– I believe that it is dramatic that we are unable to prioritize care for the elderly. In particular, the staffing at night is too poor. This is what the main union representative for the nurses in Trondheim, Ingrid Berg Selfjord, says. There are big differences between the nursing homes. Trondheim is one of 133 municipalities that spend less than the national average for the operation of nursing homes and home care. This is shown by figures that news has obtained from Statistisk Sentralbyrå. In order to equalize differences, both the Norwegian Nurses’ Association and the Norwegian Medical Association require a national staffing standard for elderly care. The municipalities’ interest organization, KS, says no. – Municipalities are different and there is no goal that everyone should spend the same amount, says area director Helge Eide in KS. Both schools and kindergartens have received staffing standards Staffing standards have been introduced in primary schools in Norway, and it was adopted by the Storting in 2017. In first to fourth grade, a teacher must not be responsible for more than 15 pupils, for example. Staffing standards have been introduced in kindergartens in Norway from 2018. The municipalities must set aside enough money for this. Source: Directorate of Education CONCERNED: Chief union representative for the nurses in Trondheim. From left Ingrid Berg Selfjord and Mia Småvik Rørdal. Photo: Eivind Aabakken Spend less on staffing Calculations show large differences in what is allocated to care for the elderly per inhabitant in the big cities in Norway. It shows figures from Oslo, Trondheim, Stavanger, Bergen and the average for the 12 large municipalities that are part of the ASSS network. Trondheim allocates NOK 594 less per inhabitant than the national average. – Even if it is corrected for differences in population composition, expenditure needs and income, Trondheim is still lower than the national average. This is what health and welfare director Wenche Dehli in Trondheim writes in an email to news. Trondheim spent NOK 160 million less on elderly care than other comparable cities in 2016, and an Elderly Plan was adopted. The politicians set the goal of reaching the average of the other cities by 2025. An extra NOK 20 million has been allocated annually. Little has changed, because other municipalities have also increased their investment in care for the elderly accordingly. The distance to other municipalities was approx. 120 million in 2021. AP kept an election promise of 300 new positions in Trondheim Elderly care was a hot topic in the election campaign in Trondheim in 2019. Mayor Rita Ottervik (Ap) promised 300 new positions in elderly care in the city, after that many reported marginal staffing in nursing homes and in home care. This promise has been kept. – There has been an increase of 304 man-years in the period from January 2019 to 30 April 2023. In addition, there is the use of external temps from a temp agency, the municipality writes in an email to news. Since the plan for the elderly was adopted in 2016, there have been 655 more man-years in care for the elderly. A total of NOK 100 million has been set aside to strengthen staffing in nursing homes and in home care since 2016, Trondheim municipality informs. Low growth in nurses The growth in the number of nurses has not been great. In 2016, there were 742 full-time nurses in the health and care service in Trondheim. This had increased to 779 full-time nurses in April 2023. An increase of only 37 more nurses in the municipal health service in Trondheim in the last seven years. Trondheim spends less on salaries for employees and the operation of nursing homes and home care than the national average, even if corrected for differences in age composition. Photo: Eivind Aabakken Different staffing at night This week, the consumer ombudsman in Trondheim sounded the alarm after several shocking stories from relatives. This is stated in an annual report, which was first discussed in Adresseavisen. These are descriptions from relatives that news has taken from the annual report: “Employees did not come when the spouse rang the alarm button. It took 40 minutes.” “The wife was told to pee in her nappy because there was only one employee on duty at night. They needed two employees for relocation. The nappy was not changed before the morning grooming”. – We think the staffing at night is far too poor. It is on the verge of being indefensible, even though it usually goes well on a day-to-day basis. This is what the main shop stewards for the nurses in Trondheim, Mia Småvik Rørdal and Ingrid Berg Selfjord, say. – Patients do not necessarily meet an employee when they wake up at night, they say. There are differences between the nursing homes, but the standard is that an employee is responsible for 20 patients a night in Trondheim. In comparison, a carer in Bærum has to accompany 17 patients a night on average. DOCTORS NOTICE WHEN THERE ARE FEWER STAFF: Remi Neverdal Birkenfeldt is a GP in Trondheim and supervises a nursing home in Trondheim one day a week. Photo: Eivind Aabakken Tablets instead of nurses Remi Neverdal Birkenfeldt is a GP and has been a supervising doctor at a nursing home in Trondheim for several years. He believes that there is not very much that is needed in terms of additional staffing to remedy a department. Over eighty percent of patients in Norwegian nursing homes have dementia. Sometimes only one or two patients need extra follow-up. If there is no caretaker, unrest can spread to an entire department, he says. Birkenfeldt admits that both sedatives and antipsychotics can be used, although the restrictions are very strict and this should only be an emergency solution when everything else has been tried to reduce anxiety in dementia patients. – The threshold becomes lower for thinking about it, asking about it, and for the doctor to try it out. Occasionally we attempt it, and sometimes it has a place in treatment in rare cases. I have the feeling that we, and I too, probably use it more often than we absolutely should. This is what the Norwegian Medical Association says The Norwegian Medical Association has for a long time called for the introduction of a national staffing standard in elderly care. That’s what Ståle Sagabråten says. He is a leader in the professional board of the Norwegian Medical Association and a specialist in general medicine/GP. Among other things, he writes this in an email to news: – The nursing homes around Norway are very differently staffed and even though the situation has improved in the last 20 years, one can probably state that the nursing home doctors are in a difficult situation with many patients in a short time. – The medical association wanted a staffing standard for nursing home doctors, but the authorities have decided that it will be up to each municipality to ensure adequate staffing. – The Medical Association has also been concerned that staffing problems and a lack of resources for environmental measures lead to too many elderly people being put on antipsychotics for behavioral problems linked to dementia. A number of elderly people are put on such medication in connection with delirium, and are then left on the medication after the delirium has calmed down. – The specialists in geriatric medicine in the Norwegian Association for Geriatrics have put this on the agenda in the Make Wise Choices campaign, which is about overcoming overdiagnosis and overtreatment that are not beneficial to patients. There are big differences. At Tempe Health and Welfare Centre, there are two employees per 24 residents per night. She follows when the alarm goes off, head of department and nurse Ragnhild Hauan. Photo: Rita Kleven Staffing standard required Chief shop steward for the Norwegian Nurses’ Association in Trondheim, Ingrid Berg Selfjord, believes a staffing standard can ensure enough staff on duty and even out differences between the municipalities. In recent years, staffing standards have been introduced in both primary schools and kindergartens in Norway. The municipalities must set aside enough money for this. – It helps lock in large parts of the municipal budget. So not having it is an increased risk, when others have got it in place, she says. The city council in Trondheim will decide on Thursday whether a local staffing standard for elderly care in Trondheim should be investigated. The proposal is presented by deputy mayor Mona Berger (SV). KS disagrees and does not want a national norm for how many employees must be at work in care for the elderly. – We think that the proposal for staffing standards is bad. Even if there were money, the main challenge is to find enough people to cover the need that will be present, says director for society, welfare and democracy in KS, Helge Eide. Many people work part-time in care for the elderly In 2016, there were 73,565 man-years in nursing homes and in home care in municipalities in Norway. Many worked part-time and the man-years were distributed among 113,242 employees. In 2022, there were 80,878 man-years in nursing homes and home care in Norway. Many worked part-time and this was distributed among 114,601 employees. In order for the municipal sector to be able to offer the same level of services over the nearest ten-year period, the number of man-years must increase by around 46,500 towards 2031, according to a calculation KS made two years ago. Source: KS Area manager in KS, Helge Eide, believes that the biggest challenge is getting enough health workers in the coming years. Photo: Tom Balgaard/news Ambulatory nurses are tested At Tempe health and welfare centre, unit manager Lill Kristin Bjørnstad believes that the biggest challenge is getting applicants for vacant positions. Now they are advertising a position as a nurse for the third time. The number of elderly people is increasing, and in Trondheim alone there will be a need for 1,200 new employees in elderly care by 2030, according to figures news has received from the municipality. In addition, there is a need for 1,100 employees to cover natural attrition. Of the 5,805 permanent employees in health and care in Trondheim, a full 46.3 percent work part-time. – We would like to have all our nurses in full-time positions, so those who wish can of course have their positions increased, says Bjørnstad. Unit manager Lill Kristin Bjørnstad at Tempe Health and Welfare Center has faith in the new experiment with ambulatory nurses at night. Photo: Eivind Aabakken They have chosen to have two employees who are responsible for 24 residents at night at the nursing home in Tempe. Recently, experiments have been started with ambulatory nurses at night at eight of the over 20 nursing homes in Trondheim. They move out when necessary, also to Tempe. – I have great faith in this. I think that we may have to try this all over the city and perhaps also at times other than night in the long run, says Lill Kristin Bjørnstad.
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Nurses demand staffing standards in elderly care in Trondheim – news Trøndelag
