It’s 11.30am on a midweek June morning in Helsinki, Finland. Duvi Leineberg, a remote care nurse, is doing the lunch rounds. But instead of jumping in a car and visiting each person one by one, she is sitting in an office looking at a large computer screen where she can see into seven people’s homes. Most are sitting at a table preparing to tuck into some food.
This is a virtual lunch group, set up to make sure older people receiving home care services in the city eat regularly and at the right time. Leineberg runs the session. She starts by checking everyone has their food and that it is warmed up. Some have soup, others have pre-prepared meals that have been delivered by home care services. People also sip coffee.
One screen shows an empty backdrop and she calls the home to check her client is all right. He walks past the screen but says he isn’t hungry and doesn’t want to eat right now. Leineberg then asks everyone if they have any plans for the afternoon. A few reply that they will go out for a walk.
A former hospital nurse, Leineberg sees the value of such groups. “Firstly, the client feels like they are a part of a bigger thing. It’s also guaranteed that they eat properly. If I spot anything that seems out of the ordinary, I can call the home care nurses who will pay them a visit if necessary.”
Her clients are also fans of the lunch group. Riitta Koskinen, 80, says through a translator: “I’m old and living alone and it’s nice to have the company. We eat at the same time – food tastes better when you’re with others – and I’ve really enjoyed it. It makes me eat and it’s good to see other people.”
Finland has a rapidly ageing population and recruitment problems in health and care. By 2070, one in three Finns is expected to be over 65. At the same time there has been a huge decline in the birth rate and the number of Finns of working age is expected to fall by around 200,000 by 2050. As a result, the demand for and cost of care services are growing while tax revenues are decreasing, leading politicians to warn that the Nordic model of highly state-funded cradle-to-grave social care will no longer be affordable.
Taina Mantyranta, a medical counsellor at the Finnish ministry of social affairs and health, admits: “Finland is facing economic constraints. We have been trying to reform our social and healthcare system for several decades. The need to develop more integrated social and health services has been clearly recognised also from a cost containment perspective. ICT and digitalisation are integral parts of the reform.”
The virtual lunch group is one aspect of Helsinki’s remote care – where clients have a tablet that links up with remote care nurses in a service centre. Remote care appointments are set up to check on clients throughout the day and to make sure they take the relevant medication. There are 800 home care clients, and nurses carry out 24,000 remote care visits a month. By the end of 2019, the service hopes to cater for 1,100 clients.
The potential savings are eye-watering. Whereas a physical home visit costs the equivalent of around £40, a remote care visit is just £4.50. Over the course of one shift, a remote care nurse can carry out over 50 visits – which works out almost 90% cheaper than if they had knocked on each of their client’s doors.
Little wonder that the city’s service centre is hoping to start a remote dinner group soon as well as other sessions. They already take clients virtually to concerts and shows. Hanna Hämäläinen, who works as a planner at the service, remembers when she took 64 clients virtually to a carol concert. A screen was placed on the front row and the priest greeted them while they watched at home on their tablets. She remembers: “The funny thing is that even if some had memory problems, they knew all the lyrics. That is the power of music and made me see that if there’s a concert, we should be there.”
Neighbouring city Espoo is also exploring remote care. By 2027, 8% of its population will be over 75. Roope Leppänen, medical director of Espoo hospital, admits that there aren’t the resources to deal with the increase. “We see remote care as a possibility. We are only starting but will expand these services quite rapidly in the coming years,” he says. However, he maintains that remote care will never fully replace physical care but that, with advancing technology and future generations that are used to digital life, it will become more and more important. He says:But he doesn’t expect it to totally replace physical care services. “People will need physical visits as well. It’s my belief that [remote care] can’t completely replace that, but tech will make [things] even easier in 10 years time.”
Both the staff and patients I meet seem to like it. Tiina Kosonen, a remote care nurse, says she is able to build close relationships with her clients. “I like it and the patients get a lot from it. It’s really intensive this contact. We look into each other’s eyes and talk together face to face.” One of her clients, 86-year-old Raimo Uimonen, who has epilepsy and lives alone says: “I get a feeling of security from this service. I also like to talk. This video contact is really important as I get this face-to-face contact and the opportunity to discuss things.”
Leppänen adds: “I’ve been on home care visits. You come into a person’s house, take your coat off and sort of intrude. Of course there are some instances where you need to be there, but if we can increase contact with the patient [surely that’s a good thing]?”
So could this type of service take off in the UK, where the number of people aged 65 and over is set to increase by more than 40% over the next 20 years?
Claire Turner, director of evidence at the Centre for Ageing Better, believes so. “If you can remotely check in on somebody, see how they are, remind them of medication, that feels like a good and practical solution [as it] enables more time for home visits for people who need physical support,” she says.
She adds: “Social contact is the stuff of life. That’s what is important to us as human beings and it doesn’t change as we get older. If part of the goal of this is to encourage people to have more contact with others who share interests or values, than that’s a good thing.”
Sarah Johnson’s visit to Helsinki was supported by Business Finland
