Recipes for Systemic Change - Helsinki Design Lab

ers or others who are assisting in the care of an elderly person living athome. As of 2007, approximately 3.9% of the population above seventy-fivewas receiving informal care support, and this number is currently increasingwith a government target of 5-6% by 2012 (Statistical Yearbook).Institutional CareIn institutional facilities, care and services are part of a total environmentdesign; A resident will receive the care and services they need, mostof the time on-site. At health centres and specialized facilities that operatelike hospitals, daily medical care structures dominate a resident’s routine,with less emphasis placed on engaging the social components of an elderlyresident’s life. The services in such facilities are usually determined to firstaddress direct medical concerns, with softer, social criteria as secondaryconcerns. Depression and loss of appetite are the sorts of general healthdecline experienced by residents, conditions which may be the result ofgeneral complaints from residents in such facilities. These complaints mayinclude stifling routines, inconsistent caregivers, and isolation from meaningfulsocial networks.In a typical nursing home, while residents have individual rooms andreceive individual care, they also spend their time in common spaces, dinetogether, cohabiting and sharing services with those of similar functionalcapacity. Medical care is integrated into daily routines accordingly: residentsare encouraged to choose and prepare their own meals, determinetheir own schedules, and participate in activities as they choose; residentswith dementia often live in more controlled environments with more structuredcare.It is the general philosophy of the more progressive facilities to use careand service delivery as an opportunity to encourage independence andself-sufficiency in the residents. At such institutions, nurses are encouragedto propose their own small innovations in helping residents improvetheir functioning, increase daily enjoyment, and maintain their independence,daily routines, habits and level of comfort in a manner similar to whatthey experienced at home. These procedures are then shared among nursesfor bottom-up development, while simultaneous top-down procedures areimplemented.In nursing homes, where common spaces are open to residents, a diningfacility might be open to the public, allowing guests and residents to dinetogether, and be designed like a restaurant so as to encourage some level ofintegration between the institution and the surrounding community. Residentsmay also receive taxi subsidies or participate in group activities, suchas shopping or museum visits.Such principals and practices reflect a general attempt at making thenursing home experience in Finland as similar to home living and home291