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Report: Major shortcomings at leading senior home care firms

An Yle investigation has revealed several serious shortcomings in the private home care system for Finland's elderly.

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File photo. Image: Henrietta Hassinen / Yle

Yle's investigative team MOT has uncovered incidents of neglect or inadequate care in the elderly home care's private sector, which in many cases compromised the safety of seniors who require help at home.

Due to a lack of available nurses, visits to seniors' homes were sometimes not carried out. On some occasions clients did not receive their medications at all, and one incident showed that a client did not receive a required insulin dose on time.

In some cases it was found that security guards had been helping seniors change their catheters, while in others taxi drivers had responded to SOS calls from seniors rather than nurses.

According to the report, one home care firm had charged their clients and the municipality for services that weren't actually carried out.

Specific cases

One of the biggest home care firms in the country, Debora, has had their share of problems. Debora employees told MOT that working conditions at the firm jeopardised the safety of its elderly clients.

The workers said that when there is not adequate time for caregivers to go to a client's home, documentation of the scheduled visit is often manipulated to make it look like an entire visit took place.

The firm has offered its services in the southwest city of Turku since 2016. At the beginning of this year however, the company became unable to keep up with all of the care services it provided, according to the city's chief of open care services, Anne Vuorinen.

"For example [the company's workers] giving doses of insulin was sometimes delayed or even left undone. That's a very serious situation that endangers patient safety," Vuorinen said.

Several former Debora employees told MOT that working for the company was chaotic, saying that delivery location and visit schemes were often changed and not taken into consideration during schedule planning which often led to delays. In some cases client breakfasts were handed out at lunchtime, according to the workers.

The former employees said that several of their colleagues at the firm did not have the appropriate permission or expertise to carry out their jobs and that the company did not ask for education certificates when they were hired.

The Regional State Administrative Agency began monitoring operations at Debora and then at the end of last year the city severed its contract with the firm. The company stopped its Turku operations in March.

"Mistakes happened all the time"

Sometimes scheduled home visits were never carried out at all. The ex-workers said when that happened the company would send seniors chocolates and flowers with the hope that the missed visits would go unnoticed.

Each time those shortcomings were noticed by the city, the company was handed a fine.

Vuorinen said she was surprised by the revelation that Debora had intentionally misled the city in its record-keeping regarding the duration of home visits.

"Mistakes happened all the time. The supervisor did not care a whole lot about them and allowed staff to work on their own," one former Debora worker said.

Debora CEO Anna-Maria Mäkelä acknowledged the workers' allegations of adjusting the records about the length of client visits but said the reasons behind them were due to poor managerial guidance and guidelines.

She said, however that she did not think the former employees were lying.

"I wouldn't say they're lying. I cannot say whether this is a misunderstanding or if this is the way one is instructed or not. I was not at the company at the time," she said.

The city of Turku is now seeking compensation from the firm for the missed visits and work shifts, but Vuorinen said it's difficult to assess how much of the billed work had not actually been carried out.

Similar stories in Lahti, Seinäjoki

In the southern city of Lahti, a group of former Debora workers have taken the firm to court, with very similar complaints as the ones Turku. The basis of the lawsuit is that home care workers are required to call clients to ask for permission to skip a scheduled visit. But the ex-workers contest that the missed visits were marked as completed by the company.

Debora's biggest competitor is the home care firm Stella Kotipalvelut, a company which has had its own share of problems with regulators. The Regional State Administrative Agency of southern Finland has audited the company several times.

Stella's shortcomings include replacing care staff with security guards, according to the MOT report.

In the western city of Seinäjoki, Stella was also found of using security guards in lieu of home care nurses. The guards reportedly changed the catheters and diapers of clients and physically lifted seniors with various types of ailments without knowing their health or medication histories. According to former Stella workers said security guards would also sometimes need to assess whether clients needed to be transported by ambulance or not.

The ex-workers said the security guards were not equipped or trained in how to deal when clients fall down in their homes, for example. One former worker said the guards had "lifted clients back into bed and then said 'good night."

They claim that this type of care was carried out by workers whose training in the field amounted to a first aid course.

Some former Stella employees said they were frightened about possible repercussions for speaking to MOT, saying the firm had forbidden them from doing so.

Stella Kotipalvelut's CEO, Juhani Pälve, told MOT in an email that 97 percent of the firm's and its subcontractor's safety assistance work is carried out by individuals trained in the social and health care sector. He said the remainder of work is carried out by security guards who have been trained in first aid and lifting skills.

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