The success of Finnish deinstitutionalization policy among the elderly in 1981-1991 was evaluated in terms of institutionalization rates and case-mix. Censuses of institutionalized people in all public and private residential homes and health centre hospitals (or nursing homes) were performed in 1981, 1986 and 1991. Data on demographic factors, diagnoses and dependency level were gathered. Censuses from the closest years of psychiatric patients were also used to obtain a comprehensive view of institutionalization. The eligibility criteria for the study were (1) age 65 years or more (2) currently in long-term care. In both men and women the overall relative reduction was 33%, and largest in psychiatric care, at over 67%. In residential home care the relative reduction was about 40%. In health centre hospitals a slight increase was seen, about 10%. Length of stay shortened in residential homes but increased in health centre wards. Dependency level increased among the elderly people in long-term institutional care during ten years. In conclusion, the deinstitutionalization rate was substantial among the elderly in Finland. However, because of rapid demographic change the absolute number of elderly in long-term care remained almost constant. The case-mix has become more demanding and the proportion of elderly in constant need of extensive help has risen.
Statistical Yearbook of Finland 1993. Helsinki: Statistics Finland, 1993.
2.
Families 1990. SVT, Population 1992: 7. Helsinki: Statistics Finland, 1990.
3.
Doty P.Long-term care in international perspective . Health Care Financing Review1988; 1988 Annual Supplement: 145–55.
4.
Mechanic D.Health Care and the Elderly . Annals, AAPSS1989; 503: 89–98.
5.
Berg S , Branch LG , Doyle AE , Sundstrom G.Institutional and Home-Based Long-Term Care Alternatives: The 1965–1985 Swedish Experience . The Gerontologist1988; 28: 825–9.
6.
Thorslund M.The de-institutionalization of care of the elderly: some notes about implementation and outcome of a Swedish case-study . Health Policy1988; 10: 44–56.
7.
Weissert WG , Cready CM , Pawelak JE.The Past and Future of Home-and Community-based Long-Term Care . The Milbank Quarterly1988; 66: 307–88.
8.
Daatland SO.Stress and strategies in care systems: the Scandinavian experience . Soc Sci Med1994; 38: 867–74.
9.
Coleman BJ.European Models of Long-Term Care in the Home and Community . International Journal of Health Services1995; 25(3): 455–74.
10.
Health for all policy in Finland. Copenhagen: WHO Regional Office for Europe, 1991.
11.
Thorslund M , Johansson L.Elderly People in Sweden: Current Realities and Future Plans . Agcing and Society1987; 7: 345–55.
12.
Thorslund M.The increasing number of very old people will change the Swedish model of the welfare state . Soc Sci Med1991; 32: 455–64.
13.
Johansson L.Elderly care policy, formal and informal care. The Swedish case . Health Policy1991; 18: 231–42.
14.
Lagergren M.The residential home – what difference does it make? Comparing the public systems of care for the elderly and disabled in two Swedish municipalities . Scand J Soc Welfare1993; 2: 25–32.
15.
Nygaard HA , Albrektsen G.Risk factors for Admission to a Nursing Home. A study of elderly people receiving home nursing . Scan J Prim Health Care1992; 10: 128–33.
16.
Kivelä S-L.Indicators of Permanent Institutional Care . Scan J Prim Health Care1985; 3: 39–43.
17.
Niinistö L.Kotona asuvien ja pysyvästi laitoshoidossa olevien vanhusten eroavuudet (The elderly at home and in permanent institutional care) (In Finnish). Helsinki: Lääkintöhallituksen tutkimuksia46, 1987.
18.
Valvanne J.Vanhusten terveystarkastuslöydösten ennu-stemerkitys. Helsinkiläisten 75-, 80- ja 85-vuotiaiden yhden vuoden seurantatutkimus (The prognostic significance of clinical findings in the elderly. A one year follow-up study of groups of people aged 75, 80 and 85 years living in Helsinki) (In Finnish). Helsinki: Geriatrian yksikkö, II sisätautien klinikka, Helsingin yliopisto, 1992.
19.
Aalto U.Pitkäaikaishoitoon Helsingissä vuosina 1978–1985 pyrkineiden laitoshoidon ja eliniän ennuste (Applicants for long-term institutional care in Helsinki in 1978–1985, fulfilment of institutional care among applicants and their life expectancy) (In Finnish). Helsinki: Helsingin kaupungin terveysvirasto, 1991.
20.
Andersson M.Institutionalization of the elderly and characteristics of nursing home patients . Compr Gerontol Suppl issue A + B1989; 3: 1–7.
21.
Kemper P , Murtaugh CM.Lifetime use of nursing home care . New Engl J Med1991; 324: 595–600.
22.
Weissert WG , Cready CM.Toward a Model for Improved Targeting of Aged at Risk of Institutionalization . HSR1989; 24: 485–510.
23.
Hanley RJ , Alecxih LMB , Wiener JM , Kennel DL.Predicting Elderly Nursing Home Admissions. Results From the 1982–1984 National Long-Term Care Survey . Research on Aging1990; 12: 199–228.
24.
Branch LG , Jette AM.A Prospective Study of Long-Term Care Institutionalization among the Aged . Am J Public Health1982; 72: 1373–9.
25.
Wingard DL , Jones DW , Kaplan RM.Institutional Care Utilization by The Elderly: A Critical Review . The Gerontologist1987; 27: 156–163.
26.
Shapiro E , Tate R.Predictors of long term care facility use among the elderly . Canadian Journal of Ageing1985; 4: 11–19.
27.
Greenberg JN , Ginn A.A Multivariate Analysis of the Predictors of Long-Term Care Placement . Home Health Care Services Quarterly1979; 1: 75–99.
28.
Vaarama M.Vanhusten palvelujen tavoitteet ja todellis-uus. Katsaus vanhusväestön elinoloihin, palvelutarpei-siin ja sosiaali-ja terveyspalveluihin (Aims and reality of services for the elderly. A survey of living conditions, need for services and health and social services) (In Finnish). Helsinki: Sosiaali-ja terveyshallitus raportteja48, 1992.
29.
Johansson L , Thorslund M.Care needs and sources of support in a nationwide sample of elderly in Sweden . Z Gerontol1992; 25: 57–62.
30.
Salmela R , Hemminki E.Health trends in the Nordic countries. Annus Medicus 1990. Kobenhavn: NOMESKO, 1990.
31.
Gierveld J , van Solinge H.Aging and its consequences for the socio-medical system. Strasbourg: Council of Europe, 1994.
32.
Holstein BE , Due P , Almind G , Holst E.The Home-Help Service in Denmark. In: Jamieson A , ed. Home Care for Older People in Europe. A Comparison of Policies and Practices. Oxford: Commission of the European Communities. Health Services Research Series No. 7. Oxford University Press, 1991: 38–62.
33.
Petersen C.The development in local authority services for elderly . Danish Medical Bulletin1992; 39: 246–8.
34.
Daatland SO.Adapting the "Scandinavian Model" of Care for Elderly People. In: Caring for Frail Elderly People. Policies in evolution. Paris: OECD, Social Policy Studies No. 19, 1996: 247–60.
35.
Health for All by the Year 2000 The Finnish National Strategy. Helsinki: Ministry of Social Affairs and Health, 1987.
36.
Health for All by the Year 2000 Revised Strategy for Co-operation. Helsinki: Ministry of Social Affairs and Health, Publication series 1993: 9, 1993.
37.
Komiteanmietintö 1996: 1 . Vanhuspolitiikkaa vuoteen 2001. Suomen vanhuspoliittisen tavoite- ja strategiato-imikunnan mietintö (Elderly policy to the year 2001. Report of the Committee of Finland's elderly policy targets and strategy) (In Finnish). Helsinki: Sosiaali- ja terveysministeriö, 1996.
38.
Valtakunnallinen suunnitelma sosiaali- ja terveydenhu-ollon järjestämisestä vuosina 1993–1996 (National plan for social and health care in 1993–1996) (In Finnish). Helsinki: Painatuskeskus, 1992.
39.
Hermanson T , Aro S , Bennett CM.Letter from Helsinki: Finland's Health Care System. Universal Access to Health Care in a Capitalistic Democracy . JAMA1994; 271: 1957–62.
40.
Health Care 1994: 2 . Health Care. Jyväskylä: National Research and Development Centre for Welfare and Health, 1994.
41.
Health 1992: 7 . Census of patients in psychiatric wards 1984–1991. Helsinki: Official Statistics of Finland, National Agency for Welfare and Health, 1992.
42.
Hakkarainen A.Changes in the mental hospital population and legal reform. Tampere: Tampereen yliopiston kansanterveystieteen laitos, 1991.
43.
Heikkinen J.Vanhainkotiasukkaan terveydentila ja ennuste (Health and prognosis of residents in an old people's home) (In Finnish). Tampere: Tampereen yliopisto, 1986.
44.
Liu K.A Data Perspective on Long-Term Care . The Gerontologist1994; 34: 476–81.
