1. 1 Towards Active Old Age European Conference on the Elderly Care 23-24 April 2004 Pori Finland Lis Wagner, R.N., H.V., Dr. PH. Associate Professor Department of Nursing Sciences, Faculty of Health Sciences, Aarhus University Denmark

2. 2 Twenty years experience with an Integrated Health care Model Lis Wagner, R.N., H.V., Dr.PH., Denmark

3. 3 Structure for Health- and Social Care for Elderly DK: 5.4 mill / 700.000 > 67 years old (13%) State -The Ministry of Interior and Health -The Ministry of Social Affairs Counties (16) Municipalities (275) Lis Wagner, R.N., H.V., Dr.PH. Denmark

4. 4 Some Statements in Elderly Policy 2003 The health service, hospitals and social care are provided at no cost to the elderly and financed through taxation Families have no legal duty to care for elderly It has been difficult to meet growing needs in the field of care for elderly people by a similar growth in the use of resources Lis Wagner, R.N., H.V., Dr.PH., Denmark

5. 5 Of elderly over 67 years old, 24% receive home help Among elderly 80-100 years old, 60% receive home help Of all hospitalized persons, 1/3 is over 65 years old and use 50% of the total amount of bed-days. (continued) Lis Wagner, R.N., H.V., Dr.PH., Denmark

6. 6 Rules and Regulations Waiting days Nursing homes  Dwellings for elderly Preventive home visits - Home visits from hospital - Geriatric teams from hospital Lis Wagner, R.N., H.V., Dr.PH., Denmark

7. 7 What were these changes based on? 1.Continuity in the individual’s life 2.Better use of elderly people’s own resources 3.To preserve elderly people’s self- determination and also the Commission raised a fund for research purposes. Lis Wagner, R.N., H.V., Dr.PH., Denmark

8. 8 POCKET MONEY Lis Wagner, R.N., H.V., Dr.PH., Denmark

9. 9 The Skaevinge Project 1984 - 1987 A municipality in Frederiksborg County Time: 1.6.1984 to 31.12.1987 (3.5 years) Population: 5000 inhabitants (500 > 67 years old) Health personnel: 130 Method:Action research Lis Wagner, R.N., H.V., Dr.PH., Denmark

10. 10 The Aims to offer health and social services to the whole municipality regardless of type of housing, and to give priority to preventive efforts to support the individual’s potential for self-care, preserve and strengthen his or her health and improve the quality of life. Lis Wagner, R.N., H.V., Dr.PH., Denmark

11. 11 Definition In action research we have the chance to try out new models that often have not been worked out in detail beforehand but are generally specified in broad outline and made more concrete and precise in this kind of collective learning process where social scientists, clients and people in the system operate. Kalleberg (1992) Lis Wagner, R.N., H.V., Dr.PH., Denmark

12. 12 Action Research Characteristics of Action Research - Collaboration between researchers and practitioners - Solutions of practical problems - Changes in current practice; and - Development of local theory as central to all forms of Action Research Lis Wagner, R.N., H.V., Dr.PH., Denmark

13. 13 The Action Research Model Quality Efficiency Idea Meetings Project team: citizens and staff Educational programme: the concept of self-care Agreement Thawing phaseSeeking phaseFreezing phase Time Project description: intervention plan Lis Wagner, R.N., H.V., Dr.PH., Denmark

14. 14 The Action Research Model Quality Efficiency Idea Meetings Agreement Thawing phase What do we, the health care staff, do wrong in an institution? Why is the nursing home an outmoded institution? Maidservant syndrome ”Helping” and ”Taking Care of” “Service package solution” Lis Wagner, R.N., H.V., Dr.PH. Denmark

15. 15 The Action Research Model Project team: citizens and staff Educational programme: the concept of self-care Agreement Seeking phase Project Team Tasks Criticism and creative thinking Lis Wagner, R.N., H.V., Dr.PH., Denmark

16. 16 The Action Research Model Educational programme: the concept of self-care Freezing phase Time Project description: intervention plan Time Self-criticism and sense of humour Organizational structure Lis Wagner, R.N., H.V., Dr.PH., Denmark

17. 17 Health Centre – autonomous groups Common budget - common training Common understanding of man 24 hour care service Lis Wagner, R.N., H.V., Dr.PH., Denmark

18. 18 Political Statement in 1987 ”We have selected this structure because we believe that responsibility, quality and creativity are more prevalent in those persons who are given the required competencies and responsibilities for their own work area, and as a result, can have a true influence on how the work should be structured.” Lis Wagner, R.N., H.V., Dr.PH., Denmark

19. 19 Frederiksvaerk Weekly Magazine/ Halsnaes Post (Wednesday, 17 October 1993) Skaevinge saves the county 175 million DKK. Prevention and care result in fewer hospital admissions and fewer doctor visits. Lis Wagner, R.N., H.V., Dr.PH., Denmark

20. 20 Frederiksborg County News (31.10.1995) Skaevinge shows the way Political interest in a new health model Impressed by Elderly Project Lone Moeller ( a minister) wants to use Skaevinge for economic considerations in counties and municipalities Lis Wagner, R.N., H.V., Dr.PH., Denmark

21. 21 Evaluation - 10 years onward (1997) (Study of an integrated health care model) Lis Wagner, R.N., H.V., Dr.PH., Denmark