Memorandum Government Offices of Sweden Ministry of Health and Social Affairs Ullalena Hæggman

Transcription

1 Memorandum Government Offices of Sweden Ministry of Health and Social Affairs Ullalena Hæggman European Year for Active Ageing and Solidarity between Generations (2012) Since 1983, the European Union has been designating specific years to highlight important social issues. On 14 September 2011, the European Parliament and the Council decided to designate 2012 as the European Year for Active Ageing and Solidarity between Generations (Decision No 940/2011/EU). The objective of this European Year is to encourage the development of an active ageing culture in Europe based on a society for all ages. Pursuant to Article 25 of the Charter of Fundamental Rights of the European Union, the Union recognises and respects the rights of the elderly to lead a life of dignity and independence and to participate in social and cultural life. The growing proportion of older people in Europe and the increase in chronic health conditions make it more important than ever to promote the healthy ageing of all, and in particular older persons, supporting their vitality and dignity by, among other things, ensuring access to appropriate and high-quality health care, long-term care and social services and developing initiatives to help prevent the health risks associated with ageing. Healthy ageing can help to increase the labour market participation of older people, enable them to be active in society for longer, improve their individual quality of life and relieve pressure on the health, social care and pension systems.

2 2 What is active ageing? Creating the best opportunities for health, participation and security with a view to improving the quality of life of people as they grow older. Active ageing helps people to achieve their potential for physical, social, and mental well-being throughout their life and participate in society, while providing them with adequate protection, security and care when they need it. Active ageing: Why is this a matter for Sweden? In Sweden, as in other European countries, demographic trends are leading to a growing proportion of older people in the population. By 2050, it is expected that the proportion of the population aged over 65 years will rise from the current 17% to around 25%. The number of people over 85 years old is expected to rise by 50% over the next 20 years, and to have doubled by This demographic development will have an impact on economic and social trends, welfare, health and care, as well as on individuals' wellbeing. Rather than the discussion about ageing focusing on functional impairments and disabilities, it should emphasise abilities and opportunities. The environment must be adapted to meet the needs of older people, rather than older people being restricted by their environment. The opportunities for active ageing are therefore an interplay between society and individuals, and between rights and support measures. Promoting active ageing also means valuing older people as a resource and thereby creating a society which guarantees its members dignity and security. We should all be able to live a good old age. Challenges and opportunities Promoting active ageing is important from both an individual and a societal perspective. Supporting older people's participation by making the labour market more flexible so that those people who can and want to work longer are able to do so, and giving people the prerequisites for living an active, stimulating and independent life as long as possible, are very important for our growth and competitiveness and, by extension, for our collective prosperity. Dignity, influence and participation The right to dignity, influence and self-determination is particularly important when people become dependent on care from society as a result of infirmity or old age. Older men and women should not need to give up their identity or personality when the need for care arises. Ageing is a natural stage of life, and elderly care is about helping older people to live their life as the person they are. Labour market participation People are going to have to work longer in order to deal with the coming demographic strain, in conjunction with presumed ongoing increases in average life expectancy, without loss of

3 welfare. This can be achieved by starting work at an earlier age, retiring later or by working more intensively during one's working life. It is reasonable to assume that the transition from work to retirement will becoming increasingly gradual, which requires working life arrangements to be adapted. Many need to work longer, but for others it is a question of the opportunity to continue to work after the age of 67 years, or of measures to make it possible to work until they are 65. There is thus no single method for achieving this objective, but rather several ways of achieving the goal of increasing the number of hours worked. Participation in society The experience of life as meaningful and understandable is of essential importance to health. When something in life is seen as meaningful, people are willing to invest energy and commitment to it, thus making their existence more purposeful. Many people take part in various types of voluntary work once they retire. All these people do an important social service, at the same time as reinforcing their feeling of self-worth and having a meaningful occupation. Involvement in voluntary work is thought to be related to better well-being, affecting both the giver and the recipient of the service. Being culturally active, for example by going to exhibitions or concerts or participating in choral singing, is of benefit to both mental and physical health. Cultural activity gives an intellectual and emotional boost and has a vitalising effect. It can be a way to break down the isolation and loneliness which often characterises older people's lives. Offering older people cultural activities that they find interesting and meaningful is a good way to banish negative life patterns and prevent illness. Health giving activities There is a great deal of research suggesting that social contacts and social support have a positive impact on health, even in advanced years. The support acts as a "health buffer" against the various difficulties of life, above all against loss or other negative changes. Participation in social activities also has a positive effect on the well-being of elderly people living at home. Initiatives to encourage social activities and contact are therefore important for older people. The human body is made to be active and needs to be used if it is to remain healthy. There is considerable evidence today of the health benefits of physical activity for older people. It can improve the oxygen-carrying capacity of the blood, muscle strength, ability to walk and balance and slow down the development of chronic disability. It is therefore very important to reach people in time. It is never too late to start moving and to benefit from an increased level of activity. Autonomous living and the living environment A living environment experienced as safe and secure, which is accessible and encourages contact with neighbours is important for all, not least for older people. Your home should be a safe and familiar environment, a part of yourself and your identity. Accessibility and ease of use have a positive effect on health. 3

4 It is important to give older people the opportunity to choose for themselves when it is time to move to sheltered housing or to opt to stay in their own home even if they become infirm. It is therefore important to improve opportunities for older people to stay in their own home whilst retaining or enhancing their security, autonomy and ability to participate in society and lead an active life. It is also important for care to be offered in people's own homes in an effective, safe and flexible manner. One way to bring this about is to develop IT and other technical applications and services in this area. 4 How the Government supports active ageing Policies and measures Sweden's objectives in this area are in line with the objectives of the European Year for Active Ageing and Solidarity between Generations The Government has implemented a series of measures aiming to enhance individual freedom of choice, self-determination, participation and influence, and measures to enhance the quality, safety and dignity of elderly care. Initiatives have also been implemented to counter ill health and promote healthy longevity. The Government intends that the European Year 2012 should further develop and reinforce this work. The Government will be continuously updating its website at to showcase activities organised as part of the European Year Dignity, influence and participation Principle In January 2011, a provision was introduced into the Social Services Act (socialtjänstlag)stating that social care for older people must be designed so that elderly people can live with dignity and a sense of well-being. This principle helps to clarify that care must be geared to people's need for dignity when they receive care or otherwise have contact with care services for the elderly. This reinforces the principle that elderly men and women should be able to live in accordance with their own identity and personality, and this must include two aspects: a dignified life and opportunities to experience well-being. This is the guiding principle in elderly care activities and thus for staff's efforts and actions. The principle is a way of thinking differently about care and a complement to the progress already under way. It contributes to greater clarity and equivalence throughout Sweden concerning the approach to be taken.

5 Freedom of choice within elderly care Older people are a diverse group, with different needs, values, interests and expectations, and they therefore need a variety of different providers as part of their care. Different focuses will have to be provided to satisfy people's varying needs. The opportunity to choose who is going to help you to get washed in the morning, and in which nursing home to live, is important. The Free Choice System Act (lag om valfrihetssystem - LOV)) was introduced on 1 January Under the LOV, elderly people have the opportunity to choose who provides their care, and to refuse care which is not working well for them. It is individuals' assessment of the service quality which decides whether the service-provider will keep the contract. The majority of local authorities in Sweden have now voluntarily chosen to enhance elderly people's freedom of choice by introducing the LOV. Those local authorities and counties deciding to introduce a free choice system will be displayed on the national website of the Legal, Financial and Administrative Services Agency (Kammarkollegiet). They are all displayed at a single location, and participation is simple and free of charge. The free choice system may, for example, include more effective catering for the needs of people who originate from outside Sweden. Many elderly people with dementia have difficulty speaking languages they learnt as adults. In such cases, it is important to be able to provide help, care and support in the patient's mother tongue. Relatives an important resource One of the Government's priorities is to support those who are caring for or assisting a relative. Relatives perform the lion's share of care work in Sweden. It is estimated that they account for 62% of the total work involved in caring for elderly people and the disabled. Almost 70% of all care provided by relatives is performed by women. Local authorities' responsibility to support relatives was clarified by means of an amendment to the Social Services Act which came into force on 1 July From 2012 onwards, the Government will be supporting relatives' associations to the tune of SEK 2 million. Participation in working life 5 "New Start Jobs" The most important measure implemented by the Government to stimulate the supply of labour among older people is the higher in-work tax credit for persons 65 years or older. Moreover, persons aged between 55 and 64 can take up a "New Start Job" for up to ten years. With "New Start Jobs", employers are given economic assistance in an amount corresponding to twice their contribution. The condition for taking up such as job is normally 12 months' unemployment but, since 1 July 2010, this has been temporarily reduced from 12 to 6 months for people over 55 years. The temporary

6 reduction in the qualification period for older people was originally intended to last until 30 June 2012, but an extension until 2013 is now planned. What is needed so that we can work longer in old age? On 14 April 2011, the Government decided to order an enquiry into pension-related age-limits. The enquiry will look at the pension-related agelimits and the opportunities for, and obstacles to, a longer working life. It will also draw up proposals and alternative strategies on how pensionrelated age-limits are to be operated, and also make suggestions for labourmarket or other measures to create better conditions for working longer into old age. The directive has been prepared in consultation with the Parliamentary Group on Pensions. An interim report will be drawn up by 16 January 2012 and a final report by 1 April Combating all forms of age discrimination Good health is the most important precondition for older employees being in a position to continue to work in old age. It is important for employers and employees to both take responsibility for promoting older employees' capacity to work. Work-related or career development measures offering greater flexibility in terms of tasks and working times make it easier for older people to continue working. It is certainly important to combat all forms of age discrimination. The Discrimination Act (2008:567) has provided protection against discrimination at work on the grounds of age since 1 January Under the Act it is forbidden, for example, to use a job-seeker's age as a selection criterion for employment, or to discriminate against a person in terms of pay, working times or other working conditions because of their age (prop. 2007/08:95, p. 499). However, discrimination on the grounds of age which has a justifiable objective, where the means used are appropriate and necessary to attain that objective, will not be considered inequitable. A Government committee Ett vidgat skydd mot åldersdiskriminering (Better Protection against Age Discrimination) was commissioned to come up with proposals about how to extend protection against age discrimination in the fields of social services, health and care and access to goods and services (SOU 2010:60). The proposal has been submitted to the Government and is currently being looked at by us. Participation in the life of the community 6 Commitment to involving older people in cultural activities Awareness is growing in many local authorities and counties of the importance of improving elderly people's access to cultural activities. Increased cooperation between those involved in cultural life and elderly people can contribute to a better quality of life and a healthier old age. Many counties have introduced cultural activities in care establishments to complement traditional care activities.

7 In autumn 2011, the Government delegated to the National Council for Cultural Affairs the task of distributing SEK 30 million to projects designed to encourage elderly persons' participation in cultural life. Participation here means both experiencing culture passively and actively creating with others. The aim of the contribution is to encourage a better system, greater cooperation and better quality in ongoing projects concerning culture for elderly people. The initiatives will also build on work already carried out or started in the field of cultural development in healthcare and elderly care, both practically and in terms of policy. The National Council for Cultural Affairs will commission an outside party to evaluate the implemented initiatives in order to ensure and enhance sustainable achievements in this area. These evaluations will be compiled in a report to be distributed to stakeholders in both the care sector and the cultural field. Health promotion activities 7 Physical activity "on prescription" The Swedish National Institute of Public Health has, on behalf of the Government, drawn up a working method to promote physical activity, known as Fysisk aktivitet på Recept (FaR - Physical activity on prescription). Around half of all care establishments in Sweden have now built routines into their programme whereby staff promote physical activity with the patients. The most common activity for those which have included such routines in their programme is the giving of verbal advice (96%), followed by physical activity "on prescription" (69%) and on referral (50%). Around two thirds (69%) of establishments have specially designated staff responsible for observing, evaluating and updating routines of this kind. A little over half of establishments have documented their routines in writing. FaR is being implemented as part of in-patient care in many parts of Sweden. There has also been a rapid development of knowledge and skills among those working in the field of physical activity, movement and training outside the health and care occupations. FaR gives these people the opportunity to combat ill health and promote public health in collaboration with persons working in the health and care sectors. Health coaches The Swedish National Institute of Public Health has been commissioned by the Government to introduce and manage pilot activities with health coaches, in collaboration with the National Board of Health and Welfare. The aim is to inspire and equip counties and local authorities to promote active and healthy ageing in collaboration with the non-profit sector. The target group is younger pensioners in reasonably good health who are given the opportunity to improve their fitness through health coaching and

8 social meeting places offering a wide range of useful, health-enhancing activities. The challenge is to find and develop ways for counties, local authorities and the non-profit sector to work together. Autonomous living and the living environment 8 The Teknik programme for elderly people Since 2007, the Government has been supporting the Teknik development programme for elderly people to the tune of SEK 22 million a year. The programme will run until the end of Experience shows that current housing conditions need to be adapted to provide better opportunities for everyday activities at home and in the vicinity. The focus is on improving housing, user-friendly technical support, appliances, and good products and services for elderly people and their relatives. The development area can be accessibility in the living environment, technical support for communication, memory aids, transportation or everyday activities. "Smart technology", where modern ICT is used to provide support or assistance, or projects involving robotics, are also eligible for funding. Other areas include the development of services, e.g. easy food shopping on the internet, technical support, reliable social alarms and opportunities for social interaction. What techniques are available and what will be needed in the future? In October 2011, the Government commissioned the Swedish Institute of Assistive Technology (HI) to survey the existence of, need and demand for IT and other technical support and services in the area of elderly care. This study will also provide information about the need for information material and support structures and other implementation assistance regarding business models, cooperation contracts and procurement, etc. The target groups are local politicians and civil servants, as well as care workers. Each local authority taking part in the survey receives SEK The survey will help the Government in deciding whether a State initiative should be implemented in this area and, if so, how it should be designed. Civil society organisations Civil society organisations play an important role as regards elderly people's opportunities to take part in society and experience a meaningful life. They contribute to the development of the social economy. Their role as providers could be developed under the same conditions as apply to other providers of social services. In this way, the emergence of a significant range of providers and suppliers can be supported. The Government's Pensions Committee Sweden's five largest pensioner organisations, the PRO, SPF, SPRF, SKPF and RPG, together constitute the Government's Pension Committee. Almost

9 people belong to one of these five organisations, and the number of members is constantly increasing. Activities The Swedish National Institute of Public Health has been commissioned to work, within its remit, to implement Sweden's participation in the European Year for Active Ageing and Solidarity between Generations Launch of the Swedish Year of Active Ageing On 8 February 2012, Maria Larsson, Minister for Children and the Elderly, and Lena Adelsohn Liljeroth, the Minister for Culture and Sport, will be launching the Swedish Year of Active Ageing, as part of the inauguration of the Seniorliv i världsklass exhibition at the Kistamässan centre in Stockholm. At this event, which will last until 10 February, the Swedish National Institute of Public Health and other relevant authorities will be sharing a stand and running a number of seminars, the common denominator of which will be the Year of Active Ageing. 9 Folkhälsostämman (public health convention) April 2012 The Folkhälsostämman is organised by the National Institute of Public Health. Cutting-edge knowledge and effective methods and strategies are presented, together with factors which have an influence on public health developments. On the third and final day of the convention, the Network of Health-Promoting Hospitals and Care Organisations will be starting its conference. These two events are linked by means of a joint event which will focus in particular on the Year of Active Ageing According to the provisional programme, Bodil Jönsson, Barbro Westerholm and Anders Hansson will be speaking on the subject of promoting good health throughout life. A healthier Sweden The Swedish National Institute of Public Health will be organising, for the third time, an awareness-raising week entitled "A healthier Sweden) in autumn This event, which will be focusing on nutrition and physical activity, will also refer to the Year of Active Ageing. National guidelines on active and healthy ageing, including pilot activity with health coaches Information and experiences gained by the National Institute of Public Health as part of its task of drawing up national guidelines on active and healthy ageing will be disseminated in various contexts as part of the Year of Active Ageing, partly though activities run by the Institute itself and partly through activities run by other stakeholders. The Institute is planning, inter alia, a large-scale conference in spring 2012 to promote an exchange of experiences between the counties, local authorities and non-profit organisations participating in the project. The national guidelines will

10 consist of a website which is due to be launched in early The website will be continually updated with new information and ideas about how the counties, local authorities and the non-profit sector can, together, promote healthy ageing. 10 Website Information on the European Year for Active Ageing and Solidarity between Generations 2012 can be found at This website will be continually updated.