Finland – Resources to support community and institutional Long-Term Care responses to COVID-19

LTCcovid Country Profile – Printable Version

1.00. Brief overview of the Long-Term Care system

Care for older people in Finland is primarily delivered at home and in the community. Over 90% of the older population (75+) live in their own home, with the majority receiving no formal care (~75%), some receive regular home care, or informal care. Less than 10% of the older population receives some kind of 24-hour sheltered housing or institutional care (source: https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

Update for: Finland Last updated: January 6th, 2022

1.01. Population size and ageing context

The current population of Finland is 5,546,270. As of 2019, the number of people aged 70 and over was 874,314. Finland is a rapidly aging country, with the number of people over 70 growing by 100,000 in just three years (source: https://findikaattori.fi/en/14).

Update for: Finland Last updated: February 10th, 2022

1.02. Long-Term Care system governance

The Ministry of Social Affairs and Health oversees the planning and drafting of all social care policy; it also monitors its service standards through 1) the National Supervisory Authority for Welfare, Valvira, which grants licenses to private and public care program, and 2) six Regional State Administrative Agencies (AVIs), which ensure standardization of care across the country.

Local municipalities are self-governing administrative units and have a key role in public administration. They are responsible for arranging and supervising the social and health services in their own area.

LTC is a policy priority for Finland’s Ministry of Social Affairs and Health, especially in the context of a rapidly growing older population with increasingly formal/institutional care needs. Clarity of accountability, assessment and monitoring when determining LTC service plans is a legislative priority. Implementation of legislative priorities is however challenging; the promoted value of self-determination often conflicts with ensuring the quality care provision plans (Ylinen et al, 2021).

References:

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L. Ylinen, S. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, MC COVID-19 working paper 04/2021. http://dx.doi.org/10.20350/digitalCSIC/13692

Update for: Finland Last updated: February 1st, 2022

1.03. Long-term care financing arrangements and coverage

LTC services are part of the universal health and social care system in Finland. The state government and municipalities are the major funders of LTC care, however despite most costs being covered by taxes, there are user fees. For example, in 2014, older people using care services paid 18.5% of the costs of care (source: http://urn.fi/URN:ISBN:978-952-302-236-2). User fees are defined by the ability to pay.

Unpaid care from families is a major part of the LTC system, and it is argued that reforms of the care system in the past 30 years have resulted in increased reliance on families, who have been provided with support through cash-for care schemes (Ylinen et al., 2021).

According to the European Union’s Ageing report 2021, public LTC expenditure in Finland represented 2.0% of Gross Domestic Product in 2019.

References:

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L. Ylinen, S. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, MC COVID-19 working paper 04/2021. http://dx.doi.org/10.20350/digitalCSIC/13692

Update for: Finland Last updated: February 10th, 2022

1.04. Approach to care provision, including sector of ownership

Municipalities determine whether they provide services themselves, work with other municipalities, purchase services from for- or non-profit actors, or set up cash benefit informal care systems (Ylinen et al., 2021).

References:

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L. Ylinen, S. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, MC COVID-19 working paper 04/2021. http://dx.doi.org/10.20350/digitalCSIC/13692

Update for: Finland Last updated: February 1st, 2022

1.05. Quality and regulation in Long-term care

The National Supervisory Authority for Welfare and Health (Valvira) and six Regional State Administrative Agencies (AVIs) are responsible for supervising Long-Term Care provision. Valvira’s role is to give directives and providing licenses to private providers, processing complaints and conduct major investigations and inspections. The AVIs are responsible for regional supervision and guidance of health care and welfare provision and responding to complaints.

Individuals who use care have a personal care and service plan which constitutes a contract between the client and the municipal authorities. This specifies the services and support a person should receive and responds to the idea of ‘self-supervision’, according to which clients should be involved in monitoring the quality of services. In 2019 serious failings in quality of care were found in some private sheltered care settings, which led to these institutions being closed down. New legislation set minimum personnel ratios in all care homes, as well as the requirement to assess all residents using interRAI by 2023 (EC, 2021 and Ylinen et al, 2021).

References:

European Commission (2021) Long-term care report. Trends, challenges and opportunities in an ageing society. Country profiles, volume II. Joint Report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL). https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8396&furtherPubs=yes

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L. Ylinen, S. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, MC COVID-19 working paper 04/2021. http://dx.doi.org/10.20350/digitalCSIC/13692

Update for: Finland Last updated: February 1st, 2022

1.06. Care coordination

Since the beginning of the 1990s there has been an effort to integrate home care at local level between social care home services and home health care, this is in the context of home care being considered as key to support people living independently for as long as possible. In 2004 a temporary law on the structural integration of health and social care was passed to remove legal obstacles to integrate home care. These processes, which at local level has involved the merger of municipal health unites with health and welfare departments, have led to more integrated care practices (Linnosmaa and Saaksvuori, 2017).

However, despite attempts at standardization of care services across the nation, there are major differences between municipalities due to their demographics; this appears to affect individuals ability to navigate the system (Ylinen et al., 2021).

References:

Linnosmaa I and Saaksvuori L (2017) Long-Term Care policy in Finland. Policy Brief. CEQUA LTC network.

Update for: Finland Last updated: February 1st, 2022

1.09. Community-based care infrastructure

The Finnish government is currently proposing reforms to the Social Welfare Act that aim to strengthen and expand home-based care, including widening the services on offer and adopting measures to secure sufficient staff.

Update for: Finland Last updated: February 1st, 2022

1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

Municipal outsourcing to the private and for-profit sector for provision of sheltered, round-the-clock LTC has significantly increased over the past decade; in recent years, reports of insufficient care and serious maltreatment in these spaces have been met with public outcry for their review. The Act on care services for older people is thus under reform and a minimum number (0.7) of nurses per clients will be required by April 2023. Municipalities appear to be struggling to maintain/keep up with growing need for more formal care services. Additionally, with the population aging and working-age population decreasing, there is a growing concern about the shortage of employees in LTC services (Forma et al., 2020).

References:

Forma, L., Aaltonen, M., Pulkki, J. (2020). ‘COVID-19 and clients of long-term care in Finland- impact and measures to control the virus’, LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 12 June 2020. Retrieved from: Finland: ltccovid.org

Update for: Finland Last updated: February 10th, 2022

1.11. Role of unpaid carers and policies to support them

Although Finland assigns its municipalities a legal responsibility to provide care services, unpaid carers still play a major role in care provision. It is argued that reforms of the care system in the past 30 years have resulted in increased reliance on families, who have been provided with support through cash-for care schemes Municipal support requires a contract between the municipality and the caregiver (Ylinen et al., 2021).

References:

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L. Ylinen, S. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, MC COVID-19 working paper 04/2021. http://dx.doi.org/10.20350/digitalCSIC/13692

Update for: Finland Last updated: February 15th, 2022

1.14. Pandemic preparedness of the Long-term care sector

Despite a robust Pandemic Preparedness plan in Finland, social welfare units (including care homes) were only briefly mentioned. It was reported that pandemic preparedness in Finland provided insufficient guidance on care of older people during crisis (Ylilnen et al., 2021).

References:

Ylinen, T., Ylinen, V., Kalliomaa-Puha, L., Ylinen, S. (2021). ‘Finland: Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future’. MC Covid Working Paper, Retrieved at: CSIC_covid_FINLANDIA.pdf

Update for: Finland Last updated: February 11th, 2022

2.01. Impact of the COVID-19 pandemic on the country (total population)

As of February 21, 2021 there have been 53,742 confirmed cases of COVID-19 in Finland, and 726 deaths, according to Our World in Data. These numbers have been steadily rising since March 2020, when the first lockdown measures were announced and the first death was reported (March 20) (Source: https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view). Numbers of cases, testing, and deaths are being recorded by the Finnish Institute for Health and Welfare (THL) (Source: https://experience.arcgis.com/experience/92e9bb33fac744c9a084381fc35aa3c7).

Update for: Finland Last updated: August 3rd, 2021

2.02. Deaths attributed to COVID-19 among people using long-term care

As of April 8, 2021, 80,842 people have tested positive for COVID-19 and 866 people have died. Of those, 29% (approximately 251) died in social care 24-hour units (Source: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s-new/coronavirus-covid-19-latest-updates/situation-update-on-coronavirus#Coronavirus_situation). In 2018, there were 50,298 residents in social care 24-hour units (Source: https://thl.fi/fi/tilastot-ja-data/tilastot-aiheittain/ikaantyneet/sosiaalihuollon-laitos-ja-asumispalvelut). Therefore, the number of COVID-19 related deaths in these units represents 0.50% of this population.

Update for: Finland Last updated: August 2nd, 2021

2.04. Impacts of the pandemic on access to care for people who use Long-Term Care

Non-urgent annual health checks, appointments, and elective surgeries have been suspended in Finland and many people voluntarily cancelled their appointments. Among the measures launched by the Finnish Government (March 16, 2020) was a plan to increase the capacity of health care and social welfare services in both the public and the private sector. New residents to care homes required testing. However, there have been reported shortcomings. It has also been reported that home care visits have been declined and day care centres have closed.

Update for: Finland Last updated: August 4th, 2021

2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

A qualitative study conducted during May to December 2020 with family members of residents in nursing homes in different parts of Finland found that family members perceived that distancing measures had aggravated the pre-existing conditions of their relatives. This included sudden progression in cognitive abilities and deterioration in physical abilities. Both family members and residents experienced grief, anxiety and severe stress (Paananen et al, 2021).

References:

Paananen J, Rannikko J, Harju M, Pirhonen J (2021) The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study. International Journal of Nursing Studies Advances, 3. https://doi.org/10.1016/j.ijnsa.2021.100031.

Update for: Finland Last updated: February 1st, 2022

2.07. Impacts of the pandemic on unpaid carers

A qualitative study conducted during May to December 2020 with family members of residents in nursing homes in different parts of Finland found that both family members and residents experienced grief, anxiety and severe stress. Family members were concerned that the residents lives were at risk due to lack of social contact and activity. They also expressed frustration at not being able to contribute to the care of their relatives or to touch them, when visits were allowed (Paananen et al, 2021).

References:

Paananen J, Rannikko J, Harju M, Pirhonen J (2021) The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study. International Journal of Nursing Studies Advances, 3. https://doi.org/10.1016/j.ijnsa.2021.100031.

Update for: Finland Last updated: February 1st, 2022

2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

According to a recent report (February 2022) by The Federation of European Social Employers, Finland has experienced an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.

Update for: Finland Last updated: February 5th, 2022 Contributors: Daisy Pharoah |

3.02. Governance of the Long-Term Care sector's pandemic response

Finland announced a state of emergency on March 16, 2020, after reaching its pandemic threshold of 156 cases on March 15 (Source https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view (p. 15)). The Ministry of Social Affairs and Health (MSAH) is responsible for the planning of the national pandemic response with the help of The Finnish Institute for Health and Welfare (THL), an independent national health research institute. Any national directive (i.e. care measures for infected LTC home residents) is then implemented by local municipalities (Source: https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620-1.pdf).

Decision-making has primarily fallen on the shoulders of the Finnish Health and Welfare research institute (THL), employed by the Ministry of Social Affairs and Health. Expertise at the municipality level is slightly unclear, although agents at the local level are clearly instrumental in bridging the gap between local need/services and nationwide policies/standards (Source: https://www.covid19healthsystem.org/countries/finland/livinghit.aspx?Section=5.%20Governance&Type=Chapter).

On the other hand, municipalities appear to have a large degree of freedom in decision making around LTC. National operators have developed guidelines for residential and domiciliary care. These guidelines were updated over time. However, most guidelines provided at the national level (including LTC guidance) were not binding for municipalities. This led to a situation that in some municipalities visiting bans were introduced ahead of the Government guideline, while others did not follow this. Other municipalities, on the other hand had implemented additional measures, such as support with shopping for older people. Regional variation of the spread of COVID-19 could have been another reason for the different application of guidelines (Source: https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620-1.pdf)

Update for: Finland Last updated: September 8th, 2021

3.02.01. National or equivalent Covid-19 Long-Term Care taskforce

While it’s difficult to determine a formal Finnish taskforce for social care during the pandemic, it’s clear that the Ministry of Social Affairs and Health and The Finnish Institute for Health and Welfare (THL) worked closely to decide certain policies (e.g. regarding LTC home visitation and self-isolation of older people). On May 4, 2020, the government announced a plan to move to a hybrid strategy, ‘test, trace, isolate and treat’. One of the main aims was to protect the elderly and high-risk groups. Their guidelines/press releases are published regularly online.

Update for: Finland Last updated: September 8th, 2021

3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic

Hospital districts became the central organising forces for the pandemic response. Concern over shortages and adequacy of healthcare personnel led to the termination of non-urgent care, most elective surgeries, medical rehabilitations, therapies, and counselling services, and annual health checks (included those of at-home care users) were suspended nationwide. However, the use of hospitals has generally been kept under control (Source: https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view (p. 20)). Early on, avoiding transfer from care homes to hospitals (and vice versa) was put on the mandated guidelines list (Source: https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620-1.pdf (p. 9)).

Update for: Finland Last updated: September 9th, 2021

3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

Finland has very good data through its health and social care registers, both in terms of data and coverage. However, during the pandemic up-to-date data on, for example, deaths in care homes and among home care clients was not available. This is in part because, in order to guarantee the quality of the data, the registers take a substantial amount of time to be updated. Statistics Finland stepped in to publish preliminary data on deaths.

Source:

Forma L, Aaltonen M, Pulkki J (2020) COVID-19 and clients of long-term care in Finland – impact and measures to control the virus. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 12 June 2020.

Update for: Finland Last updated: November 9th, 2021

3.06. Support for care sector staff and measures to ensure workforce availability

In Finland, retired staff and students that do not fall into high risk groups have been recruited to maintain staffing levels (Source: https://www.lse.ac.uk/lse-health/assets/documents/eurohealth/issues/eurohealth-v26n2.pdf).

Update for: Finland Last updated: January 12th, 2022 Contributors: Joanna Marczak |

3.06.01. Surge staffing and other measures to support care homes with outbreaks or critical staff shortages

Preparations for possible future staff shortages began quite quickly, and a survey for a reserve of health professionals, including retired workers and students, began in early spring (https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

Update for: Finland Last updated: February 18th, 2022

3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

Guidance specific to LTC units and home care was relatively timely, with specific guidelines/mandates released in March and supplemented in April and May. Most of the municipalities have acted quickly to prevent the spread of the virus and followed the given instructions. Many municipalities have also introduced additional measures on their own initiative to address regional variations in the spread of the virus. They can be seen summarized in a table on Page 9 of this report.

In 5.6 of LTC Covid Report for Finland (page 14) there is a summary of measures/dealings with people living with dementia.

Update for: Finland Last updated: September 9th, 2021

3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

A key LTC guideline, early on in the pandemic, was to avoid transfers between the care sites, such as between care homes and hospitals, whenever possible. Transfers were allowed only for medical reasons, and the new treatment site had to be notified on whether the person had had respiratory symptoms (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Update for: Finland Last updated: September 9th, 2021

3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

National government guidelines to isolation have included LTC unit visiting bans, the provision of single rooms within LTC homes for symptomatic or exposed residents, restricted use of common areas in LTC units, and limited visitation of at-home care users. Some municipalities were quick to adhere to these policies, while others delayed implementation until the end of April (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Update for: Finland Last updated: September 9th, 2021

3.07.03. Visiting and unpaid carer policies in care homes

Visits to housing services for older people and at-risk groups in Finland were prohibited alongside the announcement of a nationwide state of emergency (https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

From mid-May 2020 onwards visits in care homes (e.g. outdoors/in meeting containers) became part of the national guidelines (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Update for: Finland Last updated: November 2nd, 2021

3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

Access to testing in Finland was at first relatively restricted and has been steadily increasing. Nearly 3.2 million tests for COVID-19 have been conducted as of February 21st, 2021, but the increase in access to test only began in late July 2020 (https://experience.arcgis.com/experience/92e9bb33fac744c9a084381fc35aa3c7).

Update for: Finland Last updated: September 8th, 2021

3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

Access to PPE was an issue for Finland early on. In late March, the Ministry of Social Affairs and Health (MSAH) requested that the National Emergency Supply Agency release and distribute its stockpile to university hospital districts and municipalities. After expressed concern over lack of PPE in social care services/spaces, MSAH conducted a survey of municipalities that revealed 67% of respondents felt it impossible to follow the pandemic regulations, mainly because of a lack of protective equipment. For that reason, on May 13th the ministry mandated that the use of protective equipment was obligatory.

Source:

https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view, page 27.

Update for: Finland Last updated: November 23rd, 2021

3.11. Vaccination policies for people using and providing Long-Term Care

The vaccination rollout in Finland, determined by the THL and their vaccine expert taskforce (KRAR), prioritized older people (70+) and healthcare personnel. Finland receives its vaccines through the EU joint procurement plan (https://stm.fi/en/coronavirus-vaccines). Rates of vaccination by age can be found at (https://www.thl.fi/episeuranta/rokotukset/koronarokotusten_edistyminen.html).

Update for: Finland Last updated: November 23rd, 2021

3.12. Measures to support unpaid carers

Section 5.5 of the LTC Covid Report (page 12) provides a review of the work of Carers Finland, an organization that during the pandemic has collected information and testimonials from informal carers. Key themes from their research include heightened loneliness and isolation; decreased physical and mental functioning; emotional and logistical struggles in accessing external services; inadequate means of support (e.g. internet calls) (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Formal measures for support remain unclear. As in other countries, NGO services, such as the member associations of Carers Finland provided remote services over the phone or through virtual meetings (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Update for: Finland Last updated: September 7th, 2021

4.01. Reforms to address Long-Term Care governance

An EU report notes that Finland has launched programme for health and social services centres for the future, which will be implemented in 2020-2022 and where patients will have access to various services in one place (e.g. primary healthcare, local social work, and homecare services). Moreover, the responsibility for organising health and social will be transferred from the municipalities to 22 regional authorities to provide better access to LTC. Finland also took steps in 2018 to improve the sharing of individual social welfare information in the national archive with care institutions at county level, to improve care management.

Update for: Finland Last updated: November 24th, 2021

4.06. Reforms to improve support for unpaid carers

In 2016 Finland increased the number of holidays for informal carers who enter into a care agreement with the municipality to at least two or three days off per month; informal carers have the right to coaching and training organised by the municipality (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Finland Last updated: November 23rd, 2021

4.08. Reforms to strengthen community-based care

Update for: Finland Last updated: December 10th, 2021

4.09. Reforms to improve care homes, including new standards and building regulations

The Finnish government is currently proposing reforms to the Social Welfare Act that aim to promote diverse and flexible housing and care solutions, including communal housing and housing with 24-hour care. The communal housing would offer accessible and safe homes where people can live in apartments where they can participate in activities have support with any care needs. Both communal housing and housing with 24-hour care would be provided in the same building complex, also including ordinary apartments, with the aim that clients can get the services they need at home without having to move when their care needs change.

Long-term institutional care for older people is to be abolished by the end 2027, with a transition period to introduce and adapt the services.

Update for: Finland Last updated: December 10th, 2021