Sigrún Ingvarsdóttir Project manager

1. Combined management for home service and home nursingintroduction for employees of social home service October 9th -10th 2008 Sigrún Ingvarsdóttir Project manager

2. Prelude • 2002: Cooperation team tackling issues regarding the elderly submits a report to the Ministry of Health and the Minister of Health • 2003: Work group working on the issue of intertwining home service for the elderly established and submits a memorandum • November 18th 2003: an agreement between the Minister of Health and the Mayor of Reykjavik is signed. The agreement brings together home nursing and social home service in one package, tried for 2 years to begin with. • Project of integration prolonged for 1 year

3. Mutualmanagement of social home service and home nursing • Autumn 2007: City’s welfare committee agrees to start formal negotiations with the Ministry of Health • Pilot group from the Department of Welfare and Ministry of Health begin preparations • Mutual advisor leads the work of the pilot group • Project manager at the Dept. of Welfare • Project manager at the Ministry of Health

4. Service agreement • Vision: 3 year service agreement between the Ministry of Health and Reykjavík City regarding mutual management of home nursing and social home service under the management of Reykjavik city, coming into action at the beginning of 2009.

5. Goal and purpose • Simplify access to the service • Provision of more holistic service • Increasing oversight when it comes to users’ needs • Create dynamic systems to meet increased service needs and the demands of society • Take the next step – normal continuation of Reykjavik city’s and the Ministry of Health’s cooperation regarding integrationservices over the past years. • Support all the more political and societal emphasis regarding people in need of various assistance while wishing to live at home for as long as possible. Even more increased and continuous service than before.

6. Society’s Development • Population in Iceland is increasing – also the elderly • The nation is getting older, even though population projection don’t expect countable increase within 80+ group until after the year 2025 • People is in better health • People with disabilities live longer today than before • Demands of “the new” elderly are other than those who are considered old today • Increased demands for independence and on living as long as possible at home with security and normal house life • More diverse life demands, more diverse service tactics (personalized service) • Increased demands of choice • Increased technical development – also in home service

7. The role of social home service and home nursing • Supporting people to keep their own home and participate in society • Supporting people in the chores of everyday life • Providing health service and keeping overview over health service and treatments at home

9. The goals of home nursing are to provide personal, systematic , successful and professional home nursing and thus supporting service takers to live at home under as normal circumstances as possible despite illness or decay due to ageing The goals of social home service are to support people to live in their own home despite difficulties such as illness, disablement or diffucult family situations. Current goals

10. Manager Project manager Dpm. of office Specialist Nursing manager Project manager Dpm. Of Nursing T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 Home team Psychosis team Directing nurses and 2-3 medics Centralized home nursing

11. Félagsleg heimaþjónusta dreifstýrð

12. Creation of Setup-module • A new setup-module created within the Department of Welfare “Reykjavik’s Home Service” on January 1st 2009 following the transfer of home nursing from state to city. This new module will be supervised by head of Department. • Home nursing will belong to this new module unchanged together with social home services, evening- and weekend service. • So called “Viking squad” and social home services will be operated within the new setup-module and will operate across the city’s districts, among other things to face different needs for service. • The day service of social home service will continue to belong to service centers but professional management comes from “Reykjavik’s Home Service”. Very much cooperation will take place between managers of “Reykjavik’s Home Service” and service centers.

14. Reykjavik’s Home Service Head of RVK’s Home Service Professional manager of nursing Nursing manager Project managers of nursing Doctor Occupational therapist Team 1 – 12 Psychosis Team Home Team Professional manager of home nursing Project managers of social home service Evening- and weekend service Home service Home service “Viking squad” Skrifstofa

15. Simplifying government administration for social home service • New positions of team leaders are formed. They will be under direct management of directors of service centers but professional administration is under the responsibility of managers of social home services. Social team leaders will be the nearest bosses of employees of home service who are part of their team (they are day divisional managers or project managers) • The leaders that these changes affect the most are lead managers of social service, divisional managers and project managers (24 managers all in all) • It’s different how much these changes will affect managers at different service centers. It is being mapped and all changes regarding occupational development will be done in cooperation. With most people changes involve job reinforcement, for some possible changes. • Service center clusters and employees on work shift will continue to belong to service centers

16. New: Viking squad • A so called “Viking squad” of home service will be established, belonging to Reykjavik’s Home Service • It’s role will be: • Assisting districts with difficult cases, f.ex. where a special effort is needed in cleaning before a normal home service is provided • Bringing in extra working force when temporary need arises in districts • Substituting, when possible, during sick leaves in districts

17. New: One service gate • One application form • Each applicant fills out an application for service (appl. for social home service to be a prototype) • Extra information to be filled in when applying for home nursing (appl. for social home service to be a prototype) • Possible to submit application for social home service to either Reykjavik’s Home Service or directly to service centers • Application for home nursing sent directly to Reykjavik’s Home Service

18. Change: Evaluation of the need for service • Evaluation agents at service centers evaluate new applications on social home service as long as there’s not need for nursing service • Otherwise, teams take care of re-evaluation and work together on service plan for those receiving combined services • Results from RAI-evaluation is taken into consideration when creating service plans • Nota Bene! With this change the work of an evaluation agent will change but number of projects they undertake has grown considerably this year, due to changes in assessment for nursing home placement and it is highly unlikely that they’ll run out of projects.

19. Working in unison • In 2009, home nursing teams and home service employees will strive to find the best way for reaching the goal of working in unison. External assistance/guidance will be provided • Continuous educational plans, already available within both systems, will be systematically checked.

20. Autumn 2009 • Teams are working hard on: • Finances • Human resources • Registration issues • Developing the RAI-system • In October • Recruiting manager for Reykjavík’s Home Service • Formation of working teams mapping service and cooperation • In Oct - Nov • Guidance and support for employees begins • Service agreement signed • Human resources issues will be given special consideration due to changes, f.ex. more focus will be put on training team leaders of social home service

21. 2009 – Year of merger • January 1st the management of home nursing will be transferred to Reykjavik City – employees are working on unifying the service • February 1st, the form of government in social home service will be simplified • Evening- and weekend service will be moved to a central unit “Reykjavik’s Home Service”. Most likely this unit will be moved to a new housing. • Social home service “Viking squad” will be established

22. 2009 – Year of merger April – merger of home nursing and social home service re-evaluated and project plan regarding accelerating of merger set forward

23. Continuous preparations • New framing of service is drafted and introduced to the welfare committee and employees during October 6th – 10th 2008. • Pilot group is checking state of claims regarding home nursing service • More work teams established this autumn concerning service, work procedure and cooperation • Service agreement signed in the months of September and October 2008 • Guidance and support for employees going through changes begins in October/November • RAI-hc evaluation for clients of home nursing is being developed with deadline set on January 1st 2009 • At the beginning of 2009 employees will work together towards creating a positive cooperation field with the common goal of providing excellent service

24. Interactive information site http://www.reykjavik.is/heimathjonusta