Download Kokkuvõte dublin 2005 - HPH

13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Patients with chronic diseasis and elderly people need more attention
Helle Maeltsemees, M. D.
Head of the Eastern-Tallinn Central Hospital
Medical Rehabilitation and Long-term medical Care
Clinic
The network of health promoting hospitals in Estonia was set up five years ago and Tallinn
Järve Hospital ( later named as Eastern- Tallinn Central Hospital Medical Rehabilitation and
Long-term Care Clinic) was the first health promoting hospital in Estonia.
Health promotion became as an integral part of the daily work at this hospital.
Estonian population is aging extremely quickly. For example in the capital of Estonia –
Tallinn, the % of elderly people (older than 65 years) is 16, 7% and prognosis for the year
2030 is 20 %.
At the moment the purpose of our health policy is to retain the old persons independent as
long as possible, in their own environment
According to the Estonian last health care (and elderly care) development plan for 2015 year
in Estonia, there is planned drastically reduce the number of hospitals beds for acute treatment
in Tallinn hospitals, the same time is demand for special institution for long term patients (
planned increase in Tallinn long term hospital beds from 310 to 700) but also to develop a
toolkit for the management and performance evaluation of health and social care services for
elderly people. To open more institutions and social services for chronically ill persons and
for the frail elderly people according to their actual needs (day care centres, home care
services, basic nursing care and home nursing, post active care departments, adaptation of
comprehensive geriatric assessment instruments etc.)
During the last ten years the number of beds per 100 000 people decreased 30 % (from 972 to
673). Specialised medical care is now concentrated in major hospitals largely due to closing
down the small ones. Some of the small hospitals are also converted into long-term care
hospitals.Since this time there was practical tendency to send the old persons into hospital for
a long time without analysing their proper needs.
The HPH East-Tallinn Central Hospitals Medical Rehabilitation and Long Term Care Clinic
is until now as a leader of the reorganization the hospital care system in Tallinn for
chronically ill patients and for frail elderly people.
In our days we have continual process of establishing the geriatric rehabilitation according to
Scandinavian model in long-term medical care department of hospital in Tallinn.
The process of implementation medical rehabilitation in every day treatment process for the
elderly peoples in the Eastern -Tallinn Central Hospital Rehabilitation and Long-term
Clinic included first time also creative therapy into routine treatment program. We have
growing our experiences in the management of the treatment and nursing care in the
institutions. Many elderly people in the hospitals experience depression, isolation and
hopelessness Results of a research study carried out by the Estonians Association of
Geriatrics and Gerontology indicate that approximately 50% of elderly people are dissatisfied
with their quality of life, perceive their lives as empty and monotonous, and experience
feelings of worthlessness Elderly care in Estonia is in transition-to evaluate a country`s health
care and social care system.
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Health care in Estonia for old people is mostely financed by Health Insurance Foundation
with limited self-cofinancing. In nursing hospitals only 8 weeks are financed by Health
Insurance Foundation, self-financing is required afterwards.
The aim of our management is:
1. to create a common vision of the future health care system for elderly people, and
consequently to define approaches for acceleration of the progress to that direction.
2. to develop a toolkit for the management and performance evaluation of health and social
care services for elderly people.
3. to implement and evaluate various model solutions according to the actual needs of
patients: community care services (home care); counseling by social workers in local social
care; social care homes (with very basic nursing only); social departments; two day-care
centers for demented persons in Tallinn; no-assisted or group living houses for elderly
persons; etc
We have had completed a sucessful pilot project in the clinic: the interdisciplinary
comprehensive geriatric assessment teams started in 2004.year and since 2005 year more
than 500 comprehensive geriatric assesssment cases was done.
East-Tallinn Central Hospital is providing now the adaptation of comprehensive geriatric
assessment on the basis of the program of project CARMA (Care for the Aged at the Risk of
Marginalization ) together with the Internal Clinic of Tartu University and Estonian
Association of Gerontology and Geriatrics, associated professor of the Tartu University Dr.
Med. Kai Saks.
The activities are focussed to development of services that meet needs of frail elders
(integration of health care and social care services, priority to community based services):
•Supporting informal caregivers (counseling, day-care centres, respite care etc)
•Comprehensive geriatric assessment as a key for care planning for frail elderly persons both
in medical and social care settings.
•Development of dependency based funding of services (based on classification of client’s
needs) and good quality management in elderly care
Expected outcomses are for us, that the old Estonians people are better prepared for coping in
their later stages of life : the capability of elderly people be active and ensure that their
acceptable standard of living and status is equal with the other group in society.
Helle Mäeltsemees
Head doctor of East –Tallinn Central Hospital
Medical Rehabilitation and
Long Term Care Clinic
17.06.2005.
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