Recipes for Systemic Change - Helsinki Design Lab

But while home care has been generally accepted as the solution tothe elder care problem, there remains an absence of adequate frameworksand measures with which to design, analyse, and evaluate a meaningfulhome care structure. As a measure, functional capacity does not adequatelyaddress the needs of those individuals it hopes to describe, especially whenthose individuals are well-integrated into society.How useful is it to know whether a person can shop for themselves(a primary measure of capacity) if a family member accompanies them?There is consensus that educating families is essential to the home careprocess, but how is this process best handled? There are attempts beingmade at expanding home care services from the institutional side, but ifsociety is not expanding its attitudes and habits to meet these services, canhome care really represent a shift of responsibility from institutions intonew territory?“More research is needed into the implications of population ageing to(sic) different institutions in society and to the operation of society as awhole. More knowledge is needed about how service needs can be preventedby supporting old people’s functional capacity. Improved serviceimpact also calls for research into outcomes and effectiveness.” (Healthin Finland 145)Perhaps it is time to move beyond the acceptance of home care as thequick solution to the elder care problem and instead, start to outline comprehensivestrategies that ensure well-being without increasing institutionaldemands. Criteria such as “functional capacity” must be revised orreplaced in light of a new care regime. Clearer definitions of independenceand societal involvement must be articulated if they are to become the tangibleobjectives of a concrete system. Social and medical care cannot simplybe combined or hybridized, but must be completely rethought to encompassagents and processes that are beyond their current scope.Two anecdotes seem to illustrate the need to move beyond the rhetoricof home care advocacy in order to begin the design of a non-institutionalelder care system:In an interview, a head physician of Helsinki’s Social services departmentwas asked to explain the major problems facing an elderly person.The answer was both physical (movement) and social (loneliness) in nature.As an example, malnutrition was a particular case that encompassed bothproblems. If someone is alone, they will not eat; If someone does not eat,they become weak; If someone becomes weak, they cannot be with otherpeople comfortably. And, a viscous cycle begins. When I inquired abouta proposed solution, I was told that involving family members was theanswer. I was eloquently told that, “If every elderly person would receive aprotein drink instead of a bouquet of flowers from their family, many problemswould be solved.” I followed by asking how families could be informed295