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Copyright ACCESS Health International 2017Aging with Dignity Innovation and Challenge in Sweden the Voice of Care Professionals Sofia Widn one, the holistic strategy or big picture; and the third, a questioning, reflec- tive, learning journey that is open to change. Aging with Dignity is one strand in this triple helix. If reform processes are successful, more and more individuals across the world will have the opportunity to age with dignity. It is incumbent Copyright ACCESS Health International 2017aging with dignity 10 upon all of us to ensure that every society is able to sustain the welfare and wellbeing of their aging populations. Nils Bohlin Global Practice LeaderHealth Care and Life Sciences at Arthur D. Little Copyright ACCESS Health International 201711 Acknowledgements We are deeply grateful to all those who gave the interviews that form the core of this book. Not only did they take the time to describe their work, but they carefully reviewed and edited the final transcripts. Specifically, we wish to thank Eva Nilsson-Bgenholm, former national coordinator for the government project “De mest sjuka ldre” , the Most Fragile Elderly Project, and Maj Rom, program manager for the Most Fragile Elderly Project, for sharing their valuable expe- riences of Swedish healthcare. Ms. Nilsson-Bgenholm and Ms. Rom also recommended several follow-up interviews and case studies that allowed us to broaden the scope of this book. We were inspired by the work of Forum fr Vlfrd (Forum for Welfare) and their project on integrated care. Representatives from Forum fr Vlfrd, including Oscar Boldt-Christmas, senior partner and managing director of McKinsey Merja Manninen, temporary homecare manager, and Britt-Marie Bylin, district nurse, for their efforts in describing the opportunities and challenges of home health and integrated care; Lena Kallin-Persson, quality coordinator, and Lena Eriksson, quality coordinator, for dis- Copyright ACCESS Health International 2017aging with dignity 12 cussing the strategic and continuous work of the company in improving care services; and Jan Blomkvist, department manager of long-term care housing, Marielle Nilsson, vice unit manager of the Sjglimten Short-Term Care Home, and Ann-Sophie Holgersson, manager of the Grind Care Home. All TioHundras interviewees were very gen- erous with their time and added greatly to our understanding of care coordination in Sweden. We wish to thank Jeanna Thorslund, lawyer in the Department of Digitization at the Swedish Association of Local Authorities and Regions, for explaining the legal considerations of welfare technologies, and Dr. ke Dahlberg, advisor to the Swedish government on questions relating to the economics of welfare technologies, who described the costs and benefits of implementing welfare technology. In the course of our research, we met with users of care services. W e owe special thanks to Inga Brehmer for her efforts in hosting focus groups, and to our most frequent focus group participants, Gudrun Bergstrm, Guje Bostrm, and Ingrid Svahn. They and all the focus group participants gave us valuable insights into changing consumer needs in assistive technologies. W e also met with public sector policymakers, program managers, and the private sector. We are grateful to Magdalena Marklund, program manager for T echnology for the Elderly; to Raymond Dahlberg, senior advisor at the Agency for Participation, who described the innovative programs for seniors living in Sweden; and to Markus Merne, chief executive officer of Everon, who provided invaluable insights into the use of assisted devices and global positioning technologies in care. W e are grateful to Henrik Ahlen, digital strategist at the consulting firm Alfa Bravo, for sharing his thoughts on the future of eHealth; Patrik Sundstrm, program manager for eHealth at the Swedish Association of Local Authorities and Regions, who went through the national effort to standardize eHealth requirements and technical specifications; and Erik Weiman, former chairman of Uppsala County Council and Moderate Party politician, for describing the political priorities in the area of long-term care. Our study touches on Estonias eGovernance and eHealth systems. In particular, we would like to thank Dr. Ain Aaviksoo, deputy secretary general of eServices and innovation at the Estonian Ministry of Social Affairs; Artur Novek, implementation Copyright ACCESS Health International 201713 acknowledgements manager and architect of the Estonian eHealth Foundation; Taavi Kotka, government chief information officer and deputy secretary at the Estonian Ministry of Economic Affairs and Communications; and Stein Samsom, who explained the distributed architecture of the eGovernance system. This book includes several interviews conducted in the county of Uppsala, home to numerous innovative programs. We wish to thank Magnus Gyllenspetz, senior physician, Christina Mrk, senior physi- cian, Angela Edman, nurse, and Pia Ekeroth, nurse, for describing their work with the Mobile Emergency Team for the Elderly in Uppsala, a leading example of integrated care in Sweden; Carina Kumlin, manager, and Pia Lagerstrm, care coordinator, who discussed their work to improve the coordination of long-term care in Uppsala; Christianne Simson, program manager of Support for Relatives, for describing her tireless efforts to improve discharge processes in Uppsala; and Annika Brehmer for recommending suitable case studies and for her valuable comments. We appreciate the generosity of a number of municipalities in Sweden. In particular, we would like to thank sa Lwing, former eHomecare manager of Vsters Municipality, for explaining the eHomecare model. W e also studied the close-care system and mobile teams in Lidkping, in the southwest of Sweden. We are thankful to Marianne Alrd, care coordinator of the Mobile Operational Team, and Dr. Jesper Poucette of the Lidkping Mobile Doctor Service for explaining the Mobile Operational Team and the Mobile Doctor Service, and to the members of the Mobile Operational Team, Ulla Andin, senior physician, Anna Karlsson, resident physician, Siv Jons- son, district nurse, and Christina Pettersson, nurse, for their time. We wish to thank Lotta Roupe, assistant nurse, Silvia Sister, and manager of the Stiftelsen Silviahemmets day-care center. Ms. Roupe explained Stiftelsen Silviahemmets history and its palliative care philosophy; and Linda Martinson, Regional Manager of Aleris care come, for sharing her long experience of care methods. Apart from the interviewees, this book could not have been written without the generous help of many people. We owe a debt of thanks to Lars Thunell, board member of ACCESS Health for his advice and kind encouragement; Eva Henriksen, acting director of academic Copyright ACCESS Health International 2017aging with dignity 14 primary care centers in Stockholm County, for her guidance with this research effort; Nils Bohlin, senior partner and Global Lead of Health Care at Arthur D. Little. We wish to thank Finn Bengtson, Moderate Party Member of Parliament, for explaining his view on the Swedish healthcare system, and Jrgen Striem for sharing his views on Swedish healthcare. W e would like to thank Pamela Mazzocato and Carl Savage, postdocs at the Karolinska Institute, Stockholm, for sharing their research insights with us. We are grateful to the entire team at Villa Nest, including Sofia Fagring and Adele Treschow, for their support. We would also like to thank all of our dedicated research internsAnindita Ghandi, Louise Widn, Sigita Svirblyte, Marine Sigot, Mikael Thorberg, and Martin Godeat ACCESS Health Sweden, who have contributed to our work, edited interviews, and assisted with background information. Our particular thanks go to Stphanie Treschow, former country director of ACCESS Health Sweden, who provided guidance and support for this work from the outset, and our colleagues at ACCESS Health International for their kind encouragement, advice, and support throughout the project. W e also owe special thanks to Malin Lidforss, former consultant at ACCESS Health Sweden, for her dedication and enthusiasm in editing the interviews and the introduction. She worked closely with Susan Wile Schwarz at ACCESS Health International. Susan provided useful comments and editorial advice. We thank Zachary Gresham for his editorial contributions. The research was supported by the William A. Haseltine Charitable Foundation Trust and a grant from Garry Weber. Copyright ACCESS Health International 201715 Introduction Aging with Dignity is a close look at the future of long-term care through the lens of the Swedish healthcare system. The book provides context and analysis for the full range of in-depth interviews available on the ACCESS Health International website, accessh/agingwithdignity. We believe Sweden to be a useful model for two reasons: the high level of care Sweden has achieved for its people, particularly individuals who live with multiple chronic illnesses, provides an excellent template for any nation interested in reforming its healthcare system; and the problems encountered in Sweden anticipate what most countries, whether rich or poor, can expect to face in an era of demographic change. Over the past year, ACCESS Health has conducted interviews with long-term care professionals across Sweden. We have spoken with users of long-term care services, doctors, nurses, administrators, and government officials. Each professional we spoke with has dedicated their career to making sure their fellow citizens receive the best care possible. Each confronts a complex set of social, health, financial, and regulatory issues; each struggles to find more effective ways to improve care. The complete set of interviews on which this book is based is available at the ACCESS Health website, accesshit is in the interviews you will hear their voices, understand their perspectives, and learn about their plans and aspirations. The interviews highlight the pressure that aging populations are plac- ing on healthcare systems, long-term care infrastructure, and pension funds. W e are living longer than ever before. W e are also accumulating a greater number of chronic diseases as we age. Our healthcare systems are not designed to care for aging populations; indeed, they are often specifically designed to care for younger people with short-term health issues such as broken legs or appendicitis. Healthcare professionals in Sweden have known about this system failure for a long time, and they realize that healthcare costs are increasing rapidly because of it. Copyright ACCESS Health International 2017
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