Wednesday, May 18, 2016

Steve: Is This Any Way to Run a Country?

Senior Center at Hörnan

For Tuesday's class, one of the speakers was Steffan Osterstrom. Steffan works for Jönköping municipality and has spoken to previous classes I have brought here.  It's the 292 municipalities that have the responsibility for organizing and delivering services to older people.  This covers everything from occasional help in the home or snow removal services in the north of Sweden to nursing home care. 

Today Steffan talked about some of the trends in care, but what was really most astonishing were his descriptions of how the municipality decides what to do. Essentially, the national government sets guidelines for services for older people. A law called the Social Service Act states who has responsibility for carrying out the law and the values that should guide programs for older people, like assuring safety or supporting autonomy and quality of life. But the law does not tell municipalities what specifically they should do. Not how many nursing homes they should have.  Not how many staff they should hire. It's left to municipalities to organize care. The result is that there is considerable variability. For example, one municipality outside of Stockholm contracts all services for older people to private contractors, while other municipalities run 100% of the services themselves.  Some municipalities have proportionately more nursing home beds and others have fewer and instead emphasize home care. 

This allows modifying services to meet local needs. It also allows for innovations. Some communities, for example, are building something called security housing, which targets people over 75. In this housing, people have their own apartments and can live completely independently, but there are personnel available to help them if or when they need it. Meals are available as well as other onsite services. The idea is that community services can be provided more efficiently if people are grouped closer together, and the arrangement may help people stay at home because they feel secure that they will get help, if they need it. 

Contrast that with the U.S. Here everything gets specified in excruciating detail.  The laws specify what you can and cannot do in this type of housing, rather than allowing experimentation to determine what works best.  Spelling out exactly what a program must do leads to checking off tasks, rather than doing them well. It does not allow for local variability  or innovation. 

According to Steffan, local services reflect what elected officials choose after consultation with the staff who run the programs and in open discussions with people from the community.  Steffan told us, "It's beautiful to work in this system.  The democratic process works well."

When did you last hear a program manager say that their work is beautiful?

A Different Kind of Senior Center

In the afternoon, we visited Hörnan, a neighborhood center that provides some of the functions of a senior center.  The big difference is that the program is run largely by older volunteers, with only one part-time paid employee.  This creates a vibrancy in the. program. It belongs to the people who run it.  People can drop in when they want to have coffee, talk, play games, or listen to a speaker. We listened to a speaker who told us more than we ever thought we wanted to know about passenger ships, but we got the point. 

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