of the population in this age group Clients of old people’s homes aged over 75 on 31 Dec as a percentage of the population in this age group Figure 3.  Share of population aged 75 or older who do not use regular services and those covered by services and allowances broken down by services. (Some of the service users may be covered by several services at the same time). 14 see also Aivot- ja mieli konsensuslausuma [Consensus statement on the brain and mind; in Finnish]. https:// www.duodecim.fi/wp-content/uploads/sites/9/2020/03/Konsensuslausuma-versio-1.6-3.pdf https://www.duodecim.fi/wp-content/uploads/sites/9/2020/03/Konsensuslausuma-versio-1.6-3.pdf https://www.duodecim.fi/wp-content/uploads/sites/9/2020/03/Konsensuslausuma-versio-1.6-3.pdf 19 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND The growth in the population aged over 64 is both a resource and a challenge for both society as a whole as well as the organisation and provision of social welfare and health care services. The need for regular support and services only begins to grow more after a person reaches the age of 75. At this point, only one out of four people is within the scope of regular support or services; only one out of 100 of these individuals is treated in an institutional care facility and around 7.5 per cent in sheltered housing with 24-hour assistance (Figure 3). The diversity of the older population will increase in the coming years. 2.3 Urbanisation Urbanisation and the concentration of the population to the largest urban centres also contribute to the deterioration of the economic dependency ratio in sparsely populated areas. This makes it difficult to secure services and diminishes the competitiveness of the regions. It is estimated that around 70 per cent of the Finnish population live in cities and their fringe areas15. The moving of young people and women to growth centres for work and studies particularly worsens the dependency ratio and distorts the population structure of some regions. On the other hand, research results indicate that the attractiveness of rural areas can be increased by means of high-speed telecommunications connections and well-functioning services. The decline in rural population results in a decline in infrastructure, including the economic foundation for maintaining road, water supply and telecommunications networks, which poses major challenges for rural development. Another anticipated threat caused by urbanisation is that the social sustainability of urban areas that have been developing relatively harmoniously thus far will start declining, leading to more pronounced segregation. Urban policy is based on taking into account the increasingly diverse challenges of cities, including challenges related to ageing. Different urban regions need solutions that fit them, and central government must encourage and enable these. Strengthening the internal integrity of cities, combating segregation, reducing inequality and strengthening residential areas also supports the wellbeing and functional capacity of the ageing population, therefore also supporting their independent living at home. At the municipal level, the ageing of the population may increase social welfare and health care expenditure at the same time as tax revenue decreases as the number of working age population grows smaller. 15 Competitive advantage from clean food and responsible bioeconomy and circular economy – Futures review of the Ministry of Agriculture and Forestry. Finnish government publication series 18/2018. 20 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 2.4 Climate change The impacts of climate change also apply to older people, which makes it important to monitor and prepare for these. Prolonged heat waves can be fatal especially for people over 75 years of age. According to a study conducted in Finland a few years ago, on average, hot weather has increased mortality by up to 21 per cent in the 2000s16. Heatwaves are estimated to pose a higher risk for women than for men. As people age, the body’s temperature regulating capacity decreases, which also increases the risk of fluid deficit. Mortality risk is particularly high in people with circulatory and respiratory diseases, mental health disorders or diseases of the nervous system. Living alone can also increase the health risk17. As the harmful effects of climate change, such as warming and storms, are expected to affect vulnerable population groups most severely, the need for social support and assistance will also increase. Rising energy costs and the transition to carbon-neutral energy will also weaken the status of low-income and impoverished people, many of whom already live in inadequate conditions, unless they are provided with social support. The social welfare and health care service system will have to adapt to climate change as a result of a change in the type of people in need of help and support and the amount of help needed. One of Sitra’s 2020 megatrends18 is also related to climate change and suggests that there is an urgent need for ecological reconstruction. UN 2030 Agenda for Sustainable Development aims to redirect the global development on a track that safeguards human well-being and human rights, economic prosperity and stability of societies in an environmentally sustainable manner. Finland is committed to contribute to the promotion of the sustainable development goals. According to estimates, Finland’s biggest challenges in sustainable development policy are related to climate change, the state of the environment and consumption as well as growing inequality in society. Prime Minister Sanna Marin’s Government has identified climate change as the biggest threat to humanity and is committed to acting towards a Finland that is carbon neutral by 2035 and carbon negative quickly thereafter. It is important that this transition will be implemented through not only ecological, but also through economical and socially sustainable solutions. Any measures taken should also identify and make visible their impacts on the ageing population, and ensure that no one is left behind in society. 16 Kollanus V ja Lanki T. 2000-luvun pitkittyneiden helleaaltojen kuolleisuusvaikutukset Suomessa. Lääketieteellinen aikakausilehti Duodecim 2014;130(10):983-90. 17 https://thl.fi/fi/web/ymparistoterveys/ilmasto-ja-saa/helle (last accessed on 6 May 2020) 18 Dufva M. Megatrends 2020. Sitra reports 162, January 2020. https://thl.fi/fi/web/ymparistoterveys/ilmasto-ja-saa/helle 21 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 2.5 Funding and preparedness Demographic change is expected to increase expenditure on pensions, health care and nursing, which cannot be funded by the current, already fairly high tax rate alone19. In addition, general government revenue is not sufficient to maintain all public sector structures and tasks built on faster growth. Indebtedness will continue during the next decade. Economic growth is not considered the only means to solve the structural problems in public finances. Instead, there is also a need for measures for increasing the employment rate and improving the efficiency of public service provision. Although the state of the pension system was stable in 2018, the pressures to increase pension contributions are expected to grow unreasonably if future development remains below the projections. According to population projections, people aged over 75 will be the only growing age group. This age group will continue to cause the greatest cost pressures on social welfare and health care services. On the other hand, the pensioner population emerges as a major consumer group, as emphasised by the concept of the Silver Economy. According to an estimate by the Ministry of Finance, the key to maintaining a sustainable Nordic welfare state is achieving a permanently sufficiently high employment rate of around 80%. The actual retirement age of people at the end of their careers plays an essential role. This is influenced not only by the pension system, but also by employees’ work ability and flexible working arrangements. Continuing involvement in the workforce can be promoted by supporting people’s work ability and health, and by offering flexible opportunities for work, such as part-time work, as ageing can reduce people’s work ability. The reform of continuous learning (Ministry of Education and Culture) responds to the need to develop and renew competence at different stages of people’s lives and careers. The reform of continuous learning focuses on developing the competence of the working-age population. Various conversion, supplementary and specialisation training programmes contribute to providing people with the skills required by the changing labour market, enabling them to continue working for longer. The pension system and other social security systems must enable flexible work. 19 Work, well-being and future - Futures review of the Ministry of Finance. Finnish government publication series 17/2018. 22 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 2.6 Technological breakthrough Working life is currently undergoing a transformation which involves technological solutions replacing monotonous work tasks.20. Artificial intelligence, information technology and automation are expected to replace human labour in both industrial production and also in several service sectors and expert positions. An increase in the demand for human labour force is particularly expected to emerge in services based on personal contact, in tasks requiring creativity or craft skills, and in special tasks requiring a high level of competence. The futures review by the Ministry of Finance21 estimates that digitalisation will improve access to public services for people able and willing to use the internet. For these people, digital services available independent of time and place reduce inequalities caused to service users by factors such as geographical location or life situation. In the futures review by the Ministry of Education and Culture22 , the aim is also to develop a digital service package to support continuous learning and development of competence among the population. The package consists of services supporting continuous learning needed by citizens at different stages of their lives, services for charting and identifying competence, career planning and counselling services, competence acquisition and development services, and support services required for the interoperability of the service package. 2.7 Change in inclusion The futures review of the Ministry of Justice23 estimates that democracy has strong traditions in Finland and is highly valued among the citizens. The review emphasises that a free and vibrant civil society increases social capital and trust, and helps keeping everyone involved in society. From the point of view of a functioning democracy, it is considered important that organisational and civic activities continue to be autonomous and vibrant instead of something perceived merely as service activities. The solution is considered to include providing opportunities for participation, especially for those with 20 From transformation to new growth – Futures Review of the Ministry of Economic Affairs and Employment Finnish government publication series 20/2018. 21 Work, well-being and future – Futures review of the Ministry of Finance. Finnish government publication series 17/2018. 22 Making Finland the most competent nation in the world – Futures Review of the Ministry of Education and Culture Finnish government publication series 21/2018. 23 The Rule of Law and Stable Democracy. Futures Review of the Ministry of Justice. Finnish government publication series 14/2018. 23 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND a low level of participation. Increasing new opportunities for participation and equal use at local and regional level is also considered important, as is providing more opportunities for electronic participation. Supporting the operating conditions of organisations and volunteers is considered important. Finnish democracy relies on the rule of law, in which the constitution provides strong protection for the human dignity and integrity of every individual and other fundamental rights. Individuals must be able to trust that their rights are implemented equally and get to contribute to deciding on shared matters. It is important that everyone can participate in joint decision-making. It is key to create means for participation together to ensure that everyone can find a suitable channel for exerting influence, regardless of aspects such as digital skills and capabilities. Particular attention should be paid to vulnerable groups that lack strong structures for participation and whose voices can easily be left unheard. It is necessary for public administration to invest in appropriate and clear language use when communicating about preparation and decision-making. Local democracy and municipalities play a key role in instilling democracy and inclusion in the local level and in strengthening everyday participation. The public authorities can promote citizens’ opportunities for participation by developing legislation (including participatory rights), information steering and guidelines, communication, and by directing resources to the development of democracy and the promotion of civic involvement. Volunteering is inherently gratuitous and voluntary. The Ministry of Justice coordinates the prerequisites of volunteering at Finland’s Government level. Volunteering is an important option that increases the participation of both pensioners and older people in need of help. Strengthening the social inclusion of older people requires identifying and compiling positive examples. Municipalities and non-governmental organisations engage in diverse work aiming to support and activate older people. Loneliness could be alleviated by identifying lonely older people through means such as outreach work targeting older people and by providing different support solutions or practical support, such as volunteers helping older people with using services or spending time outdoors with them. Different services, groups and forms of support must also be made available to everyone, also in digital environments. All people, including older people, wish to live meaningful lives. They are committed to issues and objectives that are important and meaningful to them. Inclusion and active citizenship create wellbeing, openness and security. People who find their lives meaningful also tend to feel responsible for others and their environment, and appreciate and take care of their health. 24 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 One of the most important aspects of the promotion of wellbeing and health involves increasing the involvement of older people in maintaining their personal wellbeing and health, and in developing the services available for them. The presently retiring age groups are used to managing their own issues very independently. As pensioners do not constitute a homogenous group, the things they find meaningful and valuable can vary considerably. There are major socio-economic differences among pensioners. They may find meaning in their lives through both immaterial and material goods. In the future, an increasing amount of innovations will be immaterial rather than material and technological. Social problems are also increasingly immaterial challenges related to the meaningfulness of life. At the moment, there is an interest and need to perceive a large number of older adults as a resource that will be increasingly involved in society, use their time in volunteering and more involved in supporting their families in the future24. Health and functional capacity are major values for older people, as are the rights to subsistence and making personal decisions. During the early stage of the 2020 COVID-19 pandemic, the right to life was considered a fundamental right. As a result, such restrictive measures were taken that may have affected the wellbeing and functional capacity of the older population. According to a report by the working group on the coronavirus exit and reconstruction strategy led by State Secretary Hetemäki, non-governmental organisations and civic activities play an important role during the coronavirus epidemic and in related after-care. Good cooperation between the authorities, decision-makers and civil society actors is a strength that must be further developed from the perspective of both preparedness and strengthening resilience. A well-functioning and active civil society increases social capital and trust and helps taking different population groups extensively into account. 2.8 Reforming health and social service structures The ageing of the population and financial capacity have been among the reasons for the health and social services reform, which has been under preparation for several years. During the government term of Prime Minister Sanna Marin’s Government, the health and social services reform will comprise both a reform of the content of social welfare and health care services as well as a structural reform25. The reform involves developing public social welfare and health care as a whole to corresponds with changes in society. The reform will shift the focus of social and health services to basic services and the early prevention of problems. The aim will also be to speed up access to treatment. 24 Heinonen & al. Creative Foresight Space and Foresight of Future Skills. FFRC eBooks 4/2012. 25 https://soteuudistus.fi/tiedotteet-ja-uutiset https://soteuudistus.fi/tiedotteet-ja-uutiset 25 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND Basic services will be developed as part of the Future Health and Social Services Centres programme26. The programme aims to reform the operating methods of social welfare and health care and to develop service packages based on people’s needs. Social welfare and health care will collaborate as strong partners in the social welfare and health care centres of the future. There is also need for cooperation and integration in specialised social welfare and health care services as well as with other authorities and administrative branches, such as the Social Insurance Institution of Finland (KELA), education services, rescue services and TE services. In addition to the development of services, the health and social services reform will include reforming structures. In the future, self-governing regions extending beyond municipalities will be responsible for organising social welfare and health care services. The regions will produce services predominantly as public services. Private sector actors and the third sector will supplement these. Municipalities will continue to be responsible for promoting health and wellbeing. During the previous government term, a key project related to developing the home care for older people and strengthening informal care for people of all ages and related experiments created new, workable models for counties27. 26 https://soteuudistus.fi/valtionavustushaut 27 Noro A, Karppanen S. Ikäihmisten kotihoidon ja kaikenikäisten omaishoidon uudistus 2016–2018 – Tuloksia ja toimintamalleja (in Finnish) Ministry of Social Affairs and Health Reports and memoranda 2019:29. https://soteuudistus.fi/valtionavustushaut 26 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 3 Cross-administrative programme on ageing 2030 – An age-competent Finland In its programme, Prime Minister Marin’s Government28 has determined that a cross- administrative programme on ageing will be drawn up in cooperation with various ministries, municipalities, the third sector and other actors to prepare for the societal change resulting from the ageing of the population. Preliminary work for the programme has been carried out as part of official work, but they have also included extensive participation from various stakeholders since autumn 2018. The work was launched with creating an understanding of the overall situational picture. The situational picture was subsequently used as the basis for a survey conducted among key specialists in the field (see Figure 4). The survey responses were used as the basis for outlining key policies, which were then formulated into impact objectives. The aim is to achieve the objectives by 2030 (see Figure 5). Figure 4.  Preparation of the policies of the programme on ageing 28 Programme of Prime Minister Sanna Marin’s Government, 10 December 2019. Inclusive and competent Finland – a socially, economically and ecologically sustainable society. Finnish government publications 2019:31. 27 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND The functional capacity of older working-aged people has improved and careers have a longer duration Older people retain their functional capacity for a longer time Voluntary work has an established position in society Digitalisation and new technologies have increased wellbeing Services are implemented in a socially and economically sustainable manner Housing and living environments are age-friendly Figure 5.  Key policies – impact objectives by 2030 A cross-administrative group on the programme on ageing was established in early 2020. The group’s participants included the Ministry of Social Affairs and Health, the Ministry of Education and Culture, the Ministry of Economic Affairs and Employment, the Ministry of the Environment, the Finnish Institute for Health and Welfare and the Association of Finnish Municipalities. The group has been working on an action plan based on the programme on ageing as official work for the government term 2020–2023. The group has continued the preparative work by presenting concrete proposals for measures concerning the key policies and sub-objectives and related funding based on the programme on ageing as well as other funding opportunities. The work will continue so that the measures related to each impact objective will form a set of measures extending to the entire programme period. The measures will also be monitored using indicators describing the achievement of the objectives. Prime Minister Marin’s Government Programme has reserved EUR 5 million/year for the implementation of the programme on ageing in 2020, 2021 and 2022. Some of the funding for 2020 has been allocated directly to future health and social services centre applications. The group on the programme on ageing proposes that a government resolution on the objectives and approaches of the programme on ageing reaching until 2030 should be prepared by the end of this government term. 28 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 The implementation of the programme on ageing will be carried out by a ministerial level group, a steering group appointed by the Ministry of Social Affairs and Health, which includes representatives of the executive management of ministries, and an implementation group, which includes specialists and members of the current group on the programme on ageing. A project manager from the Ministry of Social Affairs and Health will be hired for the programme on ageing e for the period 2020–2023. The programme will also be implemented in extensive cooperation with various agents. The implementation and measures of the programme on ageing 2030 will be evaluated per each government term. 3.1 Programme on ageing 2030 – impact objectives The long-term operational objective is to prepare for the ageing of the population extensively and sustainably. The programme on ageing consists of six impact objectives (see also Figure 5): • The work ability of older working-aged people has improved and careers have a longer duration • Older people retain their functional capacity for a longer time • Voluntary work has an established position in society • Digitalisation and new technologies have increased wellbeing • Housing and living environments are age-friendly • Services are implemented in a socially and economically sustainable manner The achievement of the impact objectives requires targeting preventive measures and measures aiming to improve functional capacity at the older population and risk groups, and carrying out measures to maintain the functional capacity of older working-aged people and extending their careers. Promoting volunteering requires coordination structures jointly agreed among relevant actors. The structures benefit both the volunteering older people as well as society. The provision of services in a socially and economically sustainable manner benefits from instilling the good practices introduced in the key project developing home care for older people and enhancing informal care 29 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND for all age groups29. This, in turn, contributes to ensuring the equality, more efficient coordination and economic sustainability of the service system. The aim is to increase Finland’s international visibility as a model country for the development and utilisation of age technology and to ensure that our experiences and expertise are widely utilised across the world. The programme on ageing 2030 is part of an international whole related to the ageing of the population, and its preparation involves active cooperation, including the preparations of the UN/WHO Decade of Healthy Aging (2020–2030). 3.2 Operational programme 2020–2023 and preliminary proposals for measures 2023–2030 Potential solutions and related have been drafted in the group on the programme on ageing. Some of the measures have already been integrated into work for the development of the future health and social services, while others will be implemented as part of the project work of the programme on ageing. 3.2.1 Older people retain their functional capacity for a longer time Objectives 2030 • The functional capacity of older people will have improved so that the number of active life years during which people retain their functional capacity has increased and the average time for needing intensive care and nursing has shortened • New, innovative approaches support and motivate the older population in promoting their health and wellbeing through, for instance, improving nutrition, increasing physical activity, promoting mental health and strengthening inclusion. • Investing in the early identification of at-risk population groups and targeting preventive measures to them will have resulted in a decrease in the loss of functional capacity and a reduction of morbidity, especially memory disorders. 29 Reform of home care for older people and informal care for all age groups 2016–2019, Sipilä’s Government’s key project. 30 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Background As people age, their functional capacity is limited in various ways due to illnesses. Functional capacity is divided into physical, psychological, cognitive and social dimensions. The dimensions of functional capacity are both interlinked in many ways and connected to environmental preconditions and requirements as well as to the individual’s health and other personal characteristics. Cognitive functional capacity particularly decreases when a person develops a memory disorder. Finland has around 200,000 people with memory disorders, and as the number of older people increases, the number of people with memory disorders will also grow in the same proportion. Physical functional capacity refers to the physical capabilities of a person to cope with the activities important in his or her daily life. Physical functional capacity is apparent in a person’s mobility and ability to move around, for instance. Sensory functions, vision and hearing are also often included in the area of physical functional capacity. The concepts of physical fitness, physical performance and health are also closely related to physical functional capacity. Mental or psychological functional capacity refers to the individual’s resources which allow him or her to cope with challenges and crises in daily life. Mental functional capacity is related to life management, mental health and mental wellbeing, and covers functions related to emotions and thinking. Mental functional capacity also includes personality and coping with the challenges of the social environment. Persons with mental functional capacity feel well, appreciate themselves and trusts their ability to cope with everyday situations, are able to make considered decisions and feel realistically confident about the future and the surrounding world. Although cognitive functions and the functions related to information processing and thinking are key mental functions, cognitive functional capacity is typically considered an independent area of functional capacity, especially when it refers to basic cognitive functions such as memory and learning. Cognitive functional capacity involves cooperation between the different areas of information processing, which enables people to cope with their daily lives and related requirements. Cognitive functions are psychological functions related to the reception, processing, storage and use of knowledge.  31 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND Social functional capacity consists of dynamic interactions between the individual and the social network, the environment, community or society, within the opportunities and limits they contain. It is apparent in contexts such as interactive situations, coping with roles, social activity and participation as well as a sense of togetherness and inclusion.  (Finnish Institute for Health and Welfare). The sustainability of the service system requires that older people will retain their functional capacity for longer than at present. Measures supporting healthy lifestyles and wellbeing promote functional capacity and reduce illnesses, such as cardiovascular diseases, and also play a key role in preventing memory disorders. The FINGER Model30 The FINGER study carried out by the Finnish Institute for Health and Welfare showed that when older people transition to a healthier lifestyle, they retain their memory and cognitive functions and the risk of memory disorders is reduced. In fact, targeting lifestyle counselling to persons at risk of a memory disorder in primary health care is an important measure that maintains and improves the functional capacity of older people. Based on the results, the Finnish Institute for Health and Welfare has prepared an operating model for health care operators to create measures to prevent memory disorders. The model includes identifying people at risk of developing a memory disorder and supporting the preservation of memory functions with a versatile lifestyle program. The model includes a risk test for memory disorders. The prevention of memory disorders directly reduces the number of people developing memory disorders and delays the need for services. These findings indicate that introducing the FINGER model extensively in Finland is recommended, as the model includes systematic activities related to both the prevention of chronic diseases common in Finland and the maintenance of functional capacity, particularly cognitive functional capacity. 30 https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/finger-tutkimushanke/finger-toimintamalli https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/finger-tutkimushanke/finger-toimintamalli 32 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Active Ageing Index An index that describes the different dimensions of wellbeing and functional capacity has been developed at the international level for the purposes of national monitoring. While the Active Ageing Index (AAI)31 is intended for making comparisons between different countries, it could also be used for comparing different regions. 1. Measures for the period 2020–2023 • Development of lifestyle guidance, including the FINGER Model will be introduced throughout the country as part of the future health and social service centre programme. • Costs • For the purpose of implementing lifestyle guidance, incl. the FINGER Model, a total of EUR 1.9 million in the funding of the programme on ageing has been allocated to the project application processes for future health and social projects, which will take place in 2020. 2. Measures proposed for the period 2023–2030 • continuing the use of good and functional operating models • building a knowledge base for the promotion of health and wellbeing (incl. the implementation of the AAI index) Principal responsibility: Ministry of Social Affairs and Health 31 https://www.unece.org/population/aai.html https://www.unece.org/population/aai.html 33 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 3.2.2 The functional capacity of older working-aged people has improved and careers have a longer duration, particularly in the services for older people   Objectives 2030: • Preparing for ageing begins in middle age and continues when people retire (both by individuals and at the societal level) • Different solutions and types of flexibility are used to ensure longer careers and prevent age discrimination in working life • The competence and coping of those working in the services for older people and the attractiveness of the sector have been improved The challenges and development needs in the functional capacity of ageing working-aged people will be fulfilled partly by the measures implemented in the Ministry of Social Affairs and Health’s programme for well-being at work and partly by those in the programme on ageing. Increasing the competence and coping of the employees working in the services for older people and making the sector more attractive requires launching research and development activities. The monitoring of personnel working in services for older people is already carried out in the Kunta10 projects of the Finnish Institute of Occupational Health, which produce data on the staff wellbeing, absences from work due to illness and the fairness of management. The data can be used as the basis for launching development projects for purposes such as developing management and increasing self-direction. The agents involved in the services for older people include personnel, and older clients and their loved ones. Data on all of these groups are also available in the Finnish Institute for Health and Welfare (THL) research projects. As a result, there is need for more research that examines all these dimensions simultaneously. When preparing the implementation of the project, there is need to examine the projects already under way and to consider synergies between the projects. Increasing and developing staff commitment and the attractiveness of work requires also taking into consideration factors related to the education and training of social welfare and health care personnel. The reform of continuous learning by the Ministry of Education and Culture supports the flexible development of the competence of working-aged staff throughout their lives and at different stages of their careers, which also enables extending the duration of careers. In addition to regional social welfare and health care organisations, those implementing Bachelor’s and Master’s degree 34 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 programmes in universities of applied sciences in similar fields should also be included in the development projects. This enables creating a joint knowledge base which can also be utilised in education.   1. Measures for the period 2020–2023 • launching the Hyvä Veto project consisting of five work packages between the Finnish Institute of Occupational Health and the Finnish Institute for Health and Welfare, and inviting those implementing Bachelor’s and Master’s degree programmes in universities of applied sciences from relevant fields to the activities • Measure 1. Finnish Institute of Occupational Health: Data as the basis of development (analysis of available data) • Measure 2. Finnish Institute of Occupational Health: New solutions through joint development (coaching leadership and longer careers) • Measure 3. Finnish Institute of Occupational Health: Evaluation for developing models (evaluation of experiments and new operating models within and between units) • Measure 4. National Institute for Health and Welfare: Additional study on staff wellbeing (physiological measurements) in connection with a time measurement study • Measure 5. Joint research project between the Finnish Institute for Health and Welfare and the Finnish Institute of Occupational Health (examining data on staff and clients from the operational unit level, joining data in a new way) • The costs of the joint project amount to EUR 1.3 million and the project is funded from the development appropriation for home care (Ministry of Social Affairs and Health) 2. Measures proposed for the period 2023–2030 • continuing extensive development and research projects, implementation of good practices and their monitoring • involving personnel in the development of activities Principal responsibility: Ministry of Social Affairs and Health, Ministry of Education and Culture 35 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 3.2.3 Technology, artificial intelligence and robotics have increased wellbeing   Objectives 2030 • Smart technologies that support independent coping have improved the well-being of older people • Society has supported and ensured equal access for older people with a vulnerable socio-economic status to use technology that supports independent coping. • Technology, artificial intelligence and robotics are increasingly applied in the promotion of the wellbeing and health of older people and in their care and treatment. • A knowledge-based approach and the utilisation of large data masses in knowledge management have improved the cost-effectiveness of operations • Finland is a model country for developing and utilising age technology, and our experiences and expertise will be widely utilised around the world Background The development of robotics and artificial intelligence for the welfare sector offers companies numerous opportunities. The industry’s market is enormous, and growth is quick. The development of the best solutions in Finland will also create export opportunities. While the use of age technology has increased in recent years, there continues to be little utilisation of service robotics and sensors installed in people’s homes. In the coming years, the ageing population will be increasingly accustomed to using technology, which will enable more extensive use of both existing and new technologies. User-friendly and accessible technology also enables scalability of services. The benefits of age technology are revealed when it can be integrated into wider social welfare and health care structures. In other words, it is not the only solution to the challenges of ageing, but, instead, used as part of a greater whole. Technology can be diversely utilised in the services for older people and in preventive activities. Potential applications identified include improving the efficiency of personnel working hours, improving the flow of information and logistics solutions. Remote technology aims to improve the availability of health and wellbeing services, ensuring that as many people as possible can participate in the activities without an increase in costs. Remote counselling has been successfully used to promote physical activity, for example. There is also clear evidence of the effectiveness of remote rehabilitation. The results are similar as those obtained from in-person rehabilitation. 36 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Remote rehabilitation involving physical activity has proven cost-effective in patients with a heart condition. In addition to producing cost-effectiveness, both traditional and remote rehabilitation services can also slow down the growth in costs. In the future, the utilisation of robotics will also provide one possibility for increasing the cost-effectiveness of rehabilitation services. For example, rehabilitation robots have been developed for practising the operation of the upper limbs or the restoration of walking ability, and the obtained user experiences have been promising. Technology can also be utilised in the implementation of self-care services by means of various remote monitoring devices, drug dispensers, automatic reminders, and electronic advisory services and e-services. Home care remote visits are becoming increasingly prevalent, especially for those home care clients whose service needs can be met by remote visits. The Ministry of Social Affairs and Health has launched the Well-being and Health Sector’s Artificial Intelligence and Robotics Programme (Hyteairo) which brings together and coordinates development in the field. One part of the programme has involved making preparations for the establishment of piloting environments for home technology and drawing up national operating models for the field. The programme has also included preparing an operating model for the impact assessment of AI and robotisation solutions and for issuing recommendations. Hyteairo is part of the national AuroraAI development programme led by the Ministry of Finance and the Finland’s Age of Artificial Intelligence package led by the Ministry of Economic Affairs and Employment. Cooperation with the Ministry of Economic Affairs and Employment will be especially carried out in the Business and export section of the Hyteairo programme. Business Finland’s activities include the Smart Life programme that supports product development and export of companies in this industry. Discussion with the Ministry of Transport and Communications have particularly concerned the support for living at home from the perspectives of transport and logistics. All of the above parties are members of the advisory group for the Hyteairo programme. Hyteairo has commissioned the KATI project (technology and operating model supporting living at home) from VTT Technical Research Centre, and a report has already been published on the project32. The national framework for the technology and operating model supporting living at home, or the KATI model, will be further developed in collaboration with health and social service actors, users and other stakeholders. The practical application and implementation of the model as well as the suitability and use of technologies are tested by the health and social service regions to ensure sufficiently extensive impact assessment. Pilot projects carried out in the regions will be coordinated 32 Lähteenmäki J, Niemelä M, Hammar T et al. Kotona asumista tukeva teknologia – kansallinen toimintamalli ja tietojärjestelmät (KATI-malli). VTT TECHNOLOGY 373. 37 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND at the national level to produce comparable and complementary information about the success of the experiments and the effectiveness of the model. The KATISHA project is used to plan the testing of the features included in the KATI model in pilots projects, and this planning is used as the basis for opening pilot application processes in the regions.   1. Measures for the period 2020–2023 • implementing the follow-up project KATISHA for planning the national implementation of the KATI project • The costs of the KATISHA project of the programme on ageing amount to EUR 0.6 million in 2020 • The costs of the KATI project are EUR 1.2 million + discretionary government transfers for regional pilots EUR 6 million from the Ministry of Social Affairs and Health’s development appropriation for home care. 2. Measures proposed for the period 2023–2030 • Proceeding to the next technological and operational level, by continuing on the path shown by the KATI, KATISHA and KATI’s follow up pilot and promoting remote services, and the VALTAVA and TOIVO programmes and KANTA integration. Objectives: • supporting living at home by utilising information on how older people cope at home in the service system • Robotics and new special aids, e.g. exoskeletons • testing and utilising AI chatbot applications, such as the Onerva bot, in the communications between clients and caregivers • client and case management as a complete client-driven digital process • promoting clients’ self-care and independent functional capacity digitally • further promotion of the integration of client and patient data in social welfare and health care • developing performance management systems in cooperation with nurses and clients, including management of one’s work, self-directed teams etc. Principal responsibility: Ministry of Social Affairs and Health 38 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 3.2.4 Voluntary work has an established position in the ageing society   Objectives 2030 • The public sector identifies and enables voluntary activities in a way that benefits society and volunteers. • People of retirement age are increasingly participating in volunteering. • Participation in assisting loved ones and voluntary work has increased older people’s inclusion and opportunities for influence. Background Volunteering is inherently gratuitous and voluntary. Finland has extensive volunteering opportunities and the significance of voluntary work as a source of wellbeing is widely recognised. According to researchers’ estimates, the societal significance of volunteering is expected to further increase in the future. The ongoing COVID-19 pandemic has also affected the volunteering older people need and engage in. The older population has been defined as a risk group for the virus and is protected by various measures and recommendations. However, this means that fewer people are currently volunteering, and it has not been possible to carry out all forms of voluntary work involving physical encounters. On the other hand, the crisis has resulted in a growing interest in providing help and getting involved in volunteering in younger age groups. From a point of view of post-crisis management, it is important to support the opportunities for volunteering for older people while at the same time continuing to attract younger age groups to volunteering. Under the leadership of the Ministry of Justice, a project will be implemented with the aim of examining how changes in the operating environment and proposals for measures described in the programme on ageing and the National Democracy Programme 2025 will affect voluntary work in an ageing society. The project also aims to identify diversity in older people with different backgrounds and special needs concerning volunteering. The project will strengthen the knowledge base on the challenges of volunteering and make proposals for resolving these. Previous surveys on the development of the conditions for volunteering will be taken into account in the project work.33 33 Vapaaehtoistoiminnan koordinaatiota ja toimintaedellytysten kehittämistä selvittävän työryhmän loppuraportti, Valtiovarainministeriön raportti – 39/2015; Kansalaisyhteiskunnan ja vapaaehtoistoitoiminnan alatyöryhmän loppuraportti (OM, 2018) 39 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND The project will create clear visual guidelines and an incentive campaign to increase the attractiveness of voluntary work in an ageing society (e.g. increasing the wellbeing of older people and providing them with meaningful experiences). The project will increase the awareness and utilisation of instructions and materials on volunteering available on the Suomi.fi online platform. In addition, the project aims to better recognise the importance of management and coordination in promoting volunteering and to support the improvement of coopera- tion between different actors across sectoral boundaries. The project’s objectives include strengthening cooperation between municipalities and organisations as well as their op- portunities for coordinating voluntary work. The project will work towards this goal by sharing information on good practices and opportunities for cooperation, through knowl- edge-based support related to legislation and operating models, and by increasing interac- tion and partnerships between key stakeholders (including by exploring opportunities to cooperate with municipal councils for older people within the frame of the topic). The project will develop solutions and models that increase awareness of the importance of voluntary work and promote its attractiveness, for example through active communica- tions. The project will create clear visual guidelines and an incentive campaign to increase volunteering in the ageing society. The project will increase the awareness and utilisation of instructions and materials on volunteering available on the Suomi.fi online platform. The project will be prepared and implemented in an open and interactive manner that involves listening to stakeholders and engaging them in the process. The project will engage in active cooperation with, for example, the Parliament’s cooperation network for voluntary activities, the Association of Finnish Municipalities, the Advisory Board on Civil Society Policy (KANE) and non-governmental organisations. The project is linked to the National Democracy Programme 2025.   1. Measures for the period 2020–2023 • investigating the knowledge base of volunteering • what are the specific obstacles and challenges related to volunteering in an ageing society (including changes in the operating environment, and issues related to equality and the resources of NGOs) • what is the role of management and coordination in supporting volunteering; how can volunteering be supported by enabling sustainable cooperation between different sectors and actors 40 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 • what solutions and good practices are available for increasing the attractiveness of volunteering • how can the preconditions and added value brought by civic activities and volunteering be identified in society’s preparedness for crises in the future (for example, what can be learned from the COVID-19 pandemic, which aspects should be taken into account in its after-care) • developing and introducing solutions and models that motivate and encourage older people to participate in voluntary work, while at the same time also engaging younger age groups in the activities • monitoring the promotion of a measure related to the recognition and acknowledgement of content and skills learned in volunteering outlined in the government programme • increasing understanding of volunteering and its importance by implementing a large-scale communication, incentive and training campaign. • using volunteering to promote equal opportunities for older people from different backgrounds to influence their local environment and services • promoting the creation of structures and forums supporting voluntary work to improve cooperation between different actors across sectoral boundaries and strengthening the related possibilities for cooperation between municipalities and organisations (e.g. cooperation with councils for older people). • costs: • coordinator’s salary costs amount to around EUR 140,000/2 years. • communications and stakeholder cooperation EUR 40,000. • training, establishment of a meeting forum for volunteers, a cooperation forum for the exchange of information between authorities and active citizens (facilities and platforms, catering and other costs) EUR 40,000. • surveys and reports EUR 80,000 • the total cost of the project is EUR 300,000, which is allocated from the funding of the Programme on Ageing. 2. Measures proposed for the period 2023–2030 • continuing the measures used to support volunteering Principal responsibility: Ministry of Justice 41 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 3.2.5 Housing and living environments are age-friendly Objectives • Accessible and adaptable housing suitable for older people has been developed, repaired and built • The needs of older people and older people have been taken into account in the planning and development of living environments • People actively anticipate and prepare for the challenges brought by ageing concerning housing and related services Background In its programme, Prime Minister Marin’s Government has determined that a separate operational programme on housing for older people will be implemented as part of the programme on ageing prepared during the government term. The aim of the programme is to further develop good solutions for the housing of older people, such as communal living and the construction of communal homes together with municipalities. Accessibility will also be promoted through elevator and accessibility grants. The special needs of people with memory disorders and the safety of housing for the ageing population are taken into account. The housing development programme for older population coordinated by the Ministry of the Environment in the period 2013–2017 supported the development of housing for older people with a number of measures. The measures were related to repairing the existing housing stock, housing solutions, the development of residential areas, and housing services. An age-friendly housing unit is accessible and safe. Memory-friendly and age-friendly housing and the living environment enable older people to stay active even if their mobility and sensory functions are declining. Age-friendly solutions support residents’ functional capacity and inclusion. They involve both physical factors in the housing and living environment, such as physical accessibility and service accessibility, and social factors. Repairing the housing stock is an important means of transforming housing to meet residents’ needs. Government subsidies for the renovation of homes and repair advice play an important role in this context. In municipalities with dropping population rates, the renovation of the ARA housing stock in urban areas to suit older people supports the housing of older people. 42 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Multi-generational and communal housing increases inclusion and a sense of security. Communality can also be promoted in residential areas. Age-friendly living environments are created by improving accessibility and safety, and by creating various places where people can meet and engage in activities. Municipalities’ activities in the development of residential areas and housing for older people vary greatly. Large and small municipalities and urban areas and sparsely populated areas are in a very different situation. Many rural municipalities have a high number of older people and have a need to support their housing in different ways. In the future, an increasing share of the older population will live in urban areas, mainly in regular housing. Sufficiently early anticipation and preparedness for future housing needs are important for the housing of older people. This applies to an extensive range of actors in society – citizens, municipalities, housing companies, and real estate and construction companies. In March 2020, the Ministry of the Environment adopted the operational programme on housing for older people. 1. Measures for the period 2020–2023 • implementing the operational programme on housing for older people, incl. development funding for municipalities / Application for discretionary government transfers between June and August 2020 • costs • EUR 0.5 million will be allocated from the funding of the programme on ageing • operational programme on housing for older people/ government programme funding EUR 0.45 million/year 2. Measures proposed for the period 2023–2030 • implementing measures to develop the housing conditions of older people in accordance with the housing policy development pro- gramme Principal responsibility: Ministry of the Environment 43 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND 3.2.6 Services are implemented in a socially and economically sustainable manner Objectives 2030 • Reforming the services for older people ensures the high-quality care and treatment needed for promoting the wellbeing and health of older people • Client counselling and case management have ensured service integration and the organisation of cost-effective services • The services provided at home include operating models for acute care, rehabilitation and informal care, services provided 24 hours a day, and enterprise resource planning systems that support the flexible allocation of personnel according to clients’ service needs • Safe living at home has become more common and is supported in a cooperation between different sectors (e.g. physical activity, transport, education, culture, catering services) Based on the quality recommendation for older persons (2017, 2020), client counselling and case management should be organised as an intact whole at the county level that provides clients with an opportunity to use electronic services. The key project on older people and informal care created structures for functional client counselling and case management to ensure that clients receive a service package that best meets their needs. Client counselling and case management also respond to different degrees of needs for counselling and guidance. Older people without considerable support needs are referred to the activities and services organised by municipalities and the third sector, such as cultural and physical leisure time activities and communal meals. As clients have more needs, they are helped in choosing the social welfare and health care services that best suit them from the available services. The sub-projects of the key project tested and introduced various electronic services for client counselling and case management, including self-assessment forms, service menus and e-services. In the future, good models will be introduced to practice nationwide. Home care has been one of the key development areas in the services for older people. Based on the national policy, older people are entitled to continue living at home also when sick and disabled for as long as this is safe and meets the old person’s needs. Living at home is supported with services available 24 hours a day on all days of the week, operating models that support functional capacity and involve rehabilitation, and preparation for acute situations in the activities. Living at home can be supported by 44 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 technological solutions such as smart fire alarms, fire and stove alarm systems, safety phones and personal tracking devices. Sensor technology and various invisible systems installed at home can be used, even though they have only recently been introduced to practice. Nevertheless, it is worth remembering that the use of technology always requires the client’s willingness and acceptance as well as ensuring strong data security. The partial replacement or supplementing of services with electronic alternatives enables safeguarding the availability of primary services for those who need them. However, this requires providing training to older people and their loved ones as well as social welfare and health care staff. We must also prevent digital exclusion and ensure that disadvantaged people have access to the wellbeing services they need. Telehealth appointments and remote technology have particularly increased considerably during the COVID-19 outbreak.   1. Measures for the period 2020–2023 • Further developing client counselling and case management as part of the Future health and social services centres project. • A home care development programme will be implemented as part of the Future health and social services centres project: • The majority of older people live their own homes and there is a need for the further development of the services delivered at or accessed from home. • The reform of home care will be continued by means of a home care development project, which involves introducing operating models of acute care, rehabilitation and informal care at the national level, improving the availability of 24-hour services, and improving the flexible allocation of personnel based on clients’ service needs by developing case management. • Safe living at home is supported in a cooperation between different sectors (e.g. physical activity, transport, education, culture, and catering services) • The development of informal care will be implemented as part of the Future health and social services centres project: • Measures will be taken to develop the services for families with informal care through means such as developing free substitution options for informal caregivers, drawing on previously developed operating models. 45 PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 NATIONAL PROGRAMME ON AGEING 2030 – FOR AN AGE-COMPETENT FINLAND • intermediate housing: innovative ways of providing services and support, and cooperation with supervisory authorities • developing self-monitoring to ensure the quality of services Costs: • Funding for the home care development programme, EUR 6 million reserved in the Future health and social services project • Development of informal care, EUR 21 million in funding reserved in the Future health and social services project • EUR 1.9 million reserved in the programme on ageing: • Projects related to the development of services concerning intermediate housing • Projects related to the development of self-monitoring • Projects related to the development of reserve staff 2. Measures proposed for the period 2023–2030 • centralised client counselling and case management, and related advancement • utilising clients’ personal views • monitoring the service packages • remote services, particularly telehealth appointments and remote rehabilitation • utilising national data in knowledge management Principal responsibility: Ministry of Social Affairs and Health National Programme on Ageing 2030 For an age-competent Finland PUBLICATIONS OF THE MINISTRY OF SOCIAL AFFAIRS AND HEALTH 2020:38 Internet: stm.fi /en/publications PUBLICATION SALES: julkaisutilaukset.valtioneuvosto.fi ISSN PDF 1797-9854 ISBN PDF 978-952-00-8431-8 X/2020 TEO KSEN N IM I National Programme on Ageing 2030. For an age-competent Finland Description sheet Kuvailulehti Presentationsblad Table of Contents FOR THE READER 1 Background 2 An operating environment in transition 2.1 Population ageing 2.2 Wellbeing of the ageing population 2.3 Urbanisation 2.4 Climate change 2.5 Funding and preparedness 2.6 Technological breakthrough 2.7 Change in inclusion 2.8 Reforming health and social service structures 3 Cross-administrative programme on ageing 2030 – An age-competent Finland 3.1 Programme on ageing 2030 – impact objectives 3.2 Operational programme 2020–2023 and preliminary proposals for measures 2023–2030 3.2.1 Older people retain their functional capacity for a longer time 3.2.2 The functional capacity of older working-aged people has improved and careers have a longer duration, particularly in the services for older people 3.2.3 Technology, artificial intelligence and robotics have increased wellbeing 3.2.4 Voluntary work has an established position in the ageing society 3.2.5 Housing and living environments are age-friendly 3.2.6 Services are implemented in a socially and economically sustainable manner