Objective: to  explore  the  Nordic  municipal  health  and  care  services’  ability  to  promote  principal  goals  within  care  for  older  people  during  the  cOViD-19  pandemic.

Design  and  setting: two  surveys  were  conducted  among  managers  of  municipal  health  care  services  for  older  people  in  Denmark,  Finland,  Norway  and  sweden;  the  first  around  6  months  into  the  pandemic  (survey  1),  and  the  second  around  12  months  later  (survey  2).  Data  were  analysed  through  descriptive  statistics,  and  multiple  regression  (Ols).

Subjects: 1470  (survey  1,  2020)  and  745  (survey  2,  2021)  managers.  32%  in  home  care,  51%  in  nursing  homes,  17%  combined.

Results: in  all  countries  the  pandemic  seems  to  have  had  more  negative  impact  on  eldercare  services’  ability  to  promote  an  active  and  social  life,  than  on  the  ability  to  promote  or  enhance  older  people’s  mental  and  physical  health.  the  regression  analysis  indicates  that  different  factors  influence  the  ability  to  promote  these  goals.  Managers  within  nursing  homes  reported  reduced  ability  to  promote  mental  and  physical  health  and  an  active  social  life  to  a  significantly  lower  degree  than  managers  of  home  care.  the  effect  of  three  prevention  strategies  (lock  down,  testing,  and/or   organisational   change),   were   explored.   Organisational   change   (reorganize   staff   and   practice,  restrict  use  of  substitutes)  tended  to  impact  the  units’  ability  to  promote  a  social  life  in  a  positive  direction,  while  lock  down  (areas,  buffets  etc)  tended  to  impact  both  the  ability  to  promote  mental/physical  health  and  a  social  life  in  a  negative  direction.

Conclusion: Measures   that   can   improve   opportunities   for   an   active   and   social   life   during   a   pandemic  should  have  high  priority,  particularily  within  home  care.

KEY  POINTS

• it  is  important  to  learn  from  how  the  cOViD-19  outbreak  in  2020  affected  the  municipal  health  and  care  services’  ability  to  achieve  principal  goals  within  care  for  older  people.

• the  pandemic  had  a  more  negative  impact  on  the  services’  ability  to  promote  an  active  and  social  life,  than  on  their  ability  to  promote  or  enhance  mental  and  physical  health.

• Measures   that   can   improve   opportunities   for   an   active   and   social   life   during   a   pandemic   situation  should  have  high  priority,  particularily  within  home-based  care.

BACKGROUND: According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities.

METHODS: A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis.

RESULTS: The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context.

DISCUSSION/CONCLUSION: Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.

Purpose

The purpose of this paper is to give an account for preparative collaboration between the police and municipal eldercare in Sweden concerning missing persons with dementia.

Design/methodology/approach

Design/methodology/approach used was a qualitative case study design, consisting of one focus group with representatives for the participating organisations, followed by directed content analysis.

Findings

The findings showed a lack of current collaboration and reluctance to new collaborative initiatives. However, when focussing on preparative collaboration of coordinated responses to missing incidents, possibilities for improvement could be identified. The improvements concerned updated personnel response checklists, along with suggestions for an elaborate life story document in eldercare, with police access. Finally, better coordination of the return of the found person and a follow up were proposed.

Research limitations/implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal collaboration is more suitable. The amount of data in this study is a research limitation which calls for further research.

Practical implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal co-operation is more suitable.

Originality/value

The originality/value of this paper can be found in the novelty of missing person research in Sweden, and in practical suggestions for preparative collaboration concerning persons with dementia who go missing. Finally, it can be found in the suggested need for a more dynamic and process-sensitive view of collaboration in SAR or rescue operations.

Detta kapitel har fokus på forskning om samverkan inom välfärdssektorn, främst utifrån äldre- och funktionshinderomsorgens perspektiv. Mer specifikt är syftet att lyfta fram forkning om interprofessionell samverkan ur första linjens chefers perspektiv, deras utmaningar och förutsättningar föra tt hantera olika samverkanssituationer i såväl vardagliga situationer som mer extrema krissituationer. Vidare är syftet att bidra med en reflektion kring vad det innebär att leda samverkan inom välfärdsområdet utifrån teorier om interprofessionell samverkan och brukarmedverkan (co-production).

As co-production approaches to quality improvement (QI) gain importance in healthcare, hospital leaders and managers are expected to organise and support such efforts. Yet, patient and public involvement (PPI) can be challenging. Hospital organisations, emphasising knowledge and evidence domains, are characterised by operational-professional rather than patient-preference led management. Thus, PPI adds aspects of influence and responsibility that are not clearly defined or understood, with limited knowledge about how it can be orchestrated. This study, therefore, aimed to explore hospital leaders’ and managers’ contextualised experiences of managing QI efforts involving patients, by comparing two European hospitals.

The study draws on field observations and qualitative interviews with a total of 21 QI team leaders and hospital managers in a Swedish and a Dutch hospital organisation. The data were subjected to thematic analysis with a critical realist approach.

Results define seven themes, or areas, in which mechanisms are at play: (1) patient involvement in hospital QI, and (2) improving outcomes for patients, originating from the strategic view of achieving the hospital vision. Furthermore, (3) societal influence, (4) knowledge and evidence, (5) complexity, (6) individual resources, and (7) cooperation are areas in which mechanisms operate in the process. These areas are equally relevant for both hospitals, yet the mechanisms involved play out differently depending on contextual structure and local means of action.

Det råder ett stort behov av så kallade samhällsbärande yrkesgrupper inom välfärdsområdet och det är generellt problem med rekrytering inom både sjuksköterske- och polisyrket som är de yrkesgrupper som står i fokus i denna studie. Syftet med denna studie är att studera vad som attraherar studenter till välfärdsyrken och mer specifikt till sjuksköterske- respektive polisutbildning. Vidare är syftet att studera eventuella skillnader som kan relateras till kön, utbildningarnas innehåll, yrkenas arbetsvillkor och karriärvägar. Avsikten är att få en fördjupad förståelse för rekryteringsproblematiken, förväntningar på utbildningen och vad som gör att vissa studenter väljer att avbryta sina studier och därigenom bidra till ny kunskap inom området. Metoder för studien är dels kvalitativa intervjuer, enskilt eller i grupp, dels en enkätstudie med nyantagna sjuksköterske- respektive polisstuderande och studenter som avbrutit sin utbildning under det första utbildningsåret. En jämförande kvalitativ innehållsanalys har gjorts, såväl mellan utbildningarna som mellan kvinnor respektive män. Urval består av samtliga sjuksköterskestudenter som antagits till sjuksköterskeutbildningen vid Högskolan i Borås höstterminen 2021, totalt 124 personer, varav 88 medverkat i enkätstudien och tre av dessa även i fokusgruppsintervjuer. Motsvarande urval gjordes för polisutbildningen med totalt 189 antagna studenter varav 93 deltog i enkätstudien och fyra av dessa medverkade även i fokusgruppsintervjuer. Könsfördelningen är relativt jämn i polisutbildningen (39% kv) medan sjuksköterskeprogrammet har en majoritet av kvinnor (84%). Fördelningen är den motsvarande i studiens datamaterial. Preliminära resultat visar på att det som attraherar studenter till sjuksköterske- respektive polisutbildningen pekar på stora likheter vad gäller motivation och viljan att göra gott och hjälpa andra. Olikheter kan bland annat ses vad gäller förväntningar på den kommande yrkesrollen och hantering av stress, hot och våld i yrket. Konstateras kan att utbildningarna i stort försöker att attrahera studenter som tycks ha liknande värderingar och mål med sin utbildning, men i sina professioner har olika uppdrag. De förväntas inom sina olika professioner och i skilda sammanhang kunna samverka inom olika områden. Här ses en utvecklingspotential för praktisk gemensam träning i konkreta situationer redan under utbildning.

Aims: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units.

Methods: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable.

Results: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p <= .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p <= .05.

Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.