Does it "Take a Village" to Grow Old at Home?
Swedish "Night Patrols" Help Elderly Stay Out of Nursing Homes
Oct 3, 2009
Researchers find that with greater independence, older people’s attitudes toward the reality of their own aging improves, which may positively impact their physical status and demands for health services. In the United States, the term "aging in place" has become popular with gerontologists to describe how older people can stay in their own communities and homes as they age, even to the point of physical frailty. Sweden has implemented one remarkable service, called the Night Patrol, that helps its elderly population age in place, in their own homes.
The story of the Night Patrols seems almost fairy-tale like to Americans. For those now in their 60s or 70s to be able remain in their own homes as they hit 80, 90 or 100 years of age-that is, to age in place-- will require an imaginative rethinking of American support services for the elderly. At the moment, America's long term care system (which many critics say is not a "system" at all, but a patchwork quilt full of holes) relies on free family caregiving, Medicare-financed homecare workers, assisted living facilities and nursing homes.
Beyond Family Caregivers, Sweden's Elderly Also Receive Paid Services at Home
Take the case of Magdalena C., a personable and mentally active 75-year-old Swede. Magdalena resides in the home she’s lived in for over four decades, surrounded by neighbors she knows, and familiar sights and sounds.
She can no longer dress easily, has difficulty preparing her own food or bathing, suffers a nearly total loss of vision, and has chronic heart disease that requires a complex regimen of medications. She’s a widow and her only son has moved to England.
She gets through the days with the help of a government-paid home heath aide who assists her in bathing, dressing, preparing meals, and other necessities of life.
Local Communities Pitch in with "Night Patrols" for Elderly
She gets through the nights thanks to regular visits from the Night Patrols, two-person teams staffed mostly by women in their 40’s. The nurse in the team may oversee medications, give injections and intravenous infusions, and assist with a urine catheter. Clients enrolled in the program are also given alarm systems so that they can summon the patrol team in case of emergency.
Begun in the 1980s, the teams can make as few as a dozen and as many as twenty visits per shift. Each shift is prepared to take emergency calls and respond to about four unplanned calls for assistance.
Sometimes a visit takes just five minutes; other times, several hours. From 4 pm until 7 am the next morning, trained “patrols,” make house calls in a defined district or area, following a pre-arranged itinerary of scheduled visits. The first shift, called the Evening Patrol, works from 4 pm to 11 pm. A second Night Patrol visits clients in their homes from 11 pm to 7 am. Many older Swedes rely on the Evening and Night Patrol teams for years.
(For more information, see a 2003 article in the journal the Gerontologist by Bo Malmberg, PhD, Marie Ernsth, Birgitta Larsson,and Steven H. Zarit, PhD, called Angels of the Night: Evening and Night Patrols for Homebound Elders in Sweden.)
Support Ranges from Simple Companionship to Housework to Nursing Services
Sometimes the Patrols simply provide company to alleviate isolation, but the range of conditions they see, according to a study in the Swedish province of Småland, includes neurological and muscle disorders, cancer, arthritis, diabetes, ophthalmologic disease, mental illness/dementia, and pulmonary disease.
They also care for mentally ill clients and terminally ill patients.
The study reports staff as saying, "We work with all human needs, from floor scrubbing to being a nurse, a doctor, and a priest, we support relatives, give advice and so on… At night we do almost everything, we are very flexible. We think that problems are for solving."
Most long term care services, including the Night Patrols, are paid by the Swedish national health care system, which provides universal coverage.
With an aging population in the US, the challenges of aging in place are substantial. Can the idea of the Swedish Night Patrols be adapted to American communities, and our fragmented long term care and caregiving system? What other innovations in caregiving might be adapted, say from aging societies such as Japan? Health reform today is a hot-button issue, but existing proposals barely touch the tip of the iceberg of the nation's long term care needs.
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