Toh Ee Ming
Mr Seppo Käppi, 72, steers himself nimbly in a wheelchair around the Kauklahti Life and Living Centre for Senior Citizens in Espoo, the second-largest city in Finland.
The long-term care facility for senior citizens who require round-the-clock care has been his home for the last five years.
At Kauklahti, the 74 residents are mostly above the age of 75 and have conditions like stroke, severe diabetes or severe rheumatism. They each have a private one-room flat that they can do up with their own furniture, and are allowed to keep a small pet.
They are cared for by staff members who do not don uniforms.
The cheerful Mr Käppi looks forward to neighbourhood strolls, where he can request for a detour to the nearby bakery to “take the nurses out for coffee and cakes”.
The 10 taxi passes he receives per month allow him to take his wife, who lives nearby, to the market or head with friends to the capital city of Helsinki, about half an hour away by car, with a staff member tagging along.
As Singapore wrestles with the complex task of relooking care models and providing more diverse and conducive living options for its greying population, models in Finland may offer some ideas to the authorities and industry players here.
In recent years, there have been calls to move away from the typical six- to eight-bedded wards at nursing homes in Singapore, which cater to seniors who are no longer able to live independently or whose families are unable to take care of them.
In the Economics of Singapore Nursing Home Care study, released last year and commissioned by the Lien Foundation and Khoo Chwee Neo Foundation, the norm of single or twin-bedded wards in a home-like environment is recommended. The study found that nursing homes incur an average cost of S$106 per resident per day, excluding government subsidies and grants. Single- or twin-bedded rooms would cost S$8 to S$13 more per resident per day, the study by global consultancy Oliver Wyman found.
The Ministry of Health has said models and arrangements of care need to be sustainable and affordable. It also said it would study the report and hoped to discuss the findings with the Lien Foundation.
On a recent study trip to Finland sponsored by consultancy Ageing Asia and Finland’s trade promotion body Finpro, TODAY caught a glimpse of the Nordic country’s initiatives that enable its seniors to age within the community, its hospital-to-home concept, as well as technologies that improve the lives of individuals, including those with dementia.
Underpinning the provision of care across all settings was the ethos of autonomy and freedom of choice of the elderly individual.
The Kauklahti centre has a gym, sauna, restaurant, round-the-clock nurses, a physiotherapist, chiropodist and even a hair dresser. Activities offered include an art circle, singing, cooking and exercise groups. Weekly meetings, with families invited to sit in, allow the residents to air their concerns and talk about meal preferences.
An electronic alarm system detects falls, while nurses supervise the residents’ medication and support their daily living activities.
“There’s good quality (here)...It’s a good place to live,” said Mr Käppi in Finnish via a translator.
HOME, OR HOME-LIKE
Espoo — with a population of about 275,500 inhabitants in 2016 — faced a conundrum some 10 years ago not unlike Singapore’s. Back then, Finland took a medicalised approach to eldercare and many were still in four or five-bedded wards in nursing homes, while staff consisted almost exclusively of nurses, said Ms Maria Rysti, specialist in services for the elderly under the City of Espoo’s Social and Health Services.
The city council changed the service culture and management style with its Ageing Policy Programme. It supported the transition for elderly citizens to live at home, or home-like environments where they can “live their own way of life” and be treated as “subjects, not objects,” said Ms Rysti.
The goal is to have 93 per cent of people aged 75 and above in Espoo living at home and, the rest, in home-like units, in 2018.
The city council spent about 15.6 million euros to build the Kauklahti Life and Living Centre for Senior Citizens, which began operations in 2012. It is the first of four such Life and Living Centres in Espoo.
Residents pay about 1,500 euros monthly (about 20 to 50 per cent of the total cost), and the Espoo city council and taxpayers fork out the remainder. The municipality tax in Espoo is 18 per cent this year.
Plans are in store for private developers to build 14 floors of housing for the elderly in a new shopping mall in Espoonlahti, one of Espoo’s urban centres, by 2021 to 2022.
By 2021, the goal is to not have any beds for long-term inpatient care in hospitals and other institutions. “Twenty years ago, people went to hospitals to die, but not anymore,” said Ms Rysti.
KEEPING THEM OUT OF THE HOSPITAL
At the new Espoo Hospital, which opened its doors in March, the elderly are treated as “VIP clients”. Owned and built by the City of Espoo, it provides treatment and rehabilitation services to the elderly.
For instance, an elderly with hip fracture is operated on at another hospital without delay and transferred to the Espoo Hospital’s orthopaedic rehabilitation ward on the second day post-operation.
Patients in Espoo Hospital also have shorter stays, which was cut from six to eight weeks to about two to three weeks, said Mr Juha Metso, the city’s deputy mayor and head of social and health services.
The 270 single-rooms offer privacy. Numerous areas overlook the surrounding forests. Artworks are scattered around the hospital’s grounds.
By the end of the year, patients will be provided with tablets that they can use to conduct video calls with their relatives, listen to the radio, watch television or catch up on the news or social media.
Rehabilitation kiosks have instructional videos that guide patients in their exercises, easing the load of therapists.
And instead of taking the approach that doctors “know all the answers”, staff “learn to listen carefully and ask what matters to patients”, said Mr Metso.
The person-centred approach is evident elsewhere.
At the Alzheimer’s Association of Helsinki’s day care centre, executive director Teija Mikkilä is aiming to offer more than the usual art and craft activities for clients with dementia. Male clients, for instance, may one day get the opportunity to tinker with cars.
For Mr Hannu Leinonen, 72, who has dementia and drops by the centre about twice a week, the centre’s “got good food, good company… It’s just enough for me”. Outside of the centre, he plays tennis and golf.
One of the newest housing areas east of Helsinki’s bustling city centre is the smart district of Kalasatama, where a new kind of housing community for seniors living alone has sprung up.
Called Kotisatama, the nine-storey red brick building consists of some 63 flats between 38.5 and 77.5 sqm in size, which can be owner-occupied or rented.
Completed in 2015, the building houses residents aged 50 to 80. The residents share a community kitchen and dining room, a mini greenhouse and spacious roof terraces overlooking the harbour.
Owned by a private housing corporation — the bulk of whose shareholders are the residents — Kotisatama was the outcome of a project by the Active Seniors Association, founded by in 2000 to introduce the concept of a housing community for the elderly.
The residents helped to design their own flats and common areas. The dining room chairs were chosen from 82 designs, and the library’s book selection was just as carefully curated. “No rubbish, only good quality stuff,” says the association’s president and resident Leena Vahtera, 70, with a chuckle.
Under an unusual agreement, residents also take turns in groups of 12 to 13 to do the cooking and cleaning. Groups rotate every six weeks.
It is here that 79-year-old Maija Valtonen has chosen to live, moving out of her former home in Vantaa city, about 18km away, to buy a flat in Kotisatama for 450,000 euros in 2015. She had retired at age 64, after 13 years as an acting professor at the University of Kuopio’s department of applied zoology and veterinary medicine.
“Although I’m 79, I still feel I want (to live life my way). It’s nice to own your home and to get that freedom… In a house like this, you always can find friends and a social life, and it (ensures some safety),” Dr Valtonen told TODAY from her bright and cheery living room. “I can lie in my bed or get up as early as I want to, or go out to see a (movie), do some shopping, go to a show or a concert… It is absolutely enough for me.”
On a typical day, she might attend a pilates class, go for a swim or do gardening.
WHERE RESIDENTS ‘ACCIDENTALLY’ MEET
Perhaps the housing concept more familiar to Singaporeans is the Generations Block near the west harbour of Helsinki, which consists of about 262 apartments for students, people with disabilities and the elderly.
Completed in March by three developers, including the non-profit social housing company Setlementtiasunnot Oy, the complex has creatively designed communal facilities — such as a bright red walkway simulating a Metro station — for residents of different ages and backgrounds to mingle.
There is the “living room” on the first floor where residents can gather for a chat and a cup of coffee, as well as woodworking and music rooms. A mini amphitheatre provides just the space to organise movie screenings and performances.
Finnish city folk are generally “shy and reserved”, and shared spaces are a way to help create “accidental meetings” and foster a strong community spirit, said service designer Kirsten Sainio.
Residents have already formed a rock band with members aged 24 to 70. Communal brunches are held on weekends, while some elderly residents help to look after the children of young families, said Ms Sanio. In turn, the seniors receive help from their neighbours when they need it.
The intergenerational living project was awarded the best social housing production of 2017 by the Housing Finance and Development Centre of Finland. Two similar projects are being developed in the cities of Tampere and Joensuu.
A LEG-UP WITH TECHNOLOGY
Technology is also a key component of eldercare in Finland. Nordic health technology company VideoVisit partnered the City of Helsinki’s service centre in 2014 to provide virtual care services.
Clients receiving home-based care, many of whom have dementia, get video calls reminding them to take their medication and for group exercise sessions.
Nurses are able to make nearly 10 calls per hour – or close to 50 virtual “visits” per work shift – with less need to travel, said VideoVisit’s business development director Markku Sani.
And instead of invasive cameras, Finnish company MariCare Oy has developed sensor floor systems that can detect when a person falls, enters or exits the room, and gets off the bed. The data can be sent to a nurse’s smartphone; meanwhile, the resident can “live a normal life”, said sales manager Tommy Dolivo.
About 3,000 rooms, mostly in nursing homes in Finland, France and Australia, are equipped with the Elsi smart floors.
There is no shortage of health tech startups in the country, which often clinches one of the top spots in the Global Innovation Index.
Ms Mervi Lamminen, for instance, started Auntie, a preventive therapy service that uses tools like a chatbot and video sessions with professional therapists. The two-year-old company, which has operations in Finland, the United Kingdom and the Netherlands, plans to work with nurses at the upcoming wellness clinic in the Smart Kalasatama district to identify at-risk clients, such as single parents, who may need the service.
Pushing the envelope in the field of rehabilitation is another start-up called Peili Vision. It aims to offer virtual reality solutions for patients, such as those recovering from brain injury and trauma, said co-founder Joonas Pöllä. Using virtual reality headgear, the patients can play games as part of their therapy, for instance.
The “friendly” start-up culture in Finland means Mr Pöllä’s company and others in healthcare are located in a hospital. This makes it easier to set up meetings with customers.
Among the ideas Singapore could adapt from Finland is the “block coach” employed at the Generations Block, who helps to kickstart communal activities, said Ms Janice Chia, founder of Ageing Asia.
Singapore’s public housing precincts are “naturally occurring retirement communities that are intergenerational”, she said. Community kitchens and void decks with better designs for residents to gather and hang out would also increase social interactions, participation and the vibrance of communities, she said.
While locals such as Active Seniors Association’s Ms Vahtera generally felt the eldercare system in Finland was good, the country also faces challenges such keeping healthcare costs in check.
Proposed laws that Parliament could pass next year will cut healthcare costs by about three billion euros between 2019 and 2029, even as the population is ageing. Its health expenditure stood at 19.8 billion euros in 2015, about 9.4 per cent of gross domestic product.
And like seniors here, some Finnish elderly worry about the day they become unable to take care of themselves. While individuals should plan early for their old age and the authorities should provide the services and infrastructure needed, Dr Valtonen noted: “People are getting older and older… I’m a bit afraid of what happens to me.”
“A decrepit, fragile senior living alone in her or his apartment may be like a prisoner (at) home and the Finnish society (may not have) the capacity to take care of these seniors,” said Ms Vahtera.