Elderly in home care

in municipalities Pello, Rantsila and Tervola in Northern Finland

Report of Sustainable Rural Health Care Networks project

1st June 2005 – 1st September 2007

Mr Jouko Alaniva, Ms Tuula Partanen Ms Maarit Kairala, Ms Hanna-Leena Paakkolanvaara

Kemi-Tornio University of Applied Sciences (KTP) Health Care and Social Services; Technology

1st September 2007

Kemi-Tornio University of Applied Sciences

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CONTETS A few words to introduce this report………………………………………… 3 1 INTRODUCTION………………………………………………………………..………. 4 2 BACKGROUND AND OBJECTIVE……………………………………………….. 5 2.1 Two educational fields working together…………………………………. 5 2.2 Additional value from rural municipalities………………………………… 5 2.3 Starting the project…………………………………………………………………… 5 3 PROJECT IMPLEMENTATION……………………………………………. ……… 6 3.1 Project organisation…………………………………………………………………. 6 3.1.1 Steering group……………………………………………………………………..…… 6 3.1.2 Project group…………………………………………………………………………….. 7 3.1.3 Duties of project respectives…………………………………………………... 8 4 PRACTICAL LEVEL IMPLEMENTATION……………………………………… 9 4.1 Implementation model…………………………………………………………….. 9 4.2 The activities during the project……………………………………………… 11 4.2.1 Starting the project…………………………………………………………………... 11 4.2.2 Mapping the users needs………………………………………………………….. 11 4.2.3 Collaborative analysis and conclusions……………………………………. 12 4.2.4 Practical level piloting……………………………………………………………….. 12 4.2.5 Transnational cooperation………………………………………………………... 13 4.2.6 Training for implementation……………………………………………………… 13 4.2.7 Dissemination, autumn 2007……………………………………………………. 14 4.2.8 Report documents during the project………………………………………. 14 5 PROJECT RESULTS………………………………………………………………….… 15 5.1 Expected results……………………………………………………………………….. 15 5.2 Expected result: Pilot solutions……………………………………………….. 16 5.2.1 Municipality level cooperation………………………………………………….. 17 5.2.2 Definition of the pilot solutions………………………………………………… 17 5.2.3 User centered design (UCD) process……………………………………….. 18 5.3 Expected result: An innovative operations model &

implementation of technological solutions in an elderly person´s home in rural area….……………………………………………….. 19

5.3.1 Process modeling and the actors involves………………………………. 19 5.3.2 The phases of the process model……………………………………………. 21 5.3.3 Development target based of the new process model……………. 22 5.3.4 Evaluation of the process model……………………………………………… 23 5.4 Individual level results…………………………………………………………….. 25 5.5 Organisation level results……………………………………………………..... 25 5.6 Regional and international results……………………………………………. 25 5.7 Unexpected outcomes………………………………………………………………. 25 5.8 Training…………………………………………………………………………………….. 25 6 EVALUATION OF SUSTAINABLE RURAL HEALTH CARE

NETWORKS PROJECT……………………………………………………………….. 26 6.1 National level…………………………………………………………………………….. 26 6.2 Transnational level…………………………………………………………………… 29 7 DISSEMINATION AND TRANSFER EXPERIENCES……………………. 30 8 CONCLUSION…………………………………………………………………………….. 31 REFERENCES ENCLOSURES PICTURY CALLERY

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A few words to introduce this report

Sustainable Rural Health Care Networks from 1st June 2005 to 1st September 2007 has

given truth to the human people.

Working hard with people in team can give you strength, enpowerment and light

during the most darkest deeps of sorrow.

I would like to thank from the bottom of my heart every single person in our Finnish

local Steering and Working group; the elderly people and their close relatives in Finnish

rural areas and the staff of home care in municipalities Pello, Rantsila and in Tervola,

persons in Lead Partner Group in Norway, persons in transnationell groups in Sweden,

Norway and in Scotland. My best thanks to Ms Tuula Partanen; she knows the meaning

of my thanks without explanation!

In Kemi on 1st September 2007

Hanna-Leena Paakkolanvaara

Project Manager SUSTAINBALE RURAL HEALTH CARE NETWORKS project, KTP, Finland

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1 INTRODUCTION

According to several researches and inspections elderly people wish to live in their own home until the end of their life-line, also when they are not in a good shape. The condition is that the network between close relatives, near environment, official and non-official actors is working. When living at home there is a strong experience of self-decision-making at realization (e.g. Hirvonen 1995). One important thing is also successful aging – a concept introduced by Rowe and Kahn (1987). The desire of elderly people to live at home also when they are old impresses the quality of life and enpowerment. One objective of the age policy in Finland and EU is to utilise new technology in the elderly care further more. Technology is seen as a tool to meet the future challenge in the situation where fast growing aging population is demanding more services and personnel resources and this trend includes challenging cost factors as well. Municipalities Pello, Rantsila ja Tervola in the nothern Finland were the local partners with Kemi-Tornio University of Applied sciences (KTP) in Sustainable Rural Health Care Networks, eRural -project during the period 1st June 2005 - 1st September 2007. The project was part-financed by European Union. Pello, the nothernmost municipality located by Swedish border has 25 % of population people over 65 years old, 4521 inhabitants. Tervola near by Kemi city has 23 % of population people over 65 years old, 3710 inhabitants. Rantsila located near by Oulu city, the southernmost municipality in this project has approx. 19% of population people over 65 years old, 2057 inhabitants. This statistic was in the beginning of eRural -project 2005. Kemi-Tornio University of Applied sciences (KTP), Social Services and Health Care & Technology was one partner in the project Sustainable Rural Health Care Networks together with partners AKMC; Centre for Emergency and Disaster Medicine Sweden, UHI Millenium Institute AKMC, Centre for Emergency and Disaster Medicine, Scotland, NHS (National health services) Western Isles Scotland, NHS Argyll & Clyde, Scotland, NST; National centre for telemedicine Norway, HITOS, Tromsø University College, Department of Health, Norway and UMT-DMS, Regional Development Centre of Mid-Troms, Dep. of Public Sector Development Norway. The main objective of this Sustainable Rural Health Care Networks project was to improve the quality of elderly people home care living in rural areas by utilising technological solutions. This report contents the summary of the local Finnish eRural -project called Elderly in Home Care as part of the Sustainable . There is description of background of the project, implementation in practical level concluding summary of the activities during the project process. There is description as well of project results, description of working transnationaly, evaluation of project and dissemination. The main results of project are toolbox that contents a renewed operations model in the elderly home care, Work Package 1 and an innovative brain activator solution, technical cards to give guidance how to implement new eHealth solutions for the elderly home care purposes in Northern Periphery area, Work Package 3. This report contents even a summary of pictures during the SH project process in Picture Gallery.

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Some facts: Elderly people = over 65 years old persons who are living independently in their home in rural area and require social and health care services. In this project Elderly in Home Care old people are over 80 years old living at own homes at rural areas in northern Finland. eRural project = Sustainable Rural Health Care Networks project KTP = Kemi-Tornio University of Applied Sciences Sercives = Social and Health Care Services (integrated together in Finland) SH project = Sustainable Rural Health Care Project WP = Work Package

2 BACKGROUND AND OBJECTIVE

Kemi-Tornio University of Applied Sciences (KTP), Social and Health Care together with Technology made a preliminary study of the current state of welfare technology in Finland in the end of the year 2004. Based on these research results it was shown that the innovative operations and solutions in the elderly home care are needed urgently as this part of population is growing fast in the near future. The rural municipalities in the Northern Lapland will therefore face a major challenge to offer adequate but cost effective high quality services to the elderly living in the rural areas.

2.1 Two educational fields working together

On the basis of these results the KTP placed emphasis on the issues concerning elderly home care when agreed to join the EU-partly financed Sustainable Rural Health Care Networks project. The two educational units coordinated the Finnish project in cooperation: the Social and Health Care lead the Work Package 1 (WP1) sourcing for innovative cooperation networks and Technology developed new eHealth solutions for Work Package 3 (WP3) objectives. This cooperation has build a fertile platform for innovative knowledge sharing and results

2.2 Additional value from rural municipalities

In Finland municipalities are the most important service providers in the elderly home care. Municipalities of Pello, Rantsila and Tervola were found to be the most suitable cooperation partners due to the economic, geographic and demographic factors. These municipalities would bring additional practical level value for the project. They all are also long time partners of the KTP and they were very motivated to develop their processes in their elderly home care with the tools of improved teamwork and new technological solutions.

2.3 Starting of the project

The starting point of the project faced some challenges as the Grant Letter from the EU was confirmed in the autumn 2005 and the project started already in June 2005. This hindered administrative issues such as preparing the Partner Ship Agreement which would the basis of the cooperation. The municipality level key actors were both busy and not so used to work within international projects on the side of their regular assignments. There was not sufficient PR material available from the Lead Partner at the early stage of the project. Designing and translation took time before the material was at hand.

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The common view of the project objectives differed in some degree depending on the actor. It was hard to describe the objectives to the key actors as they lack at some stage the knowledge about the roles of process development, training and technology in the elderly home care. Many meetings, muncipality visits, telephone conversations, presentations with translated documentary were necessary to reach the objectives.

3 PROJECT IMPLEMENTATION

3.1 Project organisation

The project director was Ms Leena Leväsvirta who is the Dean of KTP’s Social Services and Health Care unit. Ms Leena Leväsvirta has had the main responsibility of whole Sustainable Rural Health Care -project in KTP.

The practical level work was carried through by a project group and it’s work was supervised by a steering group. Ms Leena Leväsvirta is also member of steering group of transnational Sustainable Rural Health Care Networks. Project Manager Ms Hanna-Leena Paakkolanvaara is member of working group of transnational Sustainable Rural Health Care Networks.

3.1.1 Steering group The steering group was responsible of guiding the work of Project Manager and Project group. It was possible that it would meet also for giving decision when ever there was a need to make any major changes into this project plan or to make any investments under the budget headline of ‘Equipment’ or major changes to the budget itself. The chairman of the Steering group was Ms Leena Leväsvirta and Secretary Ms Hanna-Leena Paakkolanvaara. The Steering group met in autumn 2005 two times, in spring 2006 three times, in autumn 2006 two times, in spring 2007 two times and in autumn 2007 one time. Municipality partners had a possibility to take part in the meetings via phone-meeting. The duration of every meeting was about two hours. The members of the Steering group are in table 1.

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Table 1. The members of SH project Steering Group in KTP, partner 9 in SH project

Name Organization Profession Mr Jouko Autio (1st September 2005 – 31st December 2005) Mr Mika Simoska (1st January 2006 – 1st September 2007)

Tervola municipality

Doctor/ Head of Health care

Municipal Manager

Ms Lahja Harju Pello municipality Deputy Social Manager Ms Tarja Pietarila-Heikkinen (1st September 2005 – 6th September 2006) Ms Kiti Sovisalo (6th September 2006-9th May 2007) Ms Arja Arola (9th May 2007 – 1st September 2007)

Haapavesi city (subtractor of Rantsila) Rantsila municipality Rantsila municipality

Elderly and Disabled people care Director

Registered Nurse

Registered Nurse

Mr Tapio Keskimaula KTP, Technology Development Manager, B.Sc. Eng.

Ms Leena Leväsvirta KTP, Social Services and Health Care

Dean, PhD (Social Science

Ms Hanna-Leena Paakkolanvaara, Project Manager, Social Services and Health Care

KTP, Social Services and Health Care

M.A. (Educ), Senior Lecturer, Expert/Health Promotion

Ms Tuula Partanen, Project Coordinator, Technology

KTP, Technology M.A. (Digital Media), project coordinator

Mr Arto Rautajoki KTP, Social Services and Health Care

M. Sc., Development Manager

Mr Matti Uusimäki KTP, Technology Dean, M.Sc. Eng.

3.1.2 Project group

Project group was responsible of the practical level implementation of the project and worked in close co-operation with the municipalities representatives and the elderly people involved to the pilots. To run the practical level affairs the participants had also informal work meetings in smaller groups several times during the project. The Chairman acted as a secretary of these both meetings. She was Hanna-Leena Paakkolanvaara. The Project group met in autumn 2005 five times, in spring 2006 seven times, in autumn 2006 five times, in spring 2007 seven times and in autumn 2007 one time. The duration of a meeting was about two hours. The members of the Project Group are in table 2.

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Table 2. The members of the eRural Working Group in KTP, partner 9 in SH project

Name Organization Profession Ms Kristiina Kehusmaa

Tervola municipality

Elderly care Manager

Ms Anneli Lumpus Pello municipality Elderly care coordinator Ms Tarja Pietarila-Heikkinen (1st September 2005 – 6th September 2006) Ms Kiti Sovisalo (6th September 2006-9th May 2007) Ms Arja Arola (9th May 2007 – 1st September 2007)

Rantsila municipality

Elderly and Disabled people care Director Registered Nurse

Registered Nurse

Mr Jouko Alaniva KTP, Technology B. Sc.,Technological Solutions/Systems

Mr Pekka Harjuniemi (1st June 2005 – 30th June 2006)

KTP, Technology Lecturer

Ms Maarit Kairala KTP, Social Services and Health Care

M.Sc. Senior Lecturer, Expert/ Elderly Care

Mr Tapio Keskimaula KTP, Technology B.Sc., Development Manager

Ms Hanna-Leena Paakkolanvaara, Project Manager, Social Services and Health Care

KTP, Social Services and Health Care

M.A. (Ed), Senior Lecturer, Expert/Health Promotion

Ms Tuula Partanen, Project Coordinator, Technology

KTP, Technology M.A. (Digital Media), project coordinator

Mr Arto Rautajoki KTP, Social Services and Health Care

M. Sc., Development Manager

Ms Mervi Takaeilola (1st January - 31st May 2006)

KTP, Social Services and Health Care

Register Nurse, Lecturer

3.1.3 Duties of project respectives The duties of the project group during the project have included both design and implementation assignments according to the project plan. There has been four workpackages in Sustainable Rural Health Care -project and KTP has participated in WP1 and WP3. The team members Senior Lecturer Ms Maarit Kairala and Project Manager Ms Hanna-Leena Paakkolanvaara from KTP, Social and Health Care have run WP1. Ms Mervi Takaeilola has also participated in WP1 work during the period of 1st January to 31st May 2006. The team members Project Coodinator Ms Tuula Partanen and B.Sc. (Eng) Mr Jouko Alaniva from KTP, Technology have had the tasks and responsibilities in WP 3. Lecturer Mr Pekka Harjuniemi has worked in this team during the period 1st June 2005 to 30th June 2006. The WP2 - oriented to training theme - has been delivered feedback from B.Sc. (Eng.) Mr Jouko Alaniva and Project Manager

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Ms Hanna-Leena Paakkolanvaara of the results from the user training implemented in municipalities . These three groups have worked very closely with the key actors of the municipalities e.g. making plans of meetings with staff and the elderly people at their homes. There have been several meetings with these actors in municipalities. The project group, especially B.Sc. (Eng.) Mr. Jouko Alaniva (KTP, Technology) has had responsibility of the whole process of the technological solutions and to implement technological solutions to the homes of the elderly people. Suggestions to use experts during the process and made project reports to steering group. The project group has planned the budget and analysed the potential risks. The TOP 10 risks where confirmed as follows: 1. Not enough adequate human resources available in the organisations 2. Too old age of the target group elderly testing and using the solutions 3. Commitment of the municipality level partners is weak 4. Suitable pilot targets hard to find or they disappear (death of the elderly person) 4. Unreal expectations of outcomes of the project (common understanding of the outcomes) 5. Overdraft of the budget 6. Not enough time to reach the objectives 7. Long project period (unexpected events during the 2 years and 3 month) 8 Changes in human resources 9. Competent and skills of project manager 10. The eight week long summer vacations of teachers in Finland Tasks and responsibilities for Project Manager has been as follows: the first priority has been to observe the well-being situation of persons in project group. Operational and execution and follow-up tasks have been carried out according to project plan together with project group. She was a secretary both in steering group and working group. She has collected information of the need to make any changes during the process and given the information to the steering group. She has been even a link with actors in municipalities in every tasks and with Lead Partner e.g. with Ms Linda Lien in Norway. The duties of the municipal members in the project group: cooperation with KTP and with local teams to find out the elderly people to the project, cooperation with elderly people and their closest relatives. This communication brought additional value to the work processes of the project. The quality assurance of the project results and outcomes has been based to systematic approach to work processes, adequate resourcing, sufficient knowledge sharing, open communication between actors, prompt reaction to shareholders feedback, appropriate documentation. Also valid legislation and the approved work practises both in Technology and Social and Health Care fields have been followed. Project Manager collected feedback from various shareholder six times during the whole project. The summaries of these feedbacks have been processed in the local project group and Steering Group meetings for further actions.

4 PRACTICAL LEVEL IMPLEMENTATION

4.1.Implementation model

The project is divided into nine different phases. Through these phases KTP implemented information retrieval related to SH project and sourcing of cooperation networks and partnerships for designing new service and cooperation concepts where new e-health solutions support the processes involved in the elderly home care. The

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phases of this project was carried through the plan for implementation as follows (table 3): Table 3. The plan for implementation in KTP

Schedule & dissemination

Methods & objectives

15th August -15th December ‘05 Dissemination during attaching customers and both internal and outside actors to the project .

Interview research: information retrieval about the practical level actors and environment. The target customers from two to five persons per municipality - were chosen in cooperation with the actors. The questionnaire was partly designed in cooperation with LP and commented also by the participating municipalities.

15th December ’05 - 1st February ‘06

Analysing the interview research results: finding critical factors concerning actors and customers cooperation networks, partnerships, needs for training and resources reporting the factors also for the purposes of ‘WP1 and WP3.

2nd January - 1st February ‘06

Making conclusions on the basis of analyse and designing preliminary models for elderly home care. Mapping the needs for education and technological support.

1st February - 14th April ’06

Designing new local service & co-operation concepts concerning health and social care by the basis of interview results (they were analyzed by the project group and confirmed by the steering group). Tools: specifications concerning the data needed in the processes of home care, user requirements (customers & actors) and environment requirements.

15th Mars – June

‘06

Developing new methodology for clinical and care evaluation serving created new concepts. This was implemented by developing renewed practices in the home care – the training of actors and issues concerning technology involved was included as well.

August 2006 - March ‘07

Piloting new models in municipalities (elderly people’s home environment and service providors’ premises) in co-operation with the actors and customers Includes training of the user groups (pilot customers and actors).

August ’06 - March ‘07

Collecting feedback from the customers and actors and further developing the concept mean while running the pilot.

March ‘06 - May ‘07

Evaluating the pilot and reporting results to the municipalities and SH-project WP-leaders. The report included guidelines how to further develop the concept.

June ’05 - October ‘07

Dissemination about the results to the media and co-operation networks by press releases, reports - both in printed and in electronic format. The dissemination activities was emphasised through out the project. KTP was marketing the SH-project in municipalities involved and in events, seminars, conferences and meetings.

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4.2 The activities during the project

4.2.1 Starting the project

The first contacts with municipalities were visits in Pello, Rantsila and Tervola in September 2005. The object was to confirm the participation of the municipality to the eRural-project and to inform municipality’s leaders about eRural project. The visit contained presentation of the eRural-project, participation of municipality and budgeting of eRural project. The first municipality visit in Tervola was on 22nd September 2005 and the participants were Municipal manager Mr Mika Simoska, Dr, Head of Health care Mr Jouko Autio and Elderly people care Director Helena Hartikainen. There were four persons from KTP: Dean of Health Care and Social Services Ms Leena Leväsvirta, Development Manager Mr Tapio Keskimaula, Technolgy, Project Coordinator Ms Tuula Partanen, Technology and Senior Lecturer Ms Hanna-Leena Paakkolanvaara, Health Care and Social Services. The first municipality visit in Pello was on 26th September 2005. There were five persons from Pello Deputy Social Manager Ms Lahja Harju, Elderly care coordinator Ms Anneli Lumpus, Elderly care coordinator Ms Kaisu Laitamaa and Municipality Secretary Mr Seppo Orajärvi. There were three persons from University of Applied Sciences Development Manager Mr Tapio Keskimaula, Technolgy, Development Manager Mr Arto Rautajoki Health Care and Social Services and Senior Lecturer Ms Hanna-Leena Paakkolanvaara, Health Care and Social Services. The first municipality visit in Rantsila was 30th Sept. 2005. There were one person from Rantsila municipality, municipal manager Mr Aimo Lehmikangas, Elderly and Disabled people care Director Ms Tarja Pietarila-Heikkinen and Deputy Social Manager Ms Kaisu Norrkniivilä, Haapavesi city, subtractor of Rantsila municipality. There were persons from University of Applied Sciences Dean Mr Matti Uusimäki, Technolgy, Development Manager Mr Arto Rautajoki Health Care and Social Services and Senior Lecturer Ms Hanna-Leena Paakkolanvaara, Health Care and Social Services.

4.2.2 Mapping the user needs By focusing to user perspective KTP ensured both the usability and long life-cycle of the developed pilot solutions. Therefore collecting information about local elderly people in home care was emphasized. This was done by interviewing both municipality representatives and elderly in home care. There was from two to five elderly persons in a municipality which were chosen together with actors. The guiding principles of the project were: respect for the client’s autonomy and integrity, multi professional work and empowerment of the actors. The most important perspectives in the research were individual needs and the resources of the chosen customers health and social care objectives and resources of the municipalities. There were using the structure from LP; Norway, and the mapping which based on the question form of the Lead Partner. The question form included questions to elderly people by the ICF –classification and questions about technology. The mapping period was from autumn 2005 to the beginning of February 2006. The objects for mapping was to collect information from three levels: old people, actors and organisation of social services and health care. The interview was carried out by Project Coordinator Ms Tuula Partanen and Project Manager Hanna-Leena Paakkolanvaara. In these meeting for mapping were in Tervola

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22nd November 2005. There were elderly care manager Kriistiina Kehusmaa and Doctor, head of health care Jouko Autio. Mapping in Pello was on 1st December 2005. There were elderly care coordinators Anneli Lumpus and Kaisu Laitamaa. Mapping in Rantsila was on 23rd November 2005. There were elderly and disabled people care director Tarja Pietarila-Heikkinen and seven persons from staff of home care in Rantsila. In Rantsila we met elderly persons first time in the service home; they had time for the daily activity -period in Rantsila elderly home. We met them on 23rd November 2005. In Tervola on 9th December 2005 we met five elderly people at their homes and in Pello on 2nd February 2006 we met five elderly people at their homes. There were need to ask more exactly about detals even later in Decmeber 2005 by phone and by email. The report mapping had to be ready on December 2005. The interview with elderly people in Pello was 2nd february 2006. There are not documented of this meetings in report of mapping, but all the results have been with the plans of making desicion of individual technological solution.

4.2.3 Collaborative analysis and conclusions There was organisated Workshop 16th February 2006. The object for this workshop was networking between partners in eRural-project representatives of the municipalities and KTP persons working in the project. The other object were Together shared understanding of the project, Results expected from the project, regional impressiveness and choosing pilot-objects for municipalities in accordance with the progress of the project process. As a result of the workshop was to choose pilots for municipalities. There were three persons from municipalities and seven persons from KTP. The meeting was experienced as an important one, so that people could plan together the proceeding of the project and visualize the future.

The visits to municipalities worked on as follow: Rantsila 16th March 2006, Tervola 27th March 2006 and Pello 3rd April 2006. The object was to clarify the realisation plan of the pilots together with the actors in municipalities, to have conversation about the choosing of the pilots and pre-introduction of the pilots in the municipalities,. During these meetings there were even technology representatives also present from the municipalities and KTP. In Rantsila there were three persons from Rantsila and three persons from KTP in this meeting; in Tervola two persons from Tervola and two from KTP. In Pello there were five persons from Pello and four from KTP.

4.2.4 Practical level piloting The second visits to home of elderly people in municipalities went on during the autumn 2006. The aim was to observate the home of elderly people with expert of technology. It was important to observate the environment at elderly peoples home to be sure for the plans of piloted technical solutions. In Pello on 29th September 2006 engineer Jouko Alaniva and Project manager Hanna-Leena Paakkolanvaara met four elderly people at their home and one relative. Rantsila 2nd October 2006 two elderly people at their home, one relative and two persons from KTP. Tervola September 2006 four elderly people at their home, two relatives and two persons from KTP. Installations and introductions of technical applications in the homes of elderly people were started at the November of 2006. In this experiment there are information gathered about the suitability, functionality and added value of the technology that the device could possibly provide to the user. There were also documented the possible problems in the export of the technology. The subjects of this experiment are aged between 80 and 88.

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B.Sc engineer Jouko Alaniva made several visits to municipalities for taking and install piloted devices to elderly person´s home in period autumn 2005 – early spring 2007. On 3rd October 2006 there were educational day in Kemi-Tornio University of Applied Sciences in Technological unit in Kemi. The responsibilty had the open education oraganisation in in Kemi-Tornio University of Applied Sciences. Education was for professionals of different fields of study who are designing, developing and using technology for elderly people at their work and also for people interested of the subject. There were looking participants especially from pilot municipalities of the Sustainable eRural Health Care Network –project. The aim for this course was to give methods for designing and creating different technological applications for supporting independent initiative of elderly people and for the use of persons working with elderly people. User-friendliness and the co-operation between different fields of study and professions is essential. Content of this day was as follow. The meaning of technology to elderly people and to the work done with elderly people, the ethical questions in technological solutions at elederly person´s home; the meaning of multi-profession co-operation for introduction of user-friendly applications. Presentation of Sustainable Rural Health Care Networks. There were 33 persons in this educational day.

4.2.5 Transnational cooperation In (23rd ) 24th – 25th of October 2006 there was a great event in Kemi-Tornio of Applied Sciences, in Health Care and Socail Services. KTP were hostess for the transnational meeting in Sustainable Rural Health Care Networks. KTP had guests from Norway, Scotland and Sweden. On 23rd KTP visited nursing home for elderly in Kemi. Manager Elsa Keränen was hostess. On evening activity we visited Tervola on 24th October 2006. Hostess were Municipal manager Mika Simoska together with Elderly care Manager Ms Kristiina Kehusmaa. They had presentation of Tervola municipality and elderly care system in Tervola. In the late envning there were a visit to robot cowshed with robot milker, robot feeding and robot cleaning. It was surprise that some cow went to robot milker even very late in the evening. There were an article in the Pohjolan Sanomat on 25th October 2006 about SH project transnational partner meeting in Kemi. Please, find here enclosed 1 a copy of the translated article text.

4.2.6 Training for implementation The members of working group of SH, KTP was invited to meet persons elected to a position of trust in Tervola on 24th January 2007. There were together 15 persons from Tervola municipality and three from KTP. B.Sc. Mr Jouko Alaniva was telling about the technological solutions which were taking as pilots in Tervola. Lecturer Maarit Kairala was telling about the operations model: implementation of technological solutions in an elderly person´s home. Project Manager Hanna-Leena Paakkolanvaara was telling about the facts of Sustainable Rural Health care Networks project. There were even possibilities to make questions. The Brain activator was the most innovative result in the project. It was time to visit municipalities with the brain activator with all equipments. There were visits in Tervola 1st February 2007. The object to this visit was to prepare home care clients to use technical devices provided by SH project. It was meeting at the home of elderly people between elderly people, his/hers relatives, two of home care staff and two persons from KTP, B.Sc. Mr Jouko Alaniva and Project Manager Hanna-Leena Paakkolanvaara. It was presentation of brain activator device and training to use it. IT was presentation even of technology cards. Also user information was collected during the pilot period to improve the developed solutions.

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The visit to Pello was on 7th February 2007. The object was to give training to home care staff to use piloted devices to elderly people. In Pello there were one person and ICT person as well. From KTP there were B.Sc. Mr Jouko Alaniva and Project Manager Hanna-Leena Paakkolanvaara. In Rantsila the visit was on 14th February 2007. It was taking piloted devices to elderly people and familiarizing home care staff with the devices. It was introduction even of property control device. On those visits there were two persons from home staff of Rantsila, ICT person and from KTP B.Sc. Mr Jouko Alaniva and Project Manager Hanna-Leena Paakkolanvaara. On 4th June there were a meeting in Tervola. The object for this meeting was to discuss about the innovative operations model: Implementation of technological solutions in an elderly person’s home in rural area. It was multiprofessional meeting: the staff of home care in Tervola, Kristiina Kehusmaa, eight persons and ICT person. There were lecturer Maarit Kairala, B.Sc, Mr Jouko Alaniva and Project Manager Ms Hanna-Leena Paakkolanvaara, KTP.

4.2.7 Dissemination, autumn 2007

There was held The Ending Seminar at Kemi-Tornio University of Applies Sciences in Kemi (Health Care) on 29th August 2007. In this seminar the following experts were the Key Note Speakers of this event: Project Manager, Ms Heli Sahala, Kuntaliitto, Localfinland, Finland; Municipal manager Mika Simoska Tervola, Risto Mäkikyrö, TEKES, Technological Development Centre, Finland and Irja Lepola, Doctor of Health Sciences. Programme is enclosure. There were 68 participants in this seminar. It presented SH project results and vision for the future in elderly care. There were even Education/training nr 2 in Tervola 31st August 2007. Object to this meeting was to prepare home care clients to use technical devices provided by eRural SH project. It contended the presentation of brain activator device , senior phone and technology cards. Number of participants there were five persons from Tervola and two persons from KTP. The reason to this late event was practical: the deliverer of the equipments to the brain activator was changed. The brain activator came late to Tervola; therefore even the second education happened later than planned.

4.2.8 Report documents during the project

The report documents were written in English and sent to Lead Partner. There were three of documents even in Finnish. They are Pilot report, An innovative operations model: Implementation of technological solutions in an elderly person’s home in rural area. The summary of presentations in Enclosing Seminar on 29th August 2007 is in Finnish as well. It is on KTP’s site, www.tokem.fi. The report documents were sent to local steering group and working group. They are seen on internet site on Sustainable Rural Health Care Networks, www.sustainable-health.org. The documents are on table 4.

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Table 4. Documents during eRural process

Number Name and content of report Date 1 Case Elderly People in Home Care. Project

Plan 21st December 2005, rev 1,0 February 2007, rev 2,0

2 Case Elderly in home Care. Mapping. Mapping the current situation in service provision in municipalities Pello, Rantsila and Tervola

21st December 2005

3 Case Elderly People in Home Care –municipalities Pello, Rantsila and Tervola in nothern Finland. The analysis of mapping

1st September 2006

4 Pilot report 15th May 2007 5 Summary of Enclosing Seminar on 29th

August 2007 1st September 2007

6 Final report Elderly in home Care 1st September 2007 7 Reports of Transnational meetings are in

Finnish Stornoway, Scotland Finsnes, Norway Skellefteå, Sweden Tromsö, Enclosing Seminar of Sustainable Rural Health Care Networks

June 2005 September 2005 March 2006 June 2007

5 PROJECT RESULTS

The international and local multi-disciplinary teams interaction brought up a good basis for the future cooperation. The elderly, the home care staff and their management both with the KTP representatives got a lot of new knowledge and up-to-date training.

5.1 Expected results

The main result of the project is a toolbox offering public information due to the objectives set in the Work Packages for the local project. The content of the toolbox is as follows:

• a renewed operations model in the elderly home care - piloted in Tervola municipality, Work Package 1 (WP1)

• technical cards to give guidance how to implement new eHealth solutions for the elderly home care purposes in the Northern Periphery area - piloted in Pello, Rantsila and Tervola municipalities, Work Package 3 (WP3)

• Student driven feasibility studies were made to find suitable pilot solutions • training material; folders for end-users and ICT administration • innovative brain activator solutions

The project outcomes include the appropriate documentary prepared for the Lead Partner and the local partners as agreed. The new equipment and implemented systems with appropriate training have established a fertile platform in the municipalities and the KTP for the further development of

• the computer aided cognitive training of the elderly

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• technological solutions designing to improve the welfare of the elderly

o the remote control/monitoring technology o communication networks o electrical locking o surveillance

• personnel training professional and computer skills and also to utilise

the new solutions • organisation level operations

5.2. Expected result: Pilot solutions Local pilots were an essential part of implementation of this project. Users’ experiences and needs were collected and utilised to build both commercial and customized ICT solutions to support elderly people independent living and welfare in rural areas. The KTP, Technology ran local pilots on 15th August – 15th March 2007 in cooperation with the KTP’s Social and Health Care unit and elderly home care and IT experts in the municipalities of Pello, Rantsila and Tervola. Attached to this report there are descriptions (enclosures 2 and it´s enclosures 1-5) of the piloted systems. All the solutions created during this project were based on the user interviews and open communication with the elderly and the personnel of the municipality. It was clear that new technology and computers are not very much utilised in the elderly home care processes. Information sharing and communication was therefore very important already from the beginning of the project to motivate all the necessary actors into the project. The systems were developed and provided based on the critical facts (enclosure 3) found in the user interviews performed in the late autumn of the year 2005 and in the beginning of the year 2006. After this a SWOT analysis was made and from this facts such as weaknesses in the current state and opportunities how to improve the current state were taken under consideration. Then it was necessary to negotiate with municipality level professionals of the results if they are appropriate starting point to develop new solutions and cooperation network. When the objectives were agreed the KTP started to develop new solutions and at the same time renew the operations model together with the municipality of Tervola. While developing these main objectives the communication with the actors included feedback collecting. Also feedback was collected after the pilots had ended and all the information was reported in the pilot report (picture 1).

Interviews Critical facts SWOT Weaknesses & opportunities Negotiations with the actors New solutions User feedback Improvements Improved solutions Feed back collection The pilot report ( Continuous development)

Picture 1: The activities performed for designing and implementing the pilots

(UCD, User Centered Design)

The designing of the new technical solutions included the actual design phase, actions involved with subcontracting, assembling and maintenance. It was important to produce accurate documents to be able to run the designing processes. A real-life operations model aquired network meetings in the municipality of Tervola which had been chosen to act as a pilot partner.

U C D

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In the Northern Pheriphery area the inconvenient logistic connections and ruling weather conditions have to be taken under consideration when running such a multi-disciplinery project. It would help a lot if there would be a common platform in the network for knowledge sharing and eMeetings. Logistic difficulties and unexpected weather conditions can delay agreed operations such as meetings, assembling and maintenance.

5.2.1 Municipality level cooperation

The municipality level professionals gave valuable input of the practical level knowledge in the project. They are welfare agents and key actors in the elderly home care.

• These kind of international projects are an extra duty for municipality level actors such as home care workers and managers. It was hard to find suitable time fitted for everyone in the project. Nor did all have enough time to study all the output information, produce information for all the others and partake into the meetings and training.

• At the same time there was a lack of adequately trained stand-ins for cases of

sudden sick-leaves and staff change to some other positions. Therefore it was understandable that some procedures in the project had to be postponed and rescheduled.

Most of the municipality level partners lacked adequately English language skills therefore all necessary original documents in English have to be translated into Finnish by the KTP. However interaction between actors was during this project versatile and vivid. This ensured that project objectives were achieved as planned. Among some actors in municipality it was expected that new technological systems and equipment will be launched quite rapidly at their usage after starting the project even though there was a Project Plan written in Finnish available including the implementation schedule as well.

• It was not possible to deliver all the equipment and systems as the practical level start of the project took time - administrative issues underlined – and all the necessary parts of the UCD (User Centered Design) process should be performed - such as user interviews, analysis of information, designing the systems, implementing and testing them and subcontracting the required equipment and install them - before the solutions were available to use in municipalities. A user research has to be performed to follow user centered designing methods. The involvement of the user in the design process was not correctly understood even it was emphasised regularly in the cooperation meetings.

To run a successful project it is necessary that all the partners are committed to both common objectives of the projects and their assignments to reach them. It was essential to this project that the municipality level actors delivered required information, promoted the project locally and participated actively to the meetings and required training sessions. Due to lack of resources and/or weak communication in the municipalities this kind of commitment was missing time to time.

5.2.2 Definition of the pilot solutions

As there were many national and local projects already running related to information management (such as patient information and municipality level internal information management - including network sites) those areas were left out in the design process of pilot systems. However pilots have been focused on the seamless care chain

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ideology. The role of technology is to support teamwork coordinated and implemented in cooperation with the social and health care and the ICT experts together with the users the way that the result will appear as one system to the customers. The objective is to meet customers needs better. Techology has been also implemented with the elderly and the professionals based in user centered policy and in fair cooperation with the target users. The components of the seamless care chain in the elderly home care are presented in the picture 1 here below.

Picture 2: The components of the seamless care chain in elderly home care

The pilots in Pello, Rantsila and Tervola municipality - representing the Northern Finland rural areas – included the following ICT solutions (further details about the systems will be found in the enclosure 1):

1. Peephole camera system 2. Outdoors camera system 3. Real estate monitoring system 4. Mobile Senior Telephone 5. Brain Activator – an innovative system developed during this project

5.2.3 User centered design (UCD) process

Customer’s needs were in focus when the project group designed and implemented the piloted systems and User Centered Design (UCD) desig method was used (picture 2 presents the phases of UCD process ).

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Picture 3: The phases of the User Centered Desig Process

The appropriate user information concerning the exploitation of these solutions and their further development are presented in the pilot report prepared on 15th March 2007 by the KTP (enclosure 1).

5.3 Expected result: An innovative operations model & Implementation of technological solutions in an elderly person’s home in rural area

The operations model developed in this project is called ‘Implementation of technological solutions in an elderly person's home in rural areas’. During the project several various technological solutions where piloted in rural areas on 15th August 2006 – 15th March 2007 according to technical cards produced during this project. The process model was developed in parallel with these pilots. This development work meets the requirements of the Work Package one (WP1) in the SH-project. WP1 aims to source innovative cooperation relationships to support the implementation of a new seamless care and service chain. Dr Hannele Hyppönen underlines in her doctoral thesis (Hyppönen, 2004) that technology has been very much emphasised in the development work of the elderly services as they have been developed due to the implementation of technological solutions. However there have been some difficulties in the implementation and as a result of this part of the projects have been failed and technology has not rooted into the everyday life of the elderly. Each contributory – the elderly, social and health care workers and the technology experts – have their own expectations, objectives and procedures. To root technological solutions appropriately it requires changes both in the life of the elderly and in the professionals’ work practises. In this operations model experts and earlier work practises has been utilised to develop an innovative model that breaks traditional professional barriers. Also the quality guidelines in the elderly care and services has been considered (The quality guideline for the elderly care and services, 2001 & 2007) with the cost correlation (= resources used are appropriate and adequate to meet the needs of the elderly) related to these matters (Vaarama & Ylönen, 2006).

5.3.1 Process modelling and the actors involved

This model has been developed on the basis of process ideology what enables holistic and transparency of the process with its phases and it shows also the responsibility

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areas of the actors involved. When monitoring particular phase it brings out demands for development and training with the requirements of new tools and evaluation. (Lankinen 2006). It is essential to produce this process model in cooperation with the actors in which operations has been implemented as much as possible the same way as in the operations model. For example it includes the need mapping of the elderly and the networks meetings in their homes. The process model has been estimated in cooperation with the personnel of the elderly home care in Tervola municipality. Also the feedback from the students’ final thesis (Hiukka & Jauhojärvi, 2007) has been utilised. This model has also been processed in the pilot group meetings with various interest groups representatives. The process model emphasises the customer orientation and the role of the elderly as active participant in every phase of the process. The elderly participates in evaluation, common planning, implementation, usage and assessment of the technological solution. By strengthening the participation of the elderly in this process the suitability of the technological solution to the needs and everyday life usage (usability) of the elderly will be secured. The chosen perspective is here holistic as an elderly is seen as a physical, psychic, cognitive and social actor in her/his living environment and in own social networks. The rural areas have been emphasised in this project. This sets its own resources and limitations to everyday life of the elderly and the implementation of the technological solution. Also the attitudes and actions of the people linked to the lives of the elderly are significant as they can either support or prevent the implementation. The closest network is seen as an important support instrument to the elderly and as the cooperation partner to the professionals involved. This network is build of the persons offering social support such as relatives, friends and neighbours. The closest network members have known the elderly person for a long time and they have been part of his/her life history. The elderly person has been connected emotionally to the members of this network. If the elderly person is unable to make decisions due to dementia the value of this network grows even more. The professional actors in this project have been the staff members of the elderly home care and the technological experts. The home care staff members are experts in their own professional field, local services in the elderly care and the elderly and his/her everyday life. The technological experts represent the knowledge in their own professional field with the know-how in the technological solutions: subcontracting, implementation, usage, training and maintenance. Practical level multi-disciplinary teamwork enables expertise resources combination and utilisation needed in the process development work. The members of the team share intelligent resources related to information, plans and objectives to reach something that one individual employee is unable to reach by him/herself. (Isoherranen 2005). The main challenge in the elderly care is the seamless cooperation of the actors. The seamless care and service chain is a process model that merges all the various service providers’ in social and health care to meet customers needs. This kind of seamlessness can consist of both seamlessness of the services at that moment (for example the services designed to support independent living at home) and the services customer receives during his/her life (transfer for example from home care to a sheltered home or hospital). Seamlessness requires cooperation of the actors in the fields involved in the care process. Multi-disciplinary cooperation is aimed to meet the customer needs in holistic perspective. The information is integrated in common knowledge processing due to the customer orientation. Communication process produces a case-specific goal and a common understanding of the procedures and problem solving. All the required discussion will take place in the due forum and with the operation principles agreed together by the actors involved. (Isoherranen 2005).

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In this project the actors are the elderly person, his/her closest network and the professionals. In the process model the knowledge of the elderly and the network is utilised and like so also committed to use and utilise the developed technological solutions and to merge the knowledge of the professionals. In the process model the network meetings act as a common forum for communication. This model does not emphasise only the multi-disciplinary work it also emphasises holistic perspective of the customer orientated cooperation of the experts in public, private and third sectors. Please, find here attached the process model called ‘Implementation of the technological solutions in the homes of the elderly’ as an enclosure 1.

5.3.2 The phases of the process model A. Need mapping focused to the elderly This phase is based on the changing needs of the elderly. Therefore the objective is here is to meet these needs as appropriately and well-timed as possible. In this work a preventive perspective and the practises aimed to support person’s activeness and rehabilitation are been emphasised. In the beginning of the process it is essential that the elderly home care professionals that are involved to everyday life of the elderly able to evaluate the needs of their customers. The objective is to give information about available services and search for the suitable options together with the elderly person. The valid age policy emphasises continuous evaluation as the needs and life situation are of the elderly are constantly changing. This is an essential starting point also when new technological solutions are developed for the elderly. If these solutions are inadequately targeted the elderly is not able to utilise them, she/he does is not committed to use them and these solutions will not become a part of the elderly person’s everyday life. From the municipality perspective (or from the elderly perspective if these solutions are purchased by themselves) these solutions are expensive if they do not meet the needs of the elderly. It is therefore essential to map the needs, the effects of the solutions and the benefits from them to the elderly person’s and the professionals actions in everyday life comprehensively. The technological expert will participate in the need mapping phase always when needed. B. Cooperative planning in the network meeting

After an elderly person has decided on the implementation of the technological solution there will be a network meeting at the home of the elderly person. This meeting aims to shared expertise and cooperation between various actors involved. The elderly person, his/her closest network, the home care personnel responsible of this person and the technological expert will be participating to this meeting. The objective is to agreed together about the targets, procedures and the policies of this cooperation. The convenor and the leader is a social and health care worker who act as a chairman and takes care of updating a personal care and service plan. She/he also coordinates the practical level implementation. The technological expert monitors the issues included to his/her own professional field. The customer orientation will be checked due to limitation the elderly person sets to the usage of the solution. Also issues included to installations and user training aimed to the elderly and the home care staff with a due training schedule are coordinated by this expert. Besides this also the usage and evaluation of the technological solutions are agreed in cooperation with actors involved. C. The implementation of the technological solution

After it is agreed with the actors that a technological solution will be implemented the practical level subcontracting and implementation will take place. If the solution is purchased by a municipality the respective staff member of the social and health care

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services prepared the application attached with a required expert statement and makes a decision of this purchase. If an elderly person her/himself purchases a solution there is no need for the public application process but on the basis of cost effectiveness the other phases of the process model are essential. A technology expert should check the user orientation, purchase this solution and should also take care of the installation and user training. Especially user training should be emphasised. Together with the actors involved also control and maintenance of the solution should be agreed. D. The usage of technology The elderly person is seen as an active actor in the implementation phase and his/her activeness and usage is being supported. The relatives and workers build up a network that will support and guide in the usage of technological solution and it will also monitor and register the usage together with the elderly person. These procedures have been agreed in the network meetings earlier. The elderly person need immediately or as soon as possible support if there are any difficulties with the solution. This network will also react to the changes in the needs of the elderly person during the usage of the solution.

E. Evaluation

The implementation of the technological solution will be evaluated due to the schedule agreed in the first network meeting. If there are any difficulties earlier than this the situation should be monitored and evaluated in due course. This evaluation will take place in the network meeting held in the home of the elderly person by the same participants as in the first meeting. The objective of this meeting is to evaluate the quality and cost effectiveness with the benefits and the compatibility of the solution to the activities of the elderly person and the other actors. After the evaluation the actions to make prospective changes and either the solution usage should continue or not. Also the personal care and service plan will be updated if needed.

5.3.3 Development targets based of the new process model

A successful implementation of technological solutions requires adequately professional qualifications from the staff members involved in the process. Both social and health care professional personnel and the technological experts require also general information of the target solution and its application for the elderly. Also cooperation skills will be emphasised further more in the future. The local process model should be developed and its functionality monitored in cooperation with the local actors. Social and health care personnel requires training to source the needs and the life situation of the elderly and also various options of available benefits and services aimed to support the welfare of the elderly. The laws and application procedures related to the purchase of these solutions should be clarified. Besides documentation the workers need training also on how to build up a support network and how to use the chosen technological solutions. The personal care and service plans should also include a section on technological solutions. In the elderly care there is a tendency that responsibilities of the customer process are coordinated by one person therefore it would be natural that this person would take care of the implementation of the technological solution and fitting it into the service assembly as well. The technological expert will require further training on user centered design, installation, user training together with its development, maintenance and procedures in the purchase of the solutions when serving the elderly person’s needs.

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As there are not many implemented technological solutions in the pilot region and it would bring perhaps additional value to source regional models to arrange training, to centralize technological expertise resources, rental of equipment and applications together with maintenance and storage. Besides this the regional model could include development of the equipment which would support implementation - for example when there is a need to evaluate an elderly person’s needs and situation in life from the perspectives of technological solution purchase, quality of the usage and evaluation of the cost effectiveness and also application process and renting related to technological solutions. Commitment of the organisations and their management to utilise these solutions are essential for appropriate development efforts.

5.3.4 Evaluation of the process model

This process model called ’Implementation of technological solutions in an elderly person’s home in rural area’ brings out the criteria for innovative process model and with the help of process modelling the transparency of the agreed procedures with different phases and responsible areas of the actors have been realized. The model will act as a tool for practical level actors are able to analyse and develop their own actions and source for solutions to the targets which have been raised on the basis of the process model. This model underlines also the gaps which could be bridged with further training and regional cooperation. The process model developed in the Sustainable Rural Health Care Networks project has been applied in the situation where a technological solution has been implemented in an elderly person’s home: person’s situation in life has been quite stable and also the home care staff tending this person has been the same for a long period of time. The process model can be applied also in changed circumstances as well for example when an elderly is discharged from the hospital or moved to a sheltered home. In changing situation the seamlessness of the care and service and cooperation of the actors involved will be emphasised.

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Picture 4: Process model

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5.4 Individual level results

The project offered splendid opportunities to further develop project staff’s partly novice level knowledge in project management. Also the professional competence was regenerated during the multi-disciplinary meetings and during many local house calls. It was rewarding to experience the real-life circumstances and recognize the environmental constrains in rural areas. This project was an eye-opening experience for the elderly, their relatives and the Social and Health Care personnel as well.

5.5 Organisation level results

Many new organisation level connections were sealed for future potential cooperation purposes. During the project valuable suggestions to develop the training in the fields of Social and Health Care together with Technology was received.

5.6 Regional an international results New ideas to develop tecnological solutions in the rural areas such as proper heating systems in the old houses to save costs and to add comfort of living was brought up. The dissemination and the PR of this project in the field of welfare may rise some new local business ideas and bring more jobs in the rural areas. The public reports build a interaction platform for international business actors as well

5.7 Unexpected outcomes

As some spinn-offs ot this project one Final Thesis was prepared in the KTP, Technology (RFID, Mr Marko Lahtela, 2006) with some special works, too (enclosures 4-5). In Health Care and Social Services one Final Thesis was also prepared, Nursing Studets Ms Pirjo Hiukka and Ms Raisa Jauhojärvi. (enclosure 6).

5.8 Training

The user training of the piloted solutions to was carried out in every municipality participating eRural project in January – February 2007 when the devices were taken to the municipalities. The goal was to train at least one main user for the piloted devices who works in home care and also a computer assistant with the technical ability to use the devices. The goal was also that the main user in every municipality would train all the other staff of home care working with elderly people who had piloted devices at home. In Pello the main user was Ms Anneli Lumpus, in Rantsila Ms Kiti Sovisalo until the 9th of May 2007, after that Ms Arja Arola. In Tervola the main user was Ms Kristiina Kehusmaa. In every municipality there was a clear folder for every device which had e.g. technical card from every piloted device in the eRural-project. In Steering group’s meeting 15th of February 2007 was presented that the user training should be carried out again in the municipalities. The goal was to get as many people as possible to the training. These training were done in Pello and in Rantsila at the spring of 2007. The training in Tervola was postponed to autumn. The trainings were carried out by Jouko Alaniva, and project manager Hanna-Leena Paakkolanvaara.

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In the trainings they e.g. tested Skype connection between Pello and Rantsila. The use of this connection was hoped to continue, e.g. for sharing every day life experiments working with elderly people living in rural area. It was even important to make observations from the pilots by using the documents KTP gave with every pilot. Trainers advised home care staff to inform everybody working in home care to get to know the technical cards and to notify where the technical card folder and the device folders were kept. The information about KTP taking care of the possible expenses for the piloted device was very important to the users of the devices.

The feedback for the training was very positive. Especially trainer Jouko Alaniva was said to be very clear and professional. Also technical cards with all the information needed were thanked. During the project municipalities didn’t make any changes to the technical cards.

6 EVALUATION OF SUSTAINABLE RURAL HEALTH CARE NETWORKS PROJECT 6.1 National level

During the project for control quality there has been questionings sex times. An evaluation of many events during the eRural project process has been carried out as follows. Questioning to project group 7th December 2005, questioning in workshop 14th February 2006 to project members of municipalities and project members of KTP; questioning to participants in transnational meeting in Kemi 24th - 25th October 2006; questioning II to project group 1st December 2006; questioning after the concluding seminar on 29th August 2007 and the final questioning to all members in eRural-project both in municipalities and KTP in August 2007. Results of evaluations of the implementation of the project's activities are considering their weaknesses, strengths, threats and opportunities. 1. A summary of collected feedback from the project group on 7th December 2005 There have been some difficulties for carrying out the eRural project process but however the working group has made some concrete results, such as report of mapping which sent to Lead Partner to Norway. The support of working group has been important. The cooperation between multi-disciplinery experts worked well. There has been more to do at practical level; lack of time. Also the working group members would prefer more efficient communication and knowledge sharing both on national and transnational level. During this project process a goal is to receive more knowledge about the transnational work and trends in the future. The cooperation even with transnational level was interesting; it has learnt how to meet different culture and ways of action. Working together is a great power! 2. A summary of collected feedback in workshop 14th February 2006 to project members of municipalities and project members of KTP Everybody thought it was necessary to have this workshop now after a half year from the beginning of the project. It set the trends how to continue working. We have started the network between project members in municipalities and in KTP. It would have been better if all the project members could have sat in the same table planning and changing opinions about the progress of the project. This was a good challenge to continue the project.

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3. A Summary of collected feedback from the project group on 1 st December 2006 There has been more tasks in eRural –project as members in working group of eRural –project. The well being working in SH project group is quite good with some members. The situation has not been the same with all members. However the working was going on and the project plan process was quite well on the schedule. The resources to develop e.g. the content of brain activator need to have more actors. It takes time. The working team has been good. There has been wish that even members from municipalities would been with in the meetings. There is the possibility to participate via telephone meeting. Project manager has have most cooperation with Lead Partner . Every member of Steering group and Working group has been able to see what kind of things eRural on transnational level is doing. Many have the user ID to the information network of the SH project. The cooperation with the municipal level actors has been good. You have always been welcome to visit the staff of home care and the elderly people. As the municipality elderly care personnel has taking care of dissemination on their behalf the elderly people have been aware of the purpose of visit project group members are doing. The members of KTP project group think that this project is a good start and gives possibilities to continue in next possible project. Lack of resources of project personal seems to be obstacle to better results. The first beginning it would have to be more concrete plan how to use budget as well. As novice you need more help, more education of theme how to carry out the whole project process. 4. A summary of the feedback collection from the participants of the transnational meeting in Kemi 24th - 25th October 2006 The cultural activity was very interesting: visit in Nursing home for Elderly and the social technology there; visit in Tervola municipality in rural area. To visit robot cowshed with robot milking machine, robot feeding and robot cleaning in Tervola. In the big pedigree of cows they find also cows from Scotland. They had only one wish: that the hotel they stayed would have higher international standards. 5. A summary of the feedback collection from the Ending Seminar participants on 29th August 2007 KTP wanted to collect open feedback with theme: Brickbats and bouquets. There was some who wanted to see more concrete devices of the technological solutions we had in our eRural project. This demonstration was in our plans but it was lack of Brain Activator with all equipments it needs. Some said they did not find the aims of the project. But most of feedback was very positive. They got a good idea of the wholeness of Sustainable Rural Health Care Networks -project with aim, intervention and results e.g. technological solutions and process The visitors who have their lectures during this seminar got very positive feedback: to focus to the substance of elderly people and facts and statistics from future. It was feedback also from the whole programme: many-sided. It was good that the respect of elderly people was clearly present during the seminar, not only technology. It was even worry about the situation if the elderly people living at home have technology they can be inactive. The participants from the municipalities participating SH project were satisfied as well.

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6. Final evaluation on August 2007 A. Mutual understanding on the goals of eRural-project

• Kemi-Tornio University of Applied Sciences has a realistic idea of the situation in the municipalities - staff resources and substantial capacity.

• The goal is that people living at home could live there longer by using the assistance of technical appliances.

• There might have been a need for improvement of the municipalities’ activity, but it hasn’t effect the mutual understanding.

• Securing elderly people’s living at home in the rural areas by using technology.

• It was difficult to get elderly people understand the project although the reason was to bring safety to their life at home using technology.

• Older people participating in SH the project in every municipalities. B. Realisation process in practice (succeed, ideas for development)

• My opinion is that project’s goals have been achieved pretty good. • Technical supply has been met and attitudes have changed for more

technical-friendly. • Trainings have been versatile. • One good thing was that the municipalities got to keep the devices. • Network meetings as a basis for evaluating needs. • Client visits personally by all the parties of the project. • Evaluation, planning, realisation. • Good thing from clients view. Brings safety when they learn to know who is

who. • Safety phones were a success. Devices worked and the use succeeded well. • Brain activator still in experiment-stage, but the experiments have been

successfull. • The clients don’t fully master the use of the brain activator. • Finnish games are added as soon as summer ends. • Ideas for development are thought.

D. The possibility for utilization and continuation

• We will gladly participate to the continuation project if qualifying expenses aren’t too high.

• We try to utilize the received devices as much as possible also in the future.

• Education for people giving training for using the devices is probably needed in the future also.

• There was quite a little time for listing feedback and user experiences, but created feedback can be used as a ground for planning a new project.

• We’ll probably get the same kind of safety phone devices as the ones being tested for households which don’t have landline anymore.

• The staff of home care said that they have planed to buy more senior telephones.

• It is easy to lend senior telephone to some person if they need help e.g. after operation for shorter period.

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E. Other attention

• More accurate timetables. • Device deliveries and time for user experiences. • There wasn’t enough time for the project in local level. • Same kind of project should need more time and familiarizing oneself

personally only for this project bring much more than in this case. • Change of the project staff was a bit problematic. For example there was no

informing about the project, but anyway people were satisfied to participate in SH project.

• Experiences of the elderly people were positive. • Project staff was always warmly welcomed to their homes. • Kemi-Tornio University of Applied Sciences performed the project

methodically and very well. Thank you for that! There has been a long way from the first beginning to the end of the SH project. There has been challenges that we have won with the power of cooperation between partners in municipalities and the KTP. All the events during the process have learnt a lot at personal, multi-disciplinary, municipality and individual level – especially by the human encounters. There are also some results out of analysis made that could deepen SH project research objective. Due to time and human resources the planning and implementation of this project is seen through this report. It looks like us!

6.2 Transnational level

This project linked many organisations and persons and they could share valuable information and learn from each others. The practical level work within the Work Package 1 was run efficiently by the Lead Partner representative Project Manager Ms Linda Lien. However the transnational project level cooperation lacked time to time a systematic touch. Cooperation and dialogue with the Project Manager Ms Linda Lien worked extremely well. The Lead Partner’s expert of economics changed in the early state of the project and this also caused some confusion as information came some times quite late. In some cases the KTP made initiatives to coordinate common issues related to research and reporting with the Lead Partner. The Work Package 3 had a good transnational kick-off in Stornoway Scotland but continuing work suffered from the lack of managing and coordinating the work required to reach the objectives of this work package. Also the Work Package Leader was changed during the project. There was not so much of additional value from the international cooperation even though partners interacted with each other digitally. During transnational partner meetings the presented outcomes of the other partners where found to be very interesting shared issues. An intranet site designed by the Lead Partner together with partners – a common platform for information sharing - was a welcomed improvement to support transnational communication within the project. KTP very much appreciated that all its local cooperation partners were able to share required information and communication at this site.

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7 DISSEMINATION AND TRANSFER OF EXPERIENCE

Dissemination of the eRural project has been done on local, regional and national level. The table 4 shows the most important events concerning the dissemination. The number of participants in the events has been from 2 to 68 persons. In addition there has been sharing the SH project brochure designed by Lead Partner. It has been sharing both in English and translated in Finnish.

Table 4. Dissemination under the eRural project process 1st June 2005 –

1st September 2007

Occasion Date/dates Nationality Other important

Workshop "Welfare and Health of Aging People in the North" for International Partners of Kemi-Tornio University of Applied Sciences Unit of Health Care and Social Services in Kemi

30th September to 4th October 2005

From United Kingdom, Norway, Czech Republic, Russia and Finland 18 persons

informa-tion in internet

“Gerontological social work in changing cultures and societies” in Archangelsk & Solovetsky islands, Russia

September 19-22, 2006

From United Kingdom, Norway, Czech Republic, Russia and Finland 16 persons

NordPlus Network meeting in Rovaniemi University of Applied Sciences, Health Care and Social Services

18th – 19th April 2006

From Sweden, Norway and Finland 15 persons

R&D Excellence in the Far North – Investing in Research in Finnish Lapland; organised by Lapin liitto ”European North Lapland-Oulu” office

15th November 2005

50 representatives of different regions of EU

Cooperation with the municipal partners, Workshop, Kemi-Tornio University of Applied Sciences Unit of Health Care and Social Services in Kemi

14th February 2006

11 persons

Meeting with representative from Ministry of Education, Finland Programme: 2:15-2:40 p.m. eRural –project, senior lecturer Hanna-Leena Paakkolanvaara

1st March 2006 6 persons

Seminar: Developing cooperation of R&D Excellence and Education in Kemi-Tornio University of Applied Sciences, Technology

20th September 2006

Teachers and students from Kemi-Tornio University of Applied Sciences

Presen-tation of equip-ments, e.g safety techno-logy and brain activator

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Occasion Date/dates Nationality Other

important Technology for Elderly - education day; Kemi-Tornio Open University of Applied Sciences, open University

3rd October 2006

Partners in SH project from municipalities Pello, Rantisla and Tervola Teachers and students from Kemi-Tornio University of Applied Sciences; 33 persons

Presentation of equip-ments, e.g safety techno-logy and brain activator Information in internet

Local newspapers Pohjolan Sanomat SH –networks meeting in Kemi 23rd – 24th October 2006

23rd October 2006

Information in internet enclosure 1

SH –networks meeting in Kemi Visits in Nursing Home for Elderly and Tervola municipality

22nd - 23rd – 24th October 2006

15 persons

Presentation of SH project to persons elected to a position in trust in Tervola municipality

24th January 2007

15 persons

Meeting the staff of home care in Tervola municipality. Presentation of the operations model: Implementation of technological solutions in an elderly person’s home in rural area

4th June 2007 13 persons

Ending Seminar

29th August 2007

68 persons Internet publication: articles of lectures

From Idea to Product - the whole SH process report in e format in the internet

1st September 2007

Publication in use also in the future

New SH project brochure, all the Finnish results of Sustainable Rural Health Care Networks; in Finnish and in English

from 31st August 2007

In use also in the future

There were cooperation with the elderly people and their close families several times and with the staff of home care as well. There were using phone and email.

8 CONCLUSION

The quality of life for elderly people living in the rural areas can be supported with the help of technical devices. They created a better feeling of safety to elderly people. The brain activator enables social intercourse in many levels: the feeling of isolation rising from loneliness decreases. Elderly people are able to find their roots e.g. via internet they can follow the latest news in their native place. There has been

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even an important question: “Does technical device make old people inactive if they only sit in front of PC?”

“Taking new technology to elderly peoples’ homes can also be frightening. Ethical questions have been thought in the project. Home is a private area and clients may get a feeling that it has been invaded. The majority of the municipality’s population is elderly people. Educated staff is hard to get, so technology is taken for assistance. Institute places are rare and for long there has been an idea that people should live at home as long as possible, says Elderly Care Manager Kristiina Kehusmaa from Tervola municipality.” (Local newspaper Pohjolan Sanomat 24th Ocbtber 2006, 6).

If an old person have needs of care or nursing to go to an institute, it is important that when he/she comes back home the devices that he/she uses are taken into consideration. That is why the modeling developed in this project should be utilized in every case when elderly people are coming back home from an institute. It is important to continue the development concerning the modeling e.g. in the municipalities and in the health care system and social services as well. It is necessary to have adequately trained and skilled professionals - with appropriate time resources as well - to be involved in this kind of project. The efficient internal communication will ensure that dissemination and all the required processes will be implemented appropriately. This project brought up the home care personnel’s needs for further training. This could be offered by using the latest eLearning technology. Increasing the cooperation between municipalities Pello, Rantsila and Tervola during the SH project experience is an important challenge. One reason is that the technical pilots done in the municipalities participating SH project weren’t exactly the same in municipalities. However, it is a valuable experience to the staff of home care in municipalities to have been taken part to an international Sustainable Rural Health care Networks project. The close cooperation between actors in municipalities Pello, Rantasila and Tervola and project people in Kemi-Tornio University of Applied Sciences has given many important experiences trough the whole project process. The personal contacts have become deeper in cooperation with the daily life questions. The cooperation with transnational level has been demanding, but very benefit. The value with the wholeness you can understand with the years… Continuation plans include e.g. the development of the content of the brain activator for elderly people. The acts in municipality said that they try to develop and utilize the received devices as much as possible also in the future. For example monitoring medicines as a pilot is interesting also e.g. testing the use of the welfare bracelet. Education for people giving training for using the devices is propably needed in the future also. This project has reached its objectives according to the project plan. The designed eHealth solutions and the new operational model will play an important base of the future development work. The idea of a multi-disciplinary teamwork where both technology and education are set as a tool of improving processes has been planted into the organisations. Project personnel is looking forward for vision where the more practical level solutions and improved professional level cooperation support the everyday life of the elderly in the rural areas.

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REFERENCES Hirvonen R (1995) Kotihoidon merkitys vanhukselle: Laadullinen tutkimus vanhusten

kokemuksista. Teoksessa: Sinkkonen Sirkka (toim.) Kotihoidon sisältö ja laatu Kuopiossa. Kuopion yliopisto, Hoitotieteen laitos, Sosiaalitieteiden laitos, Terveyshallinnon ja –talouden laitos. Kuopion yliopiston julkaisuja E. yhteiskuntatieteet 30. Kuopion yliopiston painatuskeskus, Kuopio; 79–90.

Hiukka, Pirjo & Jauhojärvi, Raisa 2007. Kotona asuvien vanhusten ja kotihoidon kokemuksia

eRural -projektin teknologiasta. Kemi-Tornion University of Applied Sciences. A Final Thesis in Health Care field. Unpublished reference. (The use of gerotechnology supporting elderly people. Experiences of using technology provided by the eRural – project within elderly people and homecare personnel)

Hyppönen, Hannele 2005. Tekniikka kehittyy, kehittyvätkö palvelut? Tapaustutkimus

kotipalvelujen kehittymisestä teknologiahankkeessa. Ikäihmisten hoitoa ja palveluja koskeva laatusuositus. Sosiaali- ja terveysministeriön

oppaita 2001:4. Ikäihmisten hoitoa ja palveluja koskeva laatusuositus 2007 (luonnos) Sosiaali- ja

terveysministeriö. Isoherranen Kaarina 2005. Moniammatillinen yhteistyö. Wsoy. Vantaa. Lankinen, Niko 2006. Prosessien kuvauksesta apua palvelu-uudistukseen, Duodecim 4/2006. Rowe LW & Kahn RL. 1987. Human aging: usual and successful. Science, Vol 237, Issue

4811, 143-149. (http://www.sciencemag.org/cgi/content/abstract/237/4811/143; read on 31st August 2007)

Vaarama, Marja & Ylönen, Lauri 2006. Espoon kotihoidon laatu ja kotihoidon

kohdennustehokkuus Espoon vanhuspalveluiden tuloksellisuus –projekti. Osaraportti 3.Espoon kaupunki ja Stakes.

ENCLOSURES PICTURE GALLERY

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ENCLOSURE 1 (1/2) Local newspaper POHJOLAN SANOMAT October 25th 2006, 6. Taina Nuutinen. Kemi Better quality of life to rural areas with welfare technology International project developes appliances for assistance which help elderly people to live at home for a longer time. The municipalities of Tervola, Pello and Rantsila are participating an international project which research the availability of social and health care services in rural areas, and developes new solutions. The angle is that the time elderly people live at home in rural areas can be lengthen with technology. Kemi-Tornio University of Applied Sciences research in municipalities what kind of problems elderly people living at home have and how they can be solved with technology. In addition to Northern Finland, also Northern Sweden, Northern Norway and Scotland are participating in the project. The countries have quite similar problems in the rural areas. Long distances and the low population are good examples of the challenges says the project leader norwegian Linda Lien. One example of the fact that Northern countries and Scotland are little different is that in Northern countries there is more care services to offer than in Scotland. Clients as a starting point In Scotland care services as homes for elderly are usually supplied by private companies. In addition elderly people live usually with their relatives, Lien says. Each country has a own focus-area where to concentrate in the project. In the meetings information and experiences from different countries are shared. In the pilot project in Northern Finland there has been a mapping about the technological appliances that could be useful to elderly people for living at home as long as possible. Everything is client-centered. We have interviewed elderly people participating the project about what kind of devices they need, the Dean of Health Care and Social Services Leena Leväsvirta from Kemi-Tornio University of Applied Sciences says. Project manager Hanna-Leena Paakkolanvaara tells that technological appliances are usually for improving the security / safety of elderly people’s home, remote monitoring of the property and maintaining the conscious abilities. Welfare technology is a growing area, she says. Technology can be frightening. Taking new technology to peoples’ homes can also be frightening. Ethical questions have been thought in the project. Home is a private area and clients may get a feeling that it has been invaded. There are three clients in the project from Tervola municipality. Kristiina Kehusmaa, the leader of the municipality’s elderly work, says that the elderly people

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ENCLOSURE 1 (2/2) participating to the project regard technology as a positive thing. Nevertheless the devices needed haven’t been tried yet. If the close relatives of elderly people are interested in the technology, so are the elderly people, e.g. if children have computers at home, so have the elderly people, says Kehusmaa. Tervola is participating the project because the majority of the municipality’s population is elderly people. Educated staff is hard to get, so technology is taken for assistance. Insitute places are rare and for long there has been an idea that people should live at home as long as possible, says Kehusmaa.

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KEMI-TORNIO UNIVERSITY REPORT ENCLOSURE 2 OF APPLIED SCIENCES B. Sc., Project Engineer Jouko Alaniva M.A., Project Coordinator Tuula Partanen 15th March 2007 ICT SOLUTIONS IN HOME CARE Pilots in Pello, Rantsila, and Tervola municipalities on 15th August 2006 - 15th March 2007

Local pilots act as an essential part of the project Sustainable Health Care Networks, part-financed by the European Union. This report enlightens users’ experiences of some commercial and customized ICT solutions designed to support elderly people independent living and welfare. Kemi-Tornio University of Applied Sciences (KTP), Technology has run local pilots on 15th August – 15th March 2007 in cooperation with the KTP’s Social and Health Care unit and elderly home care and IT experts in the municipalities of Pello, Rantsila and Tervola. Attached to this report there are descriptions (1-5) of the piloted systems. Specifications of the pilot systems The systems were developed and provided based on the critical facts found in the user interviews performed in the late autumn of the year 2005 and in the beginning of the year 2006. As there were many national and local projects already running related to information management (such as patient information and municipality level internal information management - including network sites) those areas were left out in the design process of pilot systems. However pilots have been focused on the seamless care chain ideology. The role of technology is to support teamwork coordinated and performed by social and health care and ICT experts (partly together with the users) the way that the result will appear as one system to the customers. The objective is to meet customers needs better. Technology has been also implemented with the elderly and the professionals based in user centered policy and in fair cooperation with the target users. The components of the seamless care chain in the elderly home care are presented in the picture 1 here below.

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Picture 1: The components of the seamless care chain in elderly home care

The pilots in which Northern Finland local features were emphasized concerned the following ICT solutions: 2. Peephole camera system (further details in enclosure1) 3. Outdoors camera system (encl. 2) 4. Real estate monitoring system (encl. 3) 5. Mobile Senior Telephone (encl. 4) 6. Brain Activator (encl. 5) – an innovative system developed during this project

In the design and development processes of these technological systems meeting the customers’ needs has been priorizated (picture 2).

Based on the information collected on the pilot period here below are presented both the user feedback and the suggestions for further development.

1 Peephole camera WS 125

A peephole camera WS 125 (a commercial product, encl. 1) was installed in an aged person’s (a female, 84 years) household in Pello municipality. 1.1 Installation and implementation The monitor can be placed where its position serves the user best. However there were some limitations placing the monitor in tight places due to its design. Therefore it was forced to be installed 10 cm out of the wall. The use of an installation accessory display (usually installed in the seat backs of the cars) is recommended. Due to doubts on low electricity consuming of the system the aged user pulled the stream cable off the plug quite often. It is essential to emphasize that this cable should be plugged at all times when the services of this system are needed.

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The piloted peephole camera system was designed for online monitoring purposes only. There is also an advanced system on the market and it includes taping mode as well. 1.2 User feedback Compared to a regular peephole in the door the system brought additional value to the aged person as the monitor screen presented information faster and easier. This system was also easy to use. 1.3 Further development The monitor could not be attached close to the wall: it has to be left approximately 10 cm from the wall. Due to user feedback this causes problems in tight places like narrow hallways.

2 Outdoors camera WCCD-906D

The commercial door camera (encl. 2) system WCCD-906D was installed outside the aged person’s (a male, 82 years) house.

The system included a combination of functions to both unlock the door and push it open and it included also a remote control device. 2.1 Installation The planned start of the pilot was postponed as it was not possible to perform outdoor installations in winter coldness. The frost period of the Northern Finland can be a limitation to implement this system promptly. However in this case the camera could be perfectly hidden behind the facade structure of the baulk building. Any passers-by could not detect the camera unless entering at the outdoor. The door of the log house has to be lifted up as the door did not open automatically otherwise. 2.2 User feedback The system added safety feeling as the door was locked at all times. In this case the door was earlier kept unlocked as the user could not open the door due to his poor physical condition (partly paralyzed and sitting in a wheelchair). The system was found also easy to use. To avoid high electricity costs the aged person plugg off the power of the monitor now and then.

3 Real estate monitoring GAC4+ system

A standard package of the commercial Fonel GAC4+ system (encl. 3) includes only a temperature monitoring sensor. Besides this the system can also be provided with a burglary alarm, various control loops and remote control sensor to unlock the door and switch a sauna remotely controlled on. The piloted system included burglary and fire alarms and temperature control of the premises as well. This system was installed into an aged person’s ( a female, 83 years) household located in Rantsila municipality.

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3.1 Installation and implementation Installation of the real estate monitoring system requires a professional electrician with latest knowledge in this field – specialization to the ICT field is recommended. The wireless monitoring systems will be launched soon to the market and this will ease the installation work, too.

There was a slight resistance in the employment of the real estate monitoring system as the aged person was not used to new technology and unaccustomed to the technical devices. The implementation of technological systems requires constant and close communication with the target group. Before the actual implementation the KTP representative carefully explained the details and benefits of the system and also underlined the easiness of use;

• To read remotely the heating system temperatures of the household the user only sends ‘42’ text message.

• If the heat is not on an automatic alarm signal will be sent to user’s telephone.

• The burglary alarm cannot be controlled remotely. • To switch off the whole system user has to push a manual button. • The system operates otherwise by itself – no constant manual control is

needed. 3.2 User feedback After the pilot period the feedback from the users was mostly positive and the instructions of use were found to be appropriate and understandable. The real estate monitoring system operated well and the system was useful to the users. The system itself was easy to use: by sending two-figure code by sms the user received the necessary information about the conditions in the target real estate. The remote control of the system by sending a sms-message was found difficult as the mobile phone buttons and its screen are too small sized to fit the elderly users needs. 3.3 Further development Clearly there is a need for further design of user interface to improve usability of the mobile phones. Both the screen and the buttons should be large enough to meet the elderlies’ needs.

4 Mobile Senior Telephone

There was seven senior telephones (commercial products, encl. 4) placed in pilot municipalities and the aged persons’ needs. Two of them were placed in Pello (females aged 55 years and 88 years), two in Rantsila (a female, 83 years and a male, 88 years) and three in Tervola (for short period needs). municipalities during the pilot period.

The Senior phone is quite light and small-sized – it is even shorter than a regular pen (a picture above on the left). The numbers per user should be programmed manually each time when the user changes. 4.1 Implementation

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There was a customized training folder for users of the senior phone. The training had two objectives: a) how to use a new telephone and b) how to transfer a phone from a user to an other user – incl. changes of settings etc. The home care staff – who would act as the trainers of the elderlies and their relatives – emphasized that the training was too heavy. They felt that it was hard to adopt all the new things in one training session. In Tervola municipality the telephone was used also in a food service van to map the possible problems in long-time constant mobile usage. It gave valuable information to the home care staff. The elderlies’ and home care staff’s direct connection to this van is valuable as it improves communication about changes in food distribution schedule (delays) and customers (the elderly) needs (special diets etc.) can be reacted better. 4.2 User feedback The feedback of the phone usage during pilot period was mainly positive. ‘It was a nice but a hard pilot period.’ and ‘Thousands of thanks.’ stated some of the aged end users. The phone was felt easy to adopt by a new end user as there are not so many things to learn to be able to use the phone properly. An elderly person should use the phone constantly as one can easily forget how to use the phone. This fact came out when an older person left the phone home when visiting a care institution for a week and it was quite hard to remember later how to use the phone. This device is not suitable to persons with impared close memory. In Tervola municipality one senior phone was use to secure leaving hospital for home after an operation. Also one phone was used on cases when the elderly has not yet telephone subscription but it is on its way. In these cases senior phone improves welfare as it increases the feeling of safety by a working and easy-to-use phone. Besides this also the food service van had one senior phone to test the mobile use of the phone. It is essential that the information between the elderly and the driver and also between home care staff and the driver is flexible. This way it is possible to inform and react to the suddent changes such as delays in food service and special diets due to operations, allergies etc. By using a senior phone communication needs were managed easy. 4.3 Further development If the phone is out of power it starts ringing at approx. 2-minutes intervals. This should be emphasized in the training, too. As the telephone has only three buttons and the access to national emergency number the scale of reachable connections was found to be too narrow. Also the use of pre-paid card surprised the user now and then as the talk time ended quite unexpectedly. The use of chip should be easier than today as if one have no earlier experience of chip usage it can be rather difficult for beginner to activate the phone again. During the pilot even the relatives could not activate the phone when they changed the chip.

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5 Brain Activator System

A view to the pilot solution touch screen design Due to the user interviews the project staff developed a customized Brain Acticator System (encl. 5) to maintain the elderly cognitive skills.

To remove the fear against technology the home care staff was trained to encourage elderlies to use actively the customized Brain Activator system. This solution was found to be inexpensive and to support efficiently communication between elderlies and relatives. 5.1 Implementation The pilot Brain Activator system was placed to a household of an 88 year old lady. After pilot period it is obvious that further training for home care staff is needed when implementing the Brain Activator System. Even though the design in this pilot was focusing on simplicity it was not easy for a beginner to start the use of high technology device as a computer is still a strange phenomenon in the field of home care. It is essential to train all persons involved in new technical solutions utilisation – the elderly, home care staff and relatives. In Rantsila municipality the attitude towards implementing technology in the aged person’s homes was fairly negative. This could be some kind of a defence reaction in a new situation. 5.2 User feedback The use of Internet phones (VoIP) was found very rewarding and useful as the system includes a web-camera as well. An aged person could easily communicate with her/his relatives via skype-phone. An USB memory stick was found to be a handy way to update the picture gallery in the system when needed. The home care staff wanted to have further training soon after the first session was over as due to inadequate resources they do not have time to learn the system by themselves at work. Also some issues collected from the user feedback is presented here below (5.3). 5.3 Further development The monitor in this system should be easy-to-turn LCD touch screen. In the pilot it was obvious that the chosen model was too consistent and the attached mouse was hard to use due to its short cabel. The cabels including the system were in the way when turning the monitor. In the future it would be more convenient to choose a wireless keyboard and a mouse in the system. The usability of the system is still a little bit poor as a user cannot control everything by a touch screen an it does not work always in expected way as its reaction to a touch is due to the strength of the push and if the push hits the right spot in the screen. These issues may rise some frustration among users. Also the table in the pilot was too high and it lacked the sufficient adjustment levers. It was hard to watch the monitor in those circumstances for a longer period. It should be also concidered if communication could be performed without the actual phone. Instead it would be

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more usable for an aged person to use a combination of a microphone and a loud speaker. The contents design together with various interest groups should be emphasized further more as advanced and customised content would bring additional value to the user groups and improve usability of this system. For the relatives and the home care personnel this system could offer a fertile platform for flexible communication. This system can be provided with a blue tooth printer, too. Then it is possible to print out documents on the spot for home care staff’s and elderlies’ needs. Based on the user interviews a visit to municipality centre has been a welcomed activity to the elderly living in their own home in rural areas. Therefore it is recommended that also the day care centres could utilise the Brain Activator during these visits as the staff could train the elderly to use the Activator and they could also prepare ‘exercise packages’ to those in need for this kind of support. The contents of these packages should be designed together with the diversified team work. In addition to this it is possible to install various activating elements to the Activator such as rehabilitation videos, various activating games and voice books to maintain cognitive skills.

6 Conclusions

Here below is presented the main conclusions based on the pilot results: 6.1 Environmental special features emphasized It is essential to plan all the necessary installations carefully in advance and take into account adequate high-skilled resources and also suitable weather conditions when outdoor installations are required. Also a visit at the location in advance is recommended as the structure of the houses in rural area can set some limitations to wiring, placing, attachment etc. 6.2 Attitudes and training in key position It is quite obvious that ICT solutions are not always welcomed to the elderlies’ households or to home care staff work places as these groups are not used to utilise modern ICT solutions. Detailed explanation is needed in advance to avoid any misunderstandings of the target groups. 6.2.1 Weight on the elderly and diversified teamwork in implementation

A very significant output from the pilot experiences has been a model of implementation (encl. 6). The KTP has together with Tervola municipality home care staff, the elderly and their relatives developed a model of implementing technology at aged people’s homes. In this process the user centered implementation and the cooperation of diversified teams has been emphasized. The roles and the attitudes of the home care personnel are substantial to bind the elderly and their relatives to adopt and learn (or to act against this objective) new ICT solutions. A proper and adequate training to all interest groups is a critical factor, too. Printed manuals should be short, clear and visual to help a beginner to adopt a new system. A digital version of training package could support individual training efficiently as the material would be available 24/7 for the target group at the Internet or a Intranet site. A big responsibility lays on municipality level management to organize an appropriate training to all of the staff members

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involved in the home care process. This ensures adequate skills and supports individual level communication to further develop these systems. 6.2.2 Relatives as trainers The aged person will adopt new systems more efficiently if the trainer is his/her own relative – a familiar person who speaks ‘the same language’ with this person. Therefore relatives should be attached to the process and appropriate information of new system should be delivered soon enough before actual implementation. Relatives should be furnished with the knowledge that they forward the right attitudes, too. All systems will support the elderlies’ welfare only if the system is appropriately and constractly used.

6.3 Forerunners – a potential to be utilised However there were few persons in the interest groups very interested in ICT and they will act as fine forerunners and examples in utilising new technology in home care. They will also be a potential group to test and experience more advanced systems later on as well as market them to others. 6.4 Customized user interface needed The mobile phone user interface is unsuited for the elderly. The device itself, the screen and the buttons are too small. 6.5 Personal technical card Due to this pilot it is recommended that home care staff maintains and develops together wth ICT personal a technical record per a home care customer. Open communication between these interest groups will bring additional value to the elderlies themselves and it will also develop further more the processes of seamless care chain in elderly home care. This so called ‘Technical card’ could be part of the care and service agreement engaged to home care. 6.6 Efficient use of web-pages It would develop the home care system in municipalities more efficiently if both Internet and internal web-pages could be utilised the way they should. The contents and the structure of the pages should be developed focusing on the improved customer service and appropriate support of the work flow in elderly home care. There should be all the necessary support material and contact information easily available for both home care staff and the elderly with their relatives. The transparency of the home care activities makes it possible for every actor to participate to continuous development. The well-designed sites decreases the total of incoming calls to home care staff in municipalities and releases human resources to support the customers’ welfare. It would be also reasonable act to develop a help-desk service in municipalities for those in need for guidance in technical issues. 6.7 Maintenance and integrated services To assure that the total system serves the customers also the maintenance of various systems should be taken under consideration. It it necessary to agree how is it resourced on practical level. It can be done by municipalities themselves or by the subcontractors. Working system also needs integrations of other systems such

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as premises monitoring including fire alarm when you need also a linkage to the local fire department. In the case of burglary alarm there could be a connection to the local police department, guarding company etc. It necessary to make an official agreement in all cases when third party action is needed to support the elderlies’ welfare. As the number of the elderly is growing in the rural areas also new enterprises are welcomed in the market to coordinate and offer these kind of services.

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Project Sustainable Rural Healthcare Networks

SPECIFICATION: DOOR CAMERA 1 (WS 125) This camera will replace a conventional door peephole as monitoring will occur via a TV –monitor or a separate small tft-monitor. There is no need to go to the door as the monitor can be placed where it serves the user best. This system improves safety as a person standing behind the door can be identified even in cases when the lightness is low.

Note! Due to limited light conditions, a black and white camera is preferred. When car tft-display is used as a monitor, you can use same 12VDC –supply for both devices. When connecting to TV–receiver, SCART – or video –connector is needed. There may be a need for extra remote switch if digibox or something else already connected to SCART –connector. Equipment prices (VAT 0%), April 2007:

• Door camera WS-125, 90 eur • 7” TFT –monitor, 120 eur • 12VDC –supply, 10 eur • Video cabling 75 ohm, 0, 55 eur/m

ENCLOSURE 2/ Enclosure1

Facts: • 1/3 B&W CCD camera • IP-67, water- and dustproof • wide-angle lens: 1.78 mm/F3/170º

(diagonal) • includes also a connection cable Photo sensor: Samsung 1/3” CCD Photo elements: 500(H) x 582 (V) PAL Resolution: 400 TV lines Power supply: DC 12V Power consumption: approx. 1 Lux @ F2.0 Video connector: RCA Weight: 80 g

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Project Sustainable Rural Healthcare Networks

SPECIFICATION: DOORCAMERA 2 (WCCD-906D)

The WCCD-906D is a wireless camera equipped with an invisible infra-red light. Person behind a door can be identified in full darkness. Camera can be installed outdoors but in low temperature rural conditions below -10ºC an extra heated box is needed.

Equipment prices (VAT 0%), April 2007:

- WCCD-906D camera 251 eur - Heated box 170 eur - NICEVIEW 7” tft-display 119 eur

ENCLOSURE 2/ Enclosure 2

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Project Sustainable Rural Healthcare Networks

SPECIFICATION: REAL ESTATE MONITORING 1 (Fonel GAC4+)

Fonel GAC4+ is a home security system including a GSM modem. The system controls house temperature and keeps eye on real estate (burglary and fire). Extra heating can be switched on automatically when room temperature is dropping on critically low level. Alarm is send as a sms-message to a mobile phone. Also a simple text-message can be sent to distant control conditions in the premises. Device checks the phone number of the incoming call and can perform requested switching as for example opens an electrical door lock - without answering a call, so there are no telecommunication costs for this function.

Note! Mains voltage installations for electrical heating control system requires a licenced expert. The system is controlled with a switch (at home/away) – there are no numerical codes to remember – however a mobile phone SIM card needed. Equipment prices (VAT 0%), April 2007:

- Fonel GAC4+ security device 310 eur - GAC TENTC 10k temperature sensor 39 eur - Magnetic switch 3 eur - Accessories for wiring

ENCLOSURE 2/ Enclosure3

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Project Sustainable Rural Healthcare Networks

SPECIFICATION:MOBILE SENIOR TELEPHONE (Mobi-Click Senior-Tel)

Mobi-Click Senior-Tel is a security device and an easy-to-use mobile phone. There are only three buttons (1, 2 and 3). The phone can be programmed via sms-messages with another mobile telephone. Emergency number (112 in Finland) can be dialed normally and there are three pre-programmed numbers in the device memory. This phone is also good for persons with poor eyesight.

Note! Before phone usage read carefully the user manual. There are some system commands to be noticed, for example ”hear” is not allowed to use due the Finnish legislation. Also keyboard locking must be switched off in many cases. Some ”talk time” should be loaded at least once a year when using so called “Prepaid” SIM-card in the phone. However the emergency number (112 in Finland) can be reached always - even if there is no talk time left. Equipment prices (VAT 0%), April 2007: - Mobi-Click senior-tel 275 eur - Prepaid SIM-card 10 -15 eur

ENCLOSURE 2/ Enclosure 4

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Project Sustainable Rural Healthcare Networks 1 (3)

SPECIFICATION: BRAIN ACTIVATOR FOR SENIORS The bifunctional Brain Activator system is based on a regular computer workstation placed on the table with wheels. There are two various work stations included in this system. On the other side of the table there is a touch screen equipped system for seniors to activate their cognitive functions. On the other side there is a keyboard controlled system for home care staff and relatives etc. LCD-screen display can be turned by 180 degrees by pivot software and the screen can be turned on the other side of the table. The system is ready for instant use after the power is switched on the computer. VOIP (Voice over Internet Protocol) video telephone is ready for instant use after user has the handset on and selects the target contact from the pop-up on window.

During periods of inactivity the system runs a serial of photographs on the screen. The photos can be saved in an usb memory stick. The system includes two memory sticks so one can be given to relatives to update photos when needed.

ENCLOSURE 2/ Enclosure 5

By turning the table around a work station for home care staff is available with a keyboard.

Touch screen for the home care customers (the elderly)

A web-camera

A VOIP- telephone

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Equipment:

- Dell Optiplex GX520 computer - LG L1730SF 17” tft touch screen - 2 usb memory sticks 512MB - numeric keyboard (for playing sudoku) - Yealink P4V usb VOIP telephone with a camera - ADSL router/firewall (internet) - Treston CTR705 trolley

Computer desktop settings:

- screen resolution 1024x768 - icon size 72 ja text size 14 - icon spacing horizontal 60, vertical 60 - energy savings ”never” - screen saver ”none” - desktop clean-up (deletes the unused icons)

Desktop icons (contents for users):

- Internet Explorer browser - recycle bin - shut down function (down.bat) - municipalities web-sites (Tervola, Pello, Rantsila) - YLE-news (www.yle.fi/uutiset/) - a cook book (www.finnfood/keittokirja) - KELA – National Social Services web-site (www.kela.fi).

2 (3)

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Applications:

- LG universal pointer device -driver and pivot software - calendarium(calendar and photo gallery) - Skype(VOIP) - SkypeMate(for usb VOIP-phone) - F-Secure internet security 2007(firewall and virus sw) - Sudoku

Instructions for system use: - a senior or a home-care worker starts the computer in the morning - a senior or a homecare worker switches off the computer in the evening - the home-care staff may use their own databases or print out documents when needed

Cleaning the touch-screen:

- the touch screen has an resistive layer on the top of its surface that must be cleaned time to time

- be careful and use just a little soap when cleaning up the screen

3 (3)

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ENCLOSURE 3 KEMI-TORNIO UNIVERSITY OF APPLIED SCIENCES T Partanen 13rd March 2006 CRITICAL FACTORS – TECHNOLOGY Municipalities of Pello, Rantsila and Tervola Common factors Municipality level factors (decision makers, managers, advisors, planners etc.): - no quality assurance policies decided or not available in the internal networks (intranet) - not adequate feedback system in the Internet pages of the municipality - missing a well-operated and organised internal electric system for supporting co-operation, learning/training & communication: knowledge creating, collecting, publishing and sharing (intranet, Internet) Personnel level factors (social & health care staff): - various professional team’s work is not supported by modern IT solutions - missing appropriate equipment: not enough computers, lap tops or mobile phones available - the skills of utilising electric information systems or equipments are not of adequate standard

Elderly people level factors (customers, patients): - are not interested in modern technology and are not eager to utilise it in their every day life - have not basic skills for using PC’s - have some physical and mental limitations for utilising IT solutions/equipments - loneliness: technological solutions might curtail social contacts further more - present technological solutions serve mainly the actors in health and social care – not elderly people or their relatives (or the inhabitants of the municipality) - no technological devices for supporting cerebral infarction patients verbal communication - emergency phones not in use or not enough available for patients - a personal safety wristband not in use due to its discomfort or user’s lack of responsibility

Other interest groups - elderly people’s relatives are not supported by any IT solutions to regularly communicate with the home care staff - no systematic training arranged/offered to the potential local stand-ins with the support of telecommunication systems - no electric feedback channels/system, instructions or forms for inhabitants in the Internet

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ENCLOSURE 4 ABSTRACT Lahtela Markus, RFID -access Control. Bachelor’s Thesis. Kemi Tornio University of Applied Sciences. Unit of Technical Education. Number of pages 31. Number of appendixes 5. 1 CD-ROM. The goal of this project was to research Radio Frequency Identification –technology (RFID) and to design a software for RFID-devices. The main point of this project was to create access control program for old people who live alone. There are also RFID-technology basis, devices and applications in this document. The work was accomplished with Visual C++-programming language. As a result of this project is an access control program. Program works with RFID-reader and collects data from tags, which pass the reader’s reading-field and give information and advice to user when needed. This thesis is done for Kemi-Tornio Polytechnic and it is a part of eRural-project. eRuralproject aims at helping the progress of health care services and at improving their quality in Northern periphery. Keywords: access control, RFID, programming

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ENCLOSURE 5

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ENCLOSURE 6 ABSTRACT KEMI – TORNIO UNIVERSITY OF APPLIED SCIENCES Unit of Social Care and Health Care and Nursing Degree Programme in Nursing PIRJO HIUKKA & RAISA JAUHOJÄRVI THE USE OF GEROTECHNOLOGY SUPPORTING ELDERLY PEOPLE Experiences of using technology provided by the eRural – project within elderly people and homecare personnel. Bachelor’s Thesis, 70 pages and 17 appendices Advisors: Maarit Kairala and Hanna – Leena Paakkolanvaara 9.5.2007 ______________________________________________________________________ Keywords: elderly, gerontechnology, home care, experiences, phenomenology, eRural The purpose of this study was to describe what kind of experiences elderly people and home care personnel at Tervola municipality have had from the technology powered by the Sustainable Rural Health Care Networks – project. Project is partly financed by the EU and one of its main goals was to understand better northern rural living environment and its meaning when producing good technological devices in to health care services. Our research was qualitative and the material was gathered using theme interview with the elderly people and a past structured questionnaire with the staff of home care. We interviewed two elderly people. Six members of the home care personnel answered to our questionnaire. The interviews took place on 2.4.2007. The analysis of the research material was made by using inductive content analysis which was based on themes finding answers to the questions. According to the results of our study elderly people and the home care personnel adopted a positive attitude towards technology which made living at home and working in home care a bit easier. The experiences from the technology provided by the eRural –project were mainly positive, but certain things that had something to do with the use of technology made it difficult. For example the monitor of the camera attached to the door was small, so it was hard to recognize the visitors. The other elderly felt that using the brain activator while being home alone was difficult. As a final conclusion the technology partly improved safety and increased the possibilities of spending time.