In Finland, moves are being made to integrate older people’s creative and cultural habits and interests into their care plans through the existing standardised care planning system. Silva Siponkoski, a consultant to the creative ageing AILI Network, explains.
This article first appeared in Love in a cold climate, our report into creative ageing practice in Finland.
In recent decades, there has been increasing discussion in Finland about how to ensure that older people’s services take into account the wishes, needs and habits of older people whether in home care, in assisted living and in nursing homes. We know that a client-oriented approach fosters a good life and the realisation of cultural rights in the final years of our lives. At the same time, we also know that art, culture and creativity are not equally accessible to all older people. Arts, culture, and other activities that support creativity are not properly targeted, because care services tend to focus on physical functioning. We have sought to identify the crucial structures that facilitate a creative everyday life and the realisation of cultural rights for clients in care. We have noted that one crucial structure is documentation and assessment of nursing. They are an essential part of social welfare and health care services: care plans and service plans govern the entire process in older people’s services and in Finland care plans are required by law. So, we decided to look at the process of documentation from a new angle, with specific reference to creativity, art and culture. Hereafter, I refer to this as Creativity, Art and Cultural Profiling.
About Creativity, Art and Cultural Profiling
Creativity, Art and Cultural Profiling is basically a way of thinking and a system for integrating the process of documentation and assessment of arts-based work with older people into the overall care documentation process. The care documentation process involves steps such as assessment of the older person, charting their overall situation, planning actions to take, documenting their implementation and then impact assessments. Creativity, Art and Cultural Profiling involves systematically documenting the following points in the care documentation process:
- survey of hopes, goals, background and preferences
- participation in creative, cultural activities
- observations during the creative activities
- impact assessment after the activities.
The data is then used in the planning and evaluation of creative work with older people. Integration of Creativity, Arts and Cultural Profiling into care work requires continuous development. One of the challenges is that there are many ways of collecting data and many documentation systems in use, and the systems differ considerably from one another in terms of content, technical concept and the quality and scope of the data collected. Efforts have, however, been made to establish standardised practices in Finland. The following are two examples of the Creativity, Arts and Cultural Profiling practices developed in Finland. These examples are included in the survey phase of documentation process, i.e. they are about collecting data on the person’s hopes, goals, background and preferences.
Tree of life
The ‘Tree of life’ poster is intended as an aid for the older person and their caregivers to get to know each other. The picture with its different elements (e.g. the tree, its apples, birds) prompts a discussion in which the elderly person can tell us about things that are important to them: dreams, hopes, significant events in their life, preferences and things that they do not like. The purpose of the ‘Tree of life’ is to gain information to inform the best possible care and service plan for that person. Once these hopes and needs have been visualised, it is easier for the caregivers to understand the client and to plan their care. The poster should be introduced when the person first becomes a client but can also be filled in later and can be updated, for instance, if there is a major change in their functional capacity. The client can decide for themselves where in their home the ‘Tree of life’ poster should be placed. It may be displayed so that every caregiver, even temporary ones, have access to the information it contains, or it may be kept in a folder or a desk drawer. The dreams entered on the poster should not remain just dreams; attempts should be made to realise them. The ‘Tree of life’ is not just about the past but is also meant to guide the future. Clients have been extremely pleased to have the chance to visualise their hopes and dreams on the poster. The ‘Tree of life’ is appended to the client’s electronic patient records and will travel with them if they are relocated to another care facility. An image of the poster and its principal contents in text form are entered into the documentation system. The ‘Tree of life’ concept was created in the Finnish city of Tampere in 2015. The city of Tampere is a member of AILI network.
The Creativity, Art and Cultural Profile RAI-LTC
One of the purposes of The AILI Network is to develop Creativity, Art and Cultural Profiling. We acquainted ourselves with the documentation systems which are in use in Finland, and after analysis, we decided to apply the international RAI system. RAI (Resident Assessment Instrument) consists of various sets of questions with which professionals can assess the functional capacity and service needs of older people. The assessment data gained through the RAI system is comprehensive and of high quality. The RAI system has been in extensive use in Finland for many years, and in recent legislative reform its use was made mandatory for all local authorities in Finland. In 2018, the AILI Network began to develop a special tool for Creativity, Art and Cultural Profiling based on data in the RAI system. The main feature of this tool – which is called the Cultural Profile – is preparing new compilations of data that already exist in the RAI system and enriching the use of that data. In other words, no separate data collection needs to be done. This is important, because we do not want to an additional burden on care staff by asking them to fill in more assessment forms. The RAI system is already familiar to professionals, supervisors and managers and therefore requires no technical training. The Cultural Profile highlights the following data in existing RAI-LTC assessments (LTC = Long-Term Care):
- background data: educational attainment, former occupations, social involvement, interests, time management, etc.
- personal goals and how these have been attained
- interests
- preferred recreational activity
- social involvement and time management
- change needs relative to current recreational activities and the time spent with them
- social involvement, interests and time management before moving to a care facility
The Cultural Profile provides information which is systematic and comparable nationwide and internationally, since the RAI-system is essentially the same in all the countries where it has been deployed.
Reflections
Considering clients as fully rounded individuals and facilitating a creative everyday life are essential components of work with older people. This is an aspect of care work that has not been documented as extensively as, say, nutrition or medication. Creativity, Art and Cultural Profiling can catalyse a sea change in our approach to older people’s services, as it encourages a client-oriented approach, allows clients to gain an everyday routine consistent with their preferences and thus improves their wellbeing. Profiling helps gain a complete picture of the individual. This documentation likewise helps integrate creativity, cultural activities and arts-based care more broadly and more closely into older people’s services and into the everyday lives of clients. The documentation helps ensure in a systematic way that clients are able to enjoy their cultural rights. It has been found in Finland that creative, culture and arts-based care for the elderly requires a smooth exchange of information between art, culture, health care and social welfare sectors and professionals. Creativity, Art and Cultural Profiling can help create a shared understanding between professionals and both facilitate and standardise information exchange.
What next?
We want to achieve a more systematic and data-driven approach to managing creative, culture and arts-based care for older people while increasing the use of research-based and effective practices, methods and techniques. In the longer-term, our goal is for this kind of profiling to be extended beyond older people to all clients of social welfare and health care services so that they too can have their individual creative and cultural wishes incorporated into their care.
