Elderly receiving medication that should be avoided, staff lacking medical competence, lame care plans and end-of-life care that does not follow the rules.
No municipality escapes criticism when the Inspectorate for Care and Care (Ivo) sums up its most comprehensive review of special housing for the elderly to date.
The challenges in Swedish elderly care have been known for a long time, and the pandemic focused the spotlight on shortcomings that had been pointed out
robberies in several places over many years.
Against this background, Ivo in 2021 began an audit of all municipalities that operate special housing for the elderly, säbo, under municipal authority, a total of 283.
A national supervision of säbo of that size has not previously been carried out by the authority.
– This is a unique supervision in scope, says Peder Carlsson, head of department at Ivo.
Flaws in everyone
After going through over 53,000 healthcare records, carrying out surveys with patients, relatives and staff and making physical inspections of the residences, all the municipalities that were part of the inspection have received a decision – and all of them show shortcomings.
– There are municipalities that have more serious deficiencies in several areas and then there are municipalities that have more isolated deficiencies. It looks a little different across the country, says Peder Carlsson and continues:
– Some municipalities actually still show shortcomings that we have pointed out before and which we are now pointing out again.
“Basic requirements”
The supervision has focused on the medical care at Säbo, where Ivo has previously found serious deficiencies in the care given at the end of life, deficiencies in the level of competence of those responsible for the medical care, as well as deficiencies in documentation and in medication management:
75 percent of those who have died lack a documented break-point conversation, that is, customized doctor-led conversations about the focus of care.
20 percent of patients receive drugs that should be avoided for the elderly.
44 percent of patients lack a documented care plan in their municipal health care record.
The fact that the accommodation facilities are often understaffed and that the elderly are cared for by staff without the right skills is a recurring shortcoming, says Ivo.
TT: How serious are these flaws?
– These are very basic requirements in a business in order to be safe and secure, and based on that we see that these are serious shortcomings, says Peder Carlsson.
“Are there opportunities”
Why it looks the way it does in many municipalities, Ivo cannot answer at the moment. It is something that will be looked at going forward.
Are there any prerequisites for remedying what the authority is now pointing to? The Inspectorate for Care and Care believes so.
– We think so. The need for personnel in these operations is a major challenge, but we also see that municipalities are taking measures in different ways. There are opportunities, says Peder Carlsson.
Facts: Ivo’s supervision of säbo
At the end of 2020, the Inspectorate for Care and Care (Ivo) directed scathing criticism at the regions, which are responsible for the medical care of people in nursing homes.
A few months later, the municipalities were also criticized for their corona handling – for poor staffing and lack of medical equipment was the rating from Ivo.
The authority has subsequently carried out an in-depth inspection of special accommodation in the country following the deficiencies that emerged early during the pandemic. The following areas have been included in the inspection:
Ivo has reviewed and analyzed survey responses from patients, relatives and staff, as well as over 53,000 municipal healthcare records from the majority of the municipally run säbo, a total of 1,985, in 283 of Sweden’s 290 municipalities.
All municipalities show deficiencies in some form.
The authority states that “the minimum level in terms of medical care and treatment at Säbo is too low” and that “no municipality fully lives up to the existing laws and regulations.”
Ivo sees, among other things, serious shortcomings linked to end-of-life care. It is also seen that the lack of skills among employees is a serious risk.
After each municipality receives a decision, they have a certain amount of time to submit a response to Ivo about how they intend to correct the deficiencies that the authority has pointed out.
Source: The Inspectorate for Care and Care