Seeking emergency care only when needed –supporting the elderly care at home with technology-assisted consultations

Seeking emergency care only when needed –supporting the elderly care at home with technology-assisted consultations

The Wellbeing Services County of North Ostrobothnia, Finland, decided to invest in the development of standard practices to improve consultation for caregivers supporting the elderly in living at home. Mari Taivaloja, Head of the Responsible Unit from the shared competence centre for services for the elderly, discussed some of the experiences of her organisation at the Medanets User Days at the end of March.

News of congested emergency wards is a common sight in the media these days. In Finland, the topic was particularly present in the media at the end of last year1. Emergency departments are filled to the brim and the waiting times can be unreasonably long. Patients waiting for further care, many of whom are elderly, are often seen as one of the reasons for the congested services. However, this group of patients does not usually seek emergency care at their own initiative; instead, they are sent to the hospital by a healthcare professional. Why is this, and what could we do to improve these circumstances?

The focal point of elderly care has shifted to homes, but the support structures of home care are inadequate

Round-the-clock inpatient care has been cut back for years. In Finland, the national objective is for the elderly to be able to live at home as long as possible and to bring the necessary services to them2. The elderly also tend to want to keep living at home. However, as a result of this shift, more and more people with increasingly poor health continue living at home. The need for home care services has increased considerably, and the number of home care customers in need of a large number of services, in particular, has grown3. At the same time, the availability of home care has declined throughout the country4 as home care is not able to meet the demand with its current resources.

“While the focal point of the services has shifted to homes, the service providers forgot to develop support structures around home care. However, home care cannot manage alone,” says Mari Taivaloja. The Wellbeing Services County of North Ostrobothnia has tackled the issue by developing home care consultation support using consistent, technology-assisted operating models. “The emergency department crisis stems from various factors, all of which require customised measures. Consultation support is only one solution, but it plays an important role in the bigger picture,” says Taivaloja.

Consultation support as an alternative to the emergency number

The need for consultation support is apparent.  In North Ostrobothnia, more than 50% of phone calls for consultation support come from inside the home care organisation. “Contacting the home care consultation support acts as an alternative to calling the emergency number and seeking emergency care. In addition to home care workers, it is used by nursing homes and family carers,” says Taivaloja.

The home is a unique operating environment – standard practices play a key role

The home is a unique and challenging operating environment. Compared to wards, the work is independent and the worker has major responsibility for making the right decisions. There is less equipment available and the ergonomics and asepsis are often inadequate. The experience and skills of the independently operating workers vary, but equal care must still be guaranteed for all. According to Taivaloja, shared working methods are vitally important. It is important to verify the workers’ competence and equipment. “Moreover, a successful operating model comes down to comprehensive, equal and seamless cooperation structures between operators,” says Taivaloja.

Technology plays a crucial role in the North Ostrobothnia model

The goal of the development in Pohde is to enable the home care worker to react to changes in the customer’s health using standardised operating models. The worker must carry sufficient equipment, examine the customer systematically with the ABCDE approach and the NEWS system, for example, and consult the correct party in line with the ISBAR model. This ensures that the assessment proceeds with a shared language based on objective parameters. In other words, the tools guide the actions and the decision-making process.

“The operating models and tools must travel with the worker. Attention must be paid to them in the employees’ orientation process,, but they must not be left behind in the orientation folder and forgotten. The Medanets app is an example of a great tool; a smartphone is easy to bring with you and the app guides the nurse to follow the agreed protocol in any situation.” The NEWS score is used as the basis for the decision to contact consultation support. The steps taken during the consultation call are guided by the ISBAR operating model.

If necessary, the worker visiting the customer and the supporting consultant can set up a video call to gain more information on the customer’s situation. A doctor can also be invited to join the video call. If this is not enough, a hospital-at-home team with a wider range of equipment can be called in to conduct a more extensive assessment of the care needs.

Remote home care is the primary service solution

If the patient’s care can be provided at home, North Ostrobothnia has decided to increasingly use remote home care technology. Officially, remote home care is the primary home care service solution in the region. At the moment, there are about 200 remote home care customers in city of Oulu, which is the capital city of the region. In addition, the equipment includes nursing cameras and advanced medical robots with an integrated camera and microphone for contacting the nurse. Compared to home visits, remote home care has even been considered a better solution when aiming to maintain the customer’s sense of initiative and functional capacity. For instance, during a home visit, a busy nurse may end up making the customer’s breakfast even if the customer could prepare it themselves under guidance.

New solutions piloted successfully

North Ostrobothnia has successfully piloted various solutions supporting living at home and offering home care consultation. The pilots have included real situations where the customer avoided having to go to the emergency ward, thanks to video connections. To enhance the NEWS process, the Early Warning Score feature of Medanets was piloted in the city of Oulu.  The NEWS process was considered fast and easy with the help of the app. Using NEWS to assess the patient created a common language for the professionals, thus promoting more efficient communications as well. In the future, workers hope for even more technological solutions and tools. For example, the hospital-at-home team needs more ECG equipment. The device is a practical example of a tool that can help reduce the congestion of prehospital care and emergency departments.

National recommendations are also needed to help develop technological solutions and use them more systematically. “In fact, public recommendations to support procurement in the wellbeing services counties are currently being prepared by the Finnish institute for health and welfare based on their programmes related to technology,” says Taivaloja. Living at home and using technology to support home care are promoted in programmes such as the institute’s ‘Technology supporting smart ageing and care at home programme in 2020–20235’.


Mari Taivaloja, presentation at the Medanets User Days 2023

1. YLE (2022): Selvitimme faktat: Päivystyksissä ympäri Suomen on jopa kaoottisen vaikeaa. Accessed 23rd May 2023.

2. THL (2023): Kotihoito. Accessed 23rd May 2023.

3. Hoiva & Terveys (2023): Kotihoidon asiakkaiden määrä kasvaa – paljon palveluita tarvitsevia jo merkittävä osa. Accessed 23rd May 2023.

4. Hoiva & Terveys (2023): Kotihoidossa henkilöstö ja käynnit vähentyneet huomattavasti: ”Hyvinvointialueiden olisi syytä kartoittaa tilanne alueellaan mahdollisimman nopeasti”. Accessed 23rd May 2023.


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