social welfare – older people 3.7 Social welfare services / units for older people The goal is that older people can live at home with the support of the appropriate home-care services. When this is no longer possible, the elderly person moves into an institution or fulltime care or residential unit, where they receive care round the clock, including terminal care. There are some 2,000 care units providing fulltime care for older people in Finland. Visits are primarily made to closed units providing fulltime care for people with memory disorders, and to psycho-geriatric units, where restrictive measures, such as locking the doors, using “back-zip” overalls, and chemical and other forms of restraint, may be used. The aim is to visit care units run by both private and public service providers within a given municipality. This allows for detecting any differences in the standard of care. Social welfare and health care units, including services for older people, are under a statutory obligation to produce a self-monitoring plan. Such a plan includes all key measures taken by the service provider to monitor their operative units, the performance of their staff and the quality of the services they provide. Staff members have a statutory obligation to report any deficiencies in the care provided. The self-monitoring plan prohibits all retaliatory measures against whistle-blowers. Visits to care units for older people always focus on the use of restrictive measures and their duration, documentation and the related decision-making. Another central theme involves ascertaining whether the care and treatment received by customers are respectful of their dignity. This aspect is particularly relevant when assessing the level of personal hygiene and arrangements for end-of-life care. The purpose of the visits is to assess the level of health care and pain management, as well as physiotherapy/rehabilitation, oral hygiene and health care, nutrition and hydration, personal hygiene and the amount of outdoor exercise received by customers. The number of staff and the suitability of the facilities are also assessed. In addition, the inspectors examine how the customers’ right to self-determination and privacy are guaranteed. Attention is also paid to the general appearance and atmosphere of the unit, the quality of indoor air, accessibility, and the availability of suitable stimuli. The inspectors review the training of the staff and the validity of fire safety and rescue plans. The tone of the reports on the visits is qualitative, because the units are homes for their residents, who may be spending the final years of their lives in them. All reports are published on the website of the Ombudsman. The purpose of the publication is to inform the general public that the operations of a certain unit are being monitored. The reports also provide residents, family members and staff with important information on the observations made during the visit. It may also be requested that the inspection report be made available to the public on the noticeboard of the unit for a period of one month. The aim is that residents, family members, and other stakeholders are able to 63