Many of Finland’s 20 largest municipalities have neglected to supervise their own elder care units while they continue to check privately-run facilities, according to a report by Yle's investigative journalism unit MOT.
The report found that more than half of the municipalities had not carried out a single inspection of their own facilities in the last five years, even though the issue of self-supervision was raised as recently as last year during crisis talks on the standard of elderly care in Finland.
Of the municipalities that responded to the MOT survey, the city of Espoo was found to equally monitor their own facilities as well as privately-run units. In the city, two inspection visits are made to every elderly care home each year, one of which is unannounced.
"Quality cannot vary depending on who provides the service. We want to ensure that our customers receive the same level of service everywhere," the city of Espoo's long-term care manager Elina Kylmänen told Yle.
In the eastern town of Kuopio, however, the city has only carried out four inspections of its own facilities since 2015; once in 2019 and three times in 2020.
The city appointed a supervisory inspector in 2015 and hired another member of supervisory staff last year, but their main task is to check private nursing homes.
"There is little time to make actual inspection visits to the city's own units," the city of Kuopio announced in a press release.
Professor calls for clarification of law
Marja Vaarama, professor emerita at the Department of Health and Social Management at the University of Eastern Finland, told Yle that supervision of facilities is important because it ensures that care units comply with the law.
Vaarama said current legislation should be further clarified.
"Legislation and quality recommendations are now circular with regard to the control and monitoring of municipalities' own activities," she said, adding that since the law does not say directly how municipalities should monitor their own care units, resources are apparently not being directed towards this aim either.
Vaarama called for the current legislation to be changed and for sanctions to be clarified, meaning that negligence and abuse would always result in a certain penalty.
"The law says elder care facilities must be well managed and supervised. Care must be taken to ensure that the quality of service is good. Obviously, we should also have a law that would remind us that the law must also be obeyed," she said, adding that the fear of losing a job may prevent nurses from addressing grievances.
The primary supervisor of nursing homes is the municipality that buys or provides the services. The municipal care homes are also supervised by the Regional State Administrative Agency as well as by the National Supervisory Authority for Welfare and Health (Valvira).
Grievances can also be reported to the Parliamentary Ombudsman or the Chancellor of Justice.